Atria Willow Glen

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Kurt Gursu. LPA explained the purpose of the visit. There are 23 residents residing in the memory care unit. LPA observed 3 care givers, 1 medtech, memory care director, and 1 activity coordinator in the memory care unit. There are 18 residents in the assisted living building. LPA observed 2 care givers and 1 medtech in the assisted living building. LPA toured the facility inside out with ADM which included the activity areas, kitchen, dining room, restrooms in Assisted Living and Memory Care. LPA randomly toured the following bedrooms: 26, 25, 24, 21, 1, 3, 4, 9, CE27, CE26, CE25, CE3, CE10, CE6. The Facility grounds were inspected, which included a community garden. There was no obstruction to block the walkways. While touring the memory care unit, During the tour of the memory care LPA tested the delayed egress doors in the memory care unit. All delayed egress doors activated when pressed. Staff responded to the delayed egress within 15 seconds of the egress being activated. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 74 degrees F, and hot water temperature was measured to range from 112-116 degrees F in resident bathrooms. Fire extinguisher was serviced in December 8, 2025. The facility was equipped with smoke and carbon monoxide detectors. The Facility Sprinkler system was last inspected on April 2, 2026. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on July 17, 2026. LPA reviewed facility disaster plan, which was last reviewed/updated on June 22, 2026. LPA reviewed facility records for 5 staff and 5 residents. LPA reviewed 5 resident medications and centrally stored medication records. No deficiencies cited during today's visit. This report was reviewed with Administrator Kurt Gursu and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Jul 29, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst Manuel Monter conducted an unannounced case management incident visit regarding a incident report. . LPA met with Administrator Kurt Gursu, On January 12, 2026, the Department received an incident report regarding R1. The incident report stated, on January 8, 2026, two staff members (S1 and S2) brought the incorrect resident to a scheduled immunization. Staff member incorrectly brought resident R2 instead of R1. No adverse reactions were reported. R1's responsible party and physician were notified. On January 29, 2026, LPA Manuel Monter interviewed ADM. ADM confirmed that the issue regarding this incident was that staff S1 and S2 made a mistake and took R1 to R2's scheduled immunization. ADM stated the staff told him, they made the mistake because R1 and R2 have similar names. ADM stated both staff were given counseling and had additional training assigned. LPA requested a copy of the documented training. No deficiencies cited during today's visit. A technical violation was provided. This report was reviewed with Administrator Ugur (Kurt) Gursu and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Jan 29, 2026

Allegation investigated: Staff handled residents in a rough manner Residents are not accorded dignity in his/her personal relationships with staff Staff is neglecting residents Activitys of Daily living.

