Atria Rancho Mirage

Allegation investigated: Staff did not prevent the facility from being in disrepair.

On 6/25/26, Licensing Program Analyst (LPA), Ahliah Sharp arrived unannounced to investigate the above listed allegation. LPAs met with Executive Director (ED), Nathan Boese, and explained the purpose of the visit LPAs toured the facility with ED. During the visit LPA conducted observations, interviews, and record reviews. LPA toured the facility and observed four (4) thermostats in common areas, each were under the permissible temperature per Title 22, at 73 and 78 degrees F, the highest being the one closest to the outside doorway. LPA interviewed ED, five (5) staff and three (3) residents to see if they were aware of the air conditioning unit being broken anytime recently, all agreed that there have been no issues with the air, despite the high temperatures this area reaches. There were no observable health and safety concerns observed at the time of this visit. ...Continued on LIC 9099C Unfounded Continued from LIC9099... On June 18, 2026, Community Care Licensing received a complaint alleging staff did not prevent the facility from being in disrepair, specifically that it was too hot in the dining area and the air conditioning units were broken. It was reported that staff were observed sweating at times and residents complained about it being too hot. LPA attempted to speak with the Reporting Party (RP) but was unsuccessful. LPA observed the client roster and no client matched the identity of Resident #1, R1 reportedly does not reside at this facility. Additionally, LPA conducted staff interviews and no staff, including ED, was aware of anyone matching the name of R1. Based on interviews with staff, residents, observations and record review, the allegation of staff preventing facility from being in disrepair is deemed unfounded. Information obtained during the investigation has proved that R1 is not associated with the facility, and there is no evidence of the air conditioning units being broken or in disrepair. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was explained and given to the ED, Nathan Boese.the state’s words, verbatim · CDSS document, Jun 25, 2026 · control 18-AS-20260618151741

Allegation investigated: Facility did not refund preadmission fees. Facility did not provide copies of admission agreement.

On May 12, 2026, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegation and to deliver findings. The Department was met by Nathan Boese Executive Director and reason for visit explained Investigation consisted of the following: On December 26, 2023, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above. During the visit, it was determined that the complaint required further investigation. On May 12, 2026, the department conducted an unannounced visit continue investigation of above allegations. The department obtained the following documentations:Staff roster, Resident roster, copy of Addmission Agreement which contains the refund policy (dated 11/16/23) On May 11, 2026, the department conducted telephone interview with R1’s responsible party. On May 12, 2026, the department conducted interview with Executive Director (A1). Page 1 of 3 Unsubstantiated The investigation revealed the following Allegation: Facility did not refund preadmission fees. The detail of complaint alleges facility has not refunded the $3372.00 preadmission fees paid for potential resident (R1) On May 11, 2026, via telephone, the department spoke with R1’s responsible party (family member) who stated that he was refunded the entire amount. It was credited back to his account. On May 12, 2026, at 10:15am the department interviewed Executive Director (A1) who was not with the facility during time of the complaint, however he was able to provide the department with documentation from that time frame. On May 12, 2026, the department received and reviewed a copy of R1’s Admission agreement which included the refund policy (dated 11/16/2023). Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Page 2 of 3 Allegation: Facility did not provide copies of admission agreement. The detail of complaint alleges that R1 never received copies of the admission agreement that he signed. On May 12, 2026, at 10:15am the department interviewed Executive Director (A1) who was not with the facility during time of the complaint, however he was able to provide the department with documentation from that time frame. A1 also stated that Residents and or responsible parties are provided a copy of what they have signed. Additionally, A1 stated that they currently use Docusign which those who sign will receive a pdf copy immediately after they sign. Lastly, A1 stated that a copy of admission agreement is place in residents file and can be accessed upon request. Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with the Executive Director. No deficiencies cited during today’s visit. Copy of report was provided. Page 3 of 3the state’s words, verbatim · CDSS document, May 12, 2026 · control 18-AS-20231222145418

Allegation investigated: Facility staff are not properly supervising residents who are a fall risk