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator Kurt Gursu. On November 10, 2025 the Department received a complaint alleging Staff handled residents in a rough manner. On November 18, 2025, LPA Manuel Monter interviewed residents R1-R9. Resident 7 Out of 9 Residents (R1-R7) stated they have never seen staff being rough with residents when providing care. 2 Out of 9 Residents (R8 & R9) were unable to provide any relevant information due to neurocognitive disorder. LPA Manuel Monter interviewed Memory Care Director (MCD) Janice Lacambra. MCD stated she hasn’t seen any instance of a staff being rough with residents when providing care. Page 1 Out of 7 Unsubstantiated LPA Manuel Monter interviewed staff S1-S8. 8 Out of 8 Staff (S1-S8) stated they have never seen staff handling residents in a rough manner. On December 5, 2025, LPA Manuel Monter interviewed residents R10-R12. 3 Out of 3 residents (R10- R12) stated they have not seen or heard about any instance of the staff handling residents in a rough manner. On December 5, 2025, LPA Manuel Monter interviewed staff S9-S16. 4 Out of 8 Staff (S9 S14-S16) stated they haven’t seen any instance of staff being rough with residents when providing care. S10 stated he/she has seen staff being rough with residents when proving care. S10 stated he/she has seen staff pulling the residents to hard and grabbing too hard. S10 stated its an ongoing issue that continues to occur. S10 stated he/she can’t say for certain who it was he/she observed since he/she has seen multiple staff being rough when providing care. S11 stated he/she has seen staff S7 handling residents in a rough manner, every time he/she works at the facility. S11 stated S7 grabs residents and pulls their shirt or squeezes their arms with too much force. S11 stated when S7 is rough, the residents yell out “ouch”. S11 stated all of the staff are rough, stating, “its all of them.” S11 stated it happens anytime he/she notices the other staff giving care. S11 stated he/she has also seen the staff, when changing the residents will toss the residents, without a care. LPA asked a follow up questions regarding details of these events; but Staff S11 would only speak about the staff as a whole and didn’t provide a response. Staff S12 and S13 stated they have seen S7 being rough with residents, by grabbing residents’ arms or shirt and pulling them with too much force. S12 and S13 stated after LPA’s visit, S7 has not been doing this since. Page 2 Out of 7 On December 5, 2025, LPA Manuel Monter interviewed Administrator (ADM) Kurt Gursu. ADM stated he has been dealing with staff in his memory care that are gossiping. ADM stated a staff member reported that staff S7 was being rough. ADM stated when he investigated, he found the resident in question and observed had no bruising or marks. ADM stated when he asked all the staff, none stated they observed this alleged abuse. ADM stated there were staff that heard about the allegation of S7 being rough, but only the staff member who reported it was the one who had allegedly observed it. ADM stated the issue is that his staff continues to gossip and claim that different groups of staff are rough or yelling. ADM stated the staff in the memory care have cliqued and are gossiping. ADM stated he has spoken to the staff, that if something does occur to tell him. ADM stated furthermore, there is some negativity between staff. ADM stated some of the staff don’t like S7 because of the way he/she presents him/herself. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur. Residents are not accorded dignity in his/her personal relationships with staff On November 10, 2025 the Department received a complaint alleging Residents are not accorded dignity in his/her personal relationships with staff. Its been alleged facility staff yell and are rude/make inappropriate comments to residents in care. It has also been alleged staff slam resident food trays. On November 18, 2025, LPA Manuel Monter interviewed residents R1-R9. Resident 7 Out of 9 Residents (R1-R7) stated they have never heard staff saying inappropriate/rude comments or yell towards residents. Resident 7 Out of 9 Residents (R1-R7) stated they have never seen or heard about staff, when serving residents, slamming plates / cups when serving residents. 2 Out of 9 Residents (R8 & R9) were unable to provide any relevant information due to neurocognitive disorder. Page 3 Out of 7 LPA Manuel Monter interviewed Memory Care Director (MCD) Janice Lacambra. MCD stated she hasn’t heard or seen any staff saying inappropriate/rude comments towards residents. MCD stated she hasn’t heard or seen any staff yelling at residents. MCD stated she is on the floor Monday thru Friday and hasn’t heard or witnessed this. MCD stated she has never seen staff slamming plates or cups. MCD stated she is also on the floor during dining time. MCD stated she has never heard or seen this happen. LPA Manuel Monter interviewed staff S1-S8. 8 Out of 8 Staff (S1-S8) stated they have never heard or seen any staff yelling at residents. 8 Out of 8 Staff (S1-S8) stated they have never heard or seen any staff saying inappropriate/rude comments towards residents. 8 Out of 8 Staff (S1-S8) stated they have never heard or seen staff slamming plates or cups. On December 5, 2025, LPA Manuel Monter interviewed residents R10-R12. 3 Out of 3 Residents (R10-R12) stated they have never heard staff saying inappropriate/rude comments or yell towards residents. 3 Out of 3 Residents (R10-R12) stated they have never seen or heard about staff, when serving residents, staff slamming plates / cups when serving residents. On December 5, 2025, LPA Manuel Monter interviewed staff S9-S16. 5 Out of 8 Staff (S9, S13 - S16) stated they have never heard or seen any staff yelling at residents. 5 Out of 8 Staff (S9, S13-S16) stated they have never heard or seen any staff saying inappropriate/rude comments towards residents. 6 Out of 8 Staff (S9,S10,S12,S14-S16) stated they have never seen or heard about staff, when serving residents, staff slamming plates / cups when serving residents. S10 stated the care givers can be harsh. S10 stated he/she has seen the staff being aggressive and harsh when communicating with residents. S10 stated he/she has seen staff saying telling a resident that they are stupid. S10 stated this occurred in the independent side of the facility. S10 stated this occurred a few months ago. S10 stated there are multiple incidents that had occurred but can't remember the details. S11 stated all the staff are rude and all the staff yell. S11 stated, “Yes, it’s all of them.” S11 stated the staff don’t care about the elderly population they are serving. S11 stated the way staff talks to residents is down to them and speaks to them in a disrespectful manner. S11 stated Staff S7 drops plates and cups in a slamming manner when serving residents. S11 stated S7 used to do that all the time, but since LPA’s visit, S7 is no longer slamming the plates and cups. Page 4 Out of 7 S12 stated S7 will yell at the residents, when its time for dinner stating, “what are you doing, its time for dinner.” S12 stated the way staff S7 communicates with residents is disrespectful and loud. S12 stated staff S7 yells at all the residents. S12 stated S7 will bring a residents meal to a resident and if a resident doesn’t want that choice or changes his/her mind, S7 will say, “you ordered that, so that’s what you’re eating.” S12 stated this was happening everyday, but since LPA’s visits, S7 has seemed to control him/herself. S13 stated he/she has seen S7 once serve a resident coffee and he/she slammed the cup down and it spilled on a resident. S13 stated this happened only once. On December 5, 2025, LPA Manuel Monter interviewed Administrator (ADM) Kurt Gursu. ADM stated his staff continues to gossip and claim that different groups of staff are yelling. ADM stated staff accuse each other of yelling. ADM stated furthermore, there is some negativity between staff. ADM stated some of the staff don’t like S7 because of the way he/she presents him/herself. ADM stated for example, the allegation of S7 yelling or other staff of yelling, management asks the accusers to explain. ADM stated the staff who make the accusations do not provide details and then recant. ADM stated he has never seen staff, when serving residents, staff dropping plates / cups when serving residents. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Staff is neglecting residents Activities of Daily living. On November 10, 2025 the Department received a complaint alleging Staff is neglecting residents Activities of Daily living. It has been alleged facility staff ignore residents asking for help / deny residents meals. It has also been alleged residents have been left soiled and unchanged / residents were not assisted with mobility assistance/transfers. Page 5 Out of 7 On November 18, 2025, LPA Manuel Monter interviewed residents R1-R9. Residents 7 Out of 9 Residents (R1-R7) stated they have never observed staff ignoring residents asking for help. Residents 7 Out of 9 Residents (R1-R7) stated they have never seen facility staff deny residents meals. Residents 7 Out of 9 Residents (R1-R7) stated they have not observed any residents who were left soiled/unchanged. Residents 7 Out of 9 Residents (R1-R7) stated they have not observed residents who were not assisted with mobility assistance/transfers. 2 Out of 9 Residents (R8 & R9) were unable to provide any relevant information due to neurocognitive disorder. LPA Manuel Monter interviewed Memory Care Director (MCD) Janice Lacambra. MCD stated she has never seen staff ignoring residents asking for help. MCD stated she has never seen staff denying residents meals. MCD stated she has never seen resident who were left soiled, neglected, un-showered or unchanged. MCD stated he/she has never witnessed this. MCD stated if she or staff observes that a resident is soiled, then the resident is changed right away. MCD stated she has never seen a resident who was neglected assistance with mobility assistance or transfers. LPA Manuel Monter interviewed staff S1-S8. 8 Out of 8 Staff (S1-S8) stated they have never seen staff ignoring residents asking for help. 8 Out of 8 Staff (S1-S8) stated they have never seen staff denying residents meals. 8 Out of 8 Staff (S1-S8) stated they have never seen a resident who was neglected assistance with mobility or transfers. 7 Out of 8 Staff (S1-S4, S6-S8) stated they have never seen resident who were left soiled, neglected, un-showered or unchanged. Staff S5 stated he/she has in several occasions seen residents who were still soiled when he/she started his/her shift. S5 stated this occurs at least once a month. S5 stated he/she doesn’t know when he/she finds residents soiled if they were neglected. On December 5, 2025, LPA Manuel Monter interviewed residents R10-R12. 3 Out of 3 Residents (R10-R12) stated they have never observed staff ignoring residents asking for help. 3 Out of 3 Residents (R10-R12) stated they have never seen facility staff deny residents meals. 3 Out of 3 Residents (R10-R12) stated they have not observed any residents who were left soiled/unchanged. 3 Out of 3 Residents (R10-R12) stated they have not observed residents who were not assisted with mobility assistance/transfers. Page 6 Out of 7 On December 5, 2025, LPA Manuel Monter interviewed staff S9-S16. 6 Out of 8 Staff (S9 S12 - S16) stated they have never observed staff ignoring residents asking for help. 7 Out of 8 Staff (S9, S11 - S16) stated they have never seen facility staff deny residents meals. 6 Out of 8 Staff (S9 S12 - S16) stated they have not observed any residents who were left soiled/unchanged. 6 Out of 8 Staff (S9 S12 - S16) stated they have not observed residents who were not assisted with mobility assistance/transfers. S10 stated he/she has observed residents left unattended in the activity room, and no staff were there or in the area. S10 stated this occurs in the memory care unit in the pm shift. S10 stated he/she has found residents soiled and wandering in the activity room. S10 stated he/she has seen the staff delay assistance to residents, stating they are doing something else. S10 stated he/she has seen residents left alone, who needed mobility assistance, who were neglected in the activity room of the memory care unit. S10 stated this happens anytime he/she see enters the memory care unit. S11 stated staff will hide in the residents bedrooms and not provide care to the residents. S11 stated she has seen residents left soiled for an extended period whenever he/she does his/her rounds in the memory care unit. S11 stated he/she has found residents in their bedroom soiled and stated staff are not changing residents and leaving them soiled. S11 stated because the staff are avoiding work, they are also not assisting residents with mobility assistance or transfers. LPA asked S11 if he/she could provide any details regarding this. S11 stated its happening constantly and can’t bring up a specific example. On December 5, 2025, LPA Manuel Monter interviewed Administrator (ADM) Kurt Gursu. ADM stated staff are not neglecting residents activities of daily living. ADM stated he has never seen staff ignoring residents who are asking for help and not providing care. ADM stated he has never seen a resident who was left soiled, neglected, un-showered or unchanged. ADM stated he has never seen staff neglecting residents with mobility assistance or transfers. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Page 7 Out of 7. On December 5, 2025, LPA Manuel Monter interviewed staff S9-S16. 8 Out of 8 staff (S9-S16) stated they are not aware of any time an incident occurred at the facility and wasn’t reported to CDSS. On December 5, 2025, LPA Manuel Monter interviewed Administrator (ADM) Kurt Gursu. ADM stated All employees have accesses to instant reporting, which employees report witnessed incident. ADM stated these reports go to Memory care director Janice and or himself to submit. ADM stated these incident reports are electronically reported. ADM stated he is not aware of any incident that occurred and wasn’t reported to CDSS Based on records reviewed, the facility submitted 6 incident reports for the month of November 2025, 10 incident reports for the month of October and 10 incident reports for the month of September. These incidents reports covered the following but not limited to incidents: witnessed falls, unwitnessed falls, altercation between residents, sickness, and emergency room visits. The Department made multiple attempts to contact the reporting party to obtain additional information regarding the specific incidents that had not been reported to CDSS. Despite numerous attempts, the Department did not receive a response from the reporting party. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 2 Out of 2.the state’s words, verbatim · CDSS document, Jan 2, 2026 · control 26-AS-20251110131747