On May 12, 2026, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegation and to deliver findings. The Department was met by Nathan Boese Executive Director and reason for visit explained Investigation consisted of the following: On August 12, 2024, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above. During the visit, it was determined that the complaint required further investigation. On May 12, 2026, the department conducted an unannounced visit to continue investigation of above allegations. The department obtained the following documentation: Staffing schedule (dated 5/12/26), Resident Roster (dated 5/12/26), R1’s facility incident reports (8/20/24, 8/2/24,7/27/24, 9/27/23), Change of conduction assessments (dated 5/14/24, 3/19/24, Hospital stay After visit summary (3/15/24), 3/12/24, 9/27/23) Physicians report LIC 602 (dated 10/4/22), Staff training on fall prevention (dated 3/20/25, 3/30/26, 12/22/24, 2/17/25) R1’s service plan (5/14/24) Suspected Elder abuse policy (various dates) On May 12, 2026, the department conducted interview with Administrator (A1), 5 staff (S1-S5) and 4 Residents (R2-R5). R1 no longer lives at the facility. page 1 of 3 Unsubstantiated The investigation revealed the following: Allegation: Facility staff are not properly supervising residents who are a fall risk The detail of the complaint alleges R1 have had multiple falls which may have been due to lack of proper supervision. On May 12, 2026, at 12:15am the department interviewed Executive Director (A1), who was not with the facility during time of the complaint, however he was able to provide the department with documentation from that time frame. On issue of staff supervision, A1 added that they have adequate coverage to meet the residents need and if someone “calls out,” there is a plan in place to have the shift covered. On May 12, 2026, between 12:40pm and 1:20pm the department interviewed 5 staff (S1-S5) regarding the allegation. Of those interviewed, 5 out of 5 denied the allegation stating that staff always provide proper supervision to the residents. 5 out of 5 stated that they have had training on fall prevention and it is refreshed frequently during in-service training/meetings. Additionally, 5 out of 5 staff state that there are enough staff to meet the residents’ needs. Lastly, the staff stated that they “work together as a team to get the job done.” On May 12, 2026, the department interviewed 4 residents (R2-R5). Of those interviewed, 4 out of 4 stated that they are treated well and staff would help them if they needed. 2 out of 4 stated that they had a fall at the facility and staff were there to help them. Lastly, 3 out of 4 stated that they feel that there is enough staff to meet their needs. 1 out of 4 stated that there is not enough staff. Page 2 of 3 On May 12, 2026, the department obtained and evaluated the following documents: R1’s facility incident reports (8/20/24, 8/2/24,7/27/24, 9/27/23), Change of condition assessments (dated 5/14/24, 3/19/24, Hospital After visit summaries (3/15/24, 3/12/24, 9/27/23) Physicians report (dated 10/4/22), Staff training on fall prevention (dated 3/20/25, 3/30/26, 12/22/24, 2/17/25) R1’s service plan (5/14/24), Suspected Elder abuse policy (various dates) The documents reviewed showed the facility followed R1’s service plan and provided proper intervention after R1’s fall such as assessment, calling 911, notifying the responsible party (family), notifying the doctor. Additionally, the department observed that they documented each incident and follow up activities. Lastly, the facility completed change of condition assessments. On May 12, 2026, the department observed the facility to be clean, safe and sanitary in addition to observing that there were sufficient staff attending to the residents at time of visit. Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with the Executive Director. No deficiencies cited during today’s visit. Copy of report was provided. Page 3 of 3the state’s words, verbatim · CDSS document, May 12, 2026 · control 18-AS-20240805155833

Allegation investigated: Staff are not trained to dispense medication. Staff are mismanaging residents medication. Staff are not keeping accurate records of medication distribution.