Type of visit: Case Management - Incident

Licensing Program Analyst Manuel Monter conducted an unannounced case management incident visit regard a self reported incident regarding alleged abuse. LPA met with Janice Lacambra, Referred to as staff S9. On October 17, 2025, the Department received an incident report from the facility. The incident report stated, S1 grabbed R1 by the left arm and forcefully pulled him/her away from the storage door near the dinning area. It was reported that S1 was yelling at R1 inside the activity room. No injuries noted on R1. On October 21, 2025, LPA interviewed Staff S2-S9. 4 Out of 8 staff (S2, S5, S7, S8) interviewed stated they have observed staff S1 yelling at residents in care. 4 Out of 8 staff (S3, S4, S6, S9) interviewed stated they haven't seen S1 yelling at residents in care. S9 stated S1 naturally has a louder speaking voice. S9 stated when he/she is communicating with residents in the dinning room or activity room, he/she sometimes needs to speak louder so residents that are hard of hearing. S9 works at the facility 5 days a week, 40 hours a week and hasn't observed S1 yelling at the residents. 3 out of 8 Staff (S2, S5 S8) interviewed stated they have seen staff S1 handing residents in a rough manner. 5 Out of 8 staff (S3, S4, S6, S7, S8) staff interviewed stated they have not seen staff S1 handle residents in a rough manner. Staff S9 stated after the accusation was made, he/she assessed R1 and did not observe any marks or bruises. LPA determined the allegation of alleged verbal/physical abuse is unsubstantiated. No deficiencies cited during today's visit. This report was Memory Care Director Janice Lacambra and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Kurt Gursu. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the activity areas, kitchen, dining room, restrooms in Assisted Living and Memory Care. LPA randomly toured the following bedrooms: CE26, CE29, CE21, CE20, CE10, CE7, 3, 5, 6, 7. The Facility grounds were inspected, which included a community garden. There was no obstruction to block the walkways. While touring the memory care unit, LPA's observed residents in participating in a memory questions activity. During the tour of the memory care LPA tested the delayed egress doors in the memory care unit. All delayed egress doors activated when pressed. Staff responded to the delayed egress within 15 seconds of the egress being activated. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was a 75 degrees F, and hot water temperature was measured to range 110-116 degrees F in Memory Care and Assisted Living bathrooms. Page 1 Out of 2. Fire extinguisher was serviced in September 2, 2025. The facility was equipped with Centralized Sprinkler System was tested on March 2025. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on September 12, 2025. LPA reviewed facility records for 4 staff and 4 residents. LPAs reviewed 4 resident medications and centrally stored medication records. LPA conducted interviews with 3 residents and two staff. No deficiencies cited during today's visit. A technical violation was given. This report was reviewed with Administrator Ugur (Kurt) Gursu and a copy of the signed report was provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: POC

On March 21, 2025, Licensing Program Analyst Manuel Monter conducted an unannounced POC visit. LPA met with Administrator (ADM) Ugur (Kurt) Gursu. LPA explained the purpose of the visit. On January 2, 2025, the facility was cited the following type A deficiencies, regarding an elopement that occurred on September 11, 2024, with the POC due of January 3, 2025. 87468.1 Personal Rights: (a)(2) & 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(4) On January 3, 2025, the Department received plan of corrections and cleared plan of corrections on January 3, 2025. On March 21, 2025, LPA conducted a POC visit to ensure the plan of corrections are being followed. LPA observed staff training records which included but not limited to: Elopement drills, Interventions and redirecting techniques for residents with wandering behaviors, Quarterly safety training. LPA received copies of the documentation of training and drills. No deficiencies cited during today's visit. This report was reviewed with Administrator Ugur (Kurt) Gursu and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Mar 21, 2025

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Manuel Monter and Simi Rai conducted an unannounced case management visit in regards an incident report, which stated a resident had eloped from the facility. LPAs met with Administrator Kurt Gursu and stated the purpose of the visit. On September 12, 2024, the Department received an Incident Report for September 11, 2024, Resident R1 had exited through a secured delayed egress door in the memory care courtyard at 8:30am. The Incident Report states staff responded to the delayed egress and began a search. While the search was underway, the facility received a call around 8:50am, and was informed R1 was on a bus. R1 was picked up at by staff at 9:05am and returned to the community. On September 13 & 16 and November 7 & 13 and December 19, 2024, LPA Monter interviewed Staff S1- S6. Staff S1 stated the day of the staff was assisting residents with the morning routine. S1 stated he/she was in the restroom when he/she heard the alarm and went to patio delayed egress where the alarm had activated. S1 stated when he/she arrived to the patio delayed egress, the door was closed but the alarm was still ringing. S1 stated he/she imputed the delayed egress code to turn off the alarm. S1 acknowledged that the delayed egress continues to ring when the door has been opened. S1 stated he/she did not immediately look around the area. S1 stated he/she thought R1 had pushed the delayed egress then just gave up and didn’t actually leave the memory care unit. S1 stated he/she then went around the memory care unit looking for R1, because he/she is the only resident who attempts to elope thru the backyard patio door. S1 stated he/she then asked other staff members if they knew where R1 was and that was when S1 stated he/she realized that R1 was not inside the memory care unit. S1 stated the facility conducted a search but couldn’t find R1. S1 stated a good Samaritan contacted the facility and informed the facility R1 had entered the bus and had stopped near the KFC (983 Meridian Ave, San Jose Ca 95126). Page 1 Out of 3. Staff S1-S5 stated R1 has the behavior of wandering and will attempt to elope from the memory care unit at least once a day. Staff S2 stated he/she was not working on the day of the elopement. Staff S3, the day of the elopement he/she was assisting a resident in room 3 when he/she heard the alarm. Staff S4 stated he/she was working the day of the elopement. S4 stated he/she told S1 to watch R1 and the other residents. S4 stated he/she was helping a resident in bedroom 4. Staff S5 stated he/she was not at the facility on the day of the elopement. Staff S6 stated the day of the elopement there was 2 care givers on shift and 1 MedTech. S6 stated 1 care giver had an appointment and was not at the facility when the elopement occurred. S6 stated he/she didn’t have an extra care giver for coverage when his/her staff left to go to his/her appointment. S6 stated R1 tries to elope at least 5 times per day and R1 has had this behavior since he/she moved in. S6 stated the delayed egress door needs to be pressed for 15 seconds to open. S6 stated the delayed egress will keep ringing and staff needs to input a code if the door has been opened. LPA interviewed Facility ADM. ADM stated that morning, R1 had pushed the egress door and eventually opened it. ADM stated a resident from independent living called the facility and informed them that he/she entered the VTA bus with R1, wherein in he/she discovered that R1 could not express where he/she was going, which prompted the call to Atria Willow Glen. Based on LPA’s observations, the delayed egress alarm in the memory care unit’s patio, the delayed egress needs to be pushed for 15 seconds to open. Once pressed, the delayed egress will activate and sound the alarm. Based on LPA’s testing, the delayed egress can be heard inside the memory care unit. Furthermore, once the delayed egress door has opened, staff needs to input a code to turn off the alarm. Based on a google maps review, the VTA bus stop, where R1 entered the bus, (Route 64B) is approximately 0.1 miles away from the facility. R1 had travel by transit and was picked up by staff across the street from the KFC on 983 Meridian Ave, San Jose Ca 95126. This is approximately 1.4 miles away from the facility. Page 2 Out of 3. Based on a Review of R1’s Physician’s report, dated August 8, 2024, R1 has a neurocognitive disorder. R1 also has wandering behavior and cannot leave the facility unassisted. Based on a review of R1’s Resident Functional Needs Service Plan, dated September 12, 2024, R1 requires supervision when leaving the community. The form also states R1 demonstrates severe memory loss requiring continuous supervision. An immediate civil penalty of $500.00 is being assessed against the facility today for violation the absence of supervision, which resulted in R1 eloping from the facility. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. This report was reviewed with Administrator Kurt Gursu and a copy of the report was provided. Appeal Rights was provided. Page 3 Out of 3.the state’s words, verbatim · CDSS document, Jan 2, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jan 3, 2025