On November 20, 2025, at 8:30 am, Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit to deliver findings. LPA met with the Administrator (A1), Nathan Boese, and the purpose of the visit was explained. LPA was granted entry to the facility. The investigation included the following: On November 20, 2025, at approximately 8:30 am, the LPA Richard requested and reviewed the following documents: the client roster (dated 09/06/2024) and the staff roster (dated 10/09/2025). Med Techs Training (dated 2023, 2024, 2025), Medication Administration Records (MARs dated 01, 2025; 02, 2025; 03, 2025; 04, 2025; 05, 2025; 06, 2025; 07, 2025; 08, 2025; and 09, 2025), and Med Techs Certificates of completion. LPA interviewed the Administrator (A1), two Med Techs (MT1-MT2), four staff members #1-4 (S1-S4), and eight Residents #1-8 (R1-R8). Report Continued on LIC9099C Unsubstantiated Allegation #1: Staff are not trained to dispense medication. The complaint alleged that when a med tech calls out, untrained caregivers dispense medication to residents. On November 20, 2025, the Licensing Program Analyst (LPA) Richard interviewed the Administrator (A1), who denied the allegation and stated that the staff who assisted the residents with medication had been trained and held certificates to assist with medication. The LPA interviewed two Med Techs (MT1, MT2), who denied the allegation and stated that all the staff who assist the residents with medication are properly trained. They also noted that the caregivers do not have access to the Medication Carts. Additionally, the LPA interviewed four staff members (S1-S4), all of whom denied the allegation and asserted that they have not been trained and have not dispensed any medications to residents. Their duty is caregiving; only Med Techs give medications. The LPA also interviewed eight residents (R1-R8), all of whom expressed satisfaction with how the facility's staff administers their medications and stated that they have no issues with them. There is no specified time when a caregiver provides them with their medications. Furthermore, on November 20, 2025, the LPA reviewed the facility training medication documents from 2023, 2024, and 2025 for all Med Tech members who assist residents with their medications. Report Continued on LIC9099C Based on the interview, the records, and the information reviewed, there was insufficient evidence to support 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 allegation is deemed unsubstantiated. Allegation #2: Staff are mismanaging residents' medication. The complaint alleged that staff members are mismanaging residents' medications, resulting in numerous errors that lead residents to refuse their medications. On November 20, 2025, LPA Richard interviewed A1, who denied the allegations and stated that only Med Techs assist with and manage the residents' medications. The LPA also interviewed two Med Techs (MT1 and MT2), who both denied the allegations. They stated that they follow the procedures outlined in the facility's internal training, which occurred from October 3, 2024, to September 14, 2025. They explained that if a resident refuses their medication, the Med Tech records it in the electronic medication administration record (E-Mar), contacts the family member and the physician, and disposes of the medication. Additionally, if medication is spilled by either staff or residents, they must contact the pharmacy to obtain a replacement and document this action in the E-Mar. Report Continued On LIC9099C On November 20, 2025, the LPA interviewed eight residents (R1-R8). Of these, five residents denied any issues with medication management. The caregiver never gave them any medication except Med Tech. On the same day, the LPA reviewed the MAR records of eight residents from 2025 and found no discrepancies in their medications. The LPA also reviewed the Med Techs' medication training, and all had completed it. The MT1 also explained to LPA how the processes of refused and/or spilled medications work. Based on the interview, the records, and the information reviewed, there was insufficient evidence to support 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 allegation is deemed unsubstantiated. Allegation #3: Staff are not keeping accurate records of medication distribution. The complaint alleged that staff were backdating and forging their names on the residents' electronic Medication Administration Records (e-MAR) and on the hard-copy log for narcotics. On November 20, 2025, at 11:30 a.m., LPA Richard, Med Tech Martinez, and Santana inspected the medication room to review the resident supply and the medication cart. Upon examining a randomly selected resident's medication supply and records, LPA found the medication record to be accurate. Report Continued on LIC9099C The information documented in the electronic record matched the number of pills dispensed to the residents. Additionally, LPA reviewed the residents' medication records and found that all were signed on the day the medications were administered. Based on the interview, the records, and the information reviewed, there was insufficient evidence to support 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 allegation is deemed unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to the administrator, Nathan Boese.the state’s words, verbatim · CDSS document, Nov 20, 2025 · control 18-AS-20230526091812