87468.1 Personal Rights: (a)(2) Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on investigation, on September 11, 2024, R1 has neurocognitive disorder and left the facility unassisted and was found by law enforcement unattended. This poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 2, 2025

Plan of correction: Administrator stated he will send a written plan of action on how the facility ensures residents with wandering behaviors will be kept safe. ADM stated he will also send a written letter of understanding regarding the regulation. ADM stated he will send the Plan of Action by POC date 1/3/25

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.2(a)(4) · Plan of correction due date: Jan 3, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Based on investigation, R1 cannot leave the facility unassisted. R1’s service plan states, R1 will be supervised when going outside the community. S1 stated he/she responded to the delayed egress alarm, & didn’t immediately search the outside of the memory care unit. This poses anthe state’s words, verbatim · CDSS document, Jan 2, 2025

Plan of correction: ADM stated the facility will (conduct elopement protocol trainings for all staff. ADM stated he will send LPA documentation this training has taken place. ADM stated he will send the plan of correction by POC date 1/3/25 (con't) immediate Health, Safety, or Personal Rights risk to persons in care.

Type of visit: Case Management - Incident

Licensing Program Analyst Manuel Monter conducted an unannounced case management- Incident visit, to conduct follow up interviews regarding an incident report, which reported a resident elopement. LPA with with Resident Services Director Trever Treadwell On September 12 2024, the Department received an incident report, regarding resident R1. The incident report (IR) stated on September 11, 2024, at 8:30am resident R1 had exited thru the delayed egress in the courtyard. The incident report stated that staff responded to the alarms and began a search. The IR also stated, that while the search was underway, the community received a call at 8:50am, that R1 was on a bus. Staff picked up R1 and returned him/her back to the community. On December 19, 2024 LPA Manuel Monter interview Memory care director and staff S1. LPA determined that the above incident requires further investigation. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Resident Services Director Trever Treadwell and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 19, 2024

Allegation investigated: Staff are not meeting resident's hygiene needs

Licensing Program Analyst (LPA) Manuel Monter and Marcela Yanez conducted an unannounced visit to deliver findings regarding the allegation listed above LPA met with Administrator Kurt Gursu On October 29, 2024, the Department received a complaint alleging Staff are not meeting resident's hygiene needs. On November 7, 2024, LPA's interviewed residents R1-R10. R1-R9 stated they have not seen any residents who were in an unkept/dirty state. 4 Out of 10 residents (R1, R2, R4, R7) interviewed stated staff assit them with their daily grooming and showers. 5 Out of 10 Residents (R3, R5, R6, R8, R9) interviewed stated they take care of their own hygine needs and don't need assitance. 9 Out 10 residents stated staff will assit them with their grooming and showering if they request. R10 stated he/she did not want to be interviewed and stated he/she was going to a bingo game. Page 1 Out of 2. Unfounded LPA's interviewed 6 staff (S1-S6). All staff interviewed stated the facility staff assist residents with their daily hygiene needs. All staff interviewed stated they have not seen any resident who is unkempt/dirty or their hygiene needs were not being met. All staff interviewed stated they have not seen any staff ignoring or neglecting residents who need assistance with their hygiene needs. LPA's interviewed ADM. ADM stated the residents are being assisted with their hygine and its part of their care plan. ADM stated he hasn't noted any residents with odor or residents with their hygiene needs not being met. During the visit, LPA's toured the facility inside and out, which included but not limited to the memory care and assisted living sections of the facility. LPA's did not observe any residents that were unhygienic / dirty or unkempt. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Nov 7, 2024 · control 26-AS-20241029132630

Allegation investigated: Staff do not provide resident with housekeeping Staff do not assist resident with grooming Staff locks resident inside of resident's living unit

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegations. LPA met with Trever Treadwell, Resident Services Director. On March 16, 2023, the Department received a complaint alleging Staff do not provide resident with housekeeping. On August 7, 2024, LPA interviewed residents R2-R6. 3 Out of 5 residents (R2-R4) stated their bedroom is cleaned everyday and they have not observed other bedrooms are dirty/unkempt. Resident R5 was unable to provide LPA answer and would digress to unrelated topics. Resident R6 declined to be interviewed. Page 1 Out of 3. Unfounded On August 7, and September 10, 2024, LPA interviewed staff S1-S8. 7 Out of 8 staff (S1-S2, S4-S8) interviewed stated facility staff enters resident bedrooms at least two times per shift. 6 Out of 7 staff (S1-S2, S4-S8) stated if a resident’s room is observed as not clean, staff will clean the bedroom. 5 Out of 8 staff stated the residents’ bedrooms are cleaned daily and house keeping cleans weekly. On September 20, 2023, August 7, September 10 and September 16, 2024, the Department conducted unannounced visits to the facility. LPA Monter observed the following bedrooms: as clean and sanitary (5,9,20,21,24,25,29,30, CE25, CE24, CE1, CE5, CE9, CE4). LPA Monter did not observe any resident bedroom as dirty or unsanitary. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Staff do not assist resident with grooming On March 16, 2023, the Department received a complaint alleging Staff do not assist resident with grooming. On August 7, 2024, LPA interviewed residents R2-R6. 2 Out of 5 residents (R2-R3) interviewed stated, they do their own grooming, but staff will assist if asked. Resident R4 stated he/she receives assistance with Grooming. 3 Out of 6 residents interviewed (R2-R4) stated they have not seen other residents dirty or in a disheveled state. Resident R5 was unable to provide LPA answer and would digress to unrelated topics. Resident R6 declined to be interviewed. On August 7, and September 10, 2024, LPA interviewed staff S1-S8. 7 Out of 8 staff (S1-S2, S4-S8) stated if a resident is seen dirty or in a disheveled state, staff will immediately help clean them up. 8 Out of 8 staff interviewed stated staff helps residents with their daily grooming. 8 Out of 8 staff stated they have not seen a resident in a disheveled state. Page 2 Out of 3. On September 20, 2023, August 7, September 10 and September 16, 2024, the Department conducted unannounced visits to the facility. LPA Monter did not observe any residents who were not groomed or in a disheveled state. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Staff locks resident inside of resident's living unit On March 16, 2023, the Department received a complaint alleging Staff locks resident inside of resident's living unit. On August 7, 2024, LPA interviewed residents R2-R6. 3 Out of 5 residents (R2-R4) stated staff don’t lock residents inside their rooms. 3 Out of 5 (R2-R4) residents interviewed stated they can unlock their bedroom door by twisting the doorknob. Resident R5 was unable to provide LPA