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Seo Jeon and Janira Arreola conducted an unannounced annual required visit. Upon entry, LPA was greeted by Nathan Boese, Executive Director, and informed them of the purpose of the visit. At the time of the visit, there were (17) staff members and (113) residents present. Facility Overview: The facility is a two story building with (110) bedrooms and (126) bathrooms. Second floor is designated for memory care unit. The facility has fenced swimming pool and a hot tub. Infection Control: LPA observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility has infection control plan in file. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. The outdoor area was free of hazards. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Hot water temperature was 106°F. LPA reviewed annual inspection report conducted by fire marshal dated January 8, 2025 with passing inspection. Fire extinguishers located at hallways have current inspection tags. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C...... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate. Record Review and Resident/Staff Files: LPA reviewed files for four staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Five resident files were reviewed and contained all required documentation. Health-Related Services/Incidental Medical Services: All resident medications were securely locked in a medication room. LPA reviewed medications for four (4) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. Disaster Preparedness: LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on September 22, 2025, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 29, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Yolanda Delgado and Armando Perez arrived unannounced to conduct an annual inspection. Upon arrival LPAs was greeted by facility staff and granted entry. LPAs began inspection with introduction, visit purpose and provided the facility with LPA identification and business card. Resident record review began- Six (6) records were reviewed. LPAs reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Physical Plant and Safety of Environment/Operational Requirements- LPAs toured the facility inside and outside. The facility is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 109.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. A medication room is provided for medications and sharp objects. LPAs verified there is a telephone working at this location. Food Service- Food supply meets the requirement of one week supply of nonperishable and 2 day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA began review of employee records- Six (6) records were reviewed. LPAs reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. (Continued on next page) (Continued on from page 1) The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current. LPAs made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation and the structure remains unchanged according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 12/8/2023. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 09/18/2024. LPA allocated time to prepare this report for delivery. Based on the information received during this visit today, there are no deficiency is being cited per Title 22, Division 6 of The California Code of Regulations. This report was reviewed with and a copy provided to the facility representative provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Sep 20, 2024

Allegation investigated: Staff will not change resident's diaper

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to initiate and deliver findings regarding the allegation listed above. LPA was granted entry and met with Executive Director Monique Moreira, who was Informed of the purpose of the visit. LPA toured the facility, conducted interviews, and collected pertinent documents regarding the allegation listed above. Regarding the allegation “Staff will not change resident's diaper” it was reported the facility is refusing to change Resident One (R1) diaper. Interview with R1 revealed staff will ask R1 if their diaper needs to be changed or staff will turn R1 to inspect R1’s diaper throughout the day. R1 denied the allegation of staff not changing their diaper. Interview with Resident Service Coordinator Jillian Ryan revealed staff check on R1 every two hours or if R1 has a bowel movement, R1 will call the front desk and staff will assist R1 with changing their diaper. Record review of R1’s needs and service plan dated 02/07/2024 revealed R1 did not require assistance from staff with toileting but due to R1’s change in condition, R1 is incontinent and requires care and staff assistance. Unsubstantiated Therefore based on interviews and record review, the allegation “Staff will not change resident’s diaper” has been deemed UNSUBTATIANED at this time. A finding of UNSUBSTANTIATED means 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. An exit interview was conducted and a copy of this report was provided to Executive Director Monique Moreira.the state’s words, verbatim · CDSS document, Mar 20, 2024 · control 18-AS-20240313165847

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Crystal Colvin arrived unannounced to conduct a case management visit to obtain signatures for an amended case management report deficiency page dated 1/12/23. LPA met with Executive Director Monique Moreira and advised them of the purpose of today’s visit. No other citations were noted on today's visit. An exit interview was conducted with Executive Director Monique Moreira and a copy of this report and amended LIC809D from 1/12/23 was provided.the state’s words, verbatim · CDSS document, Feb 29, 2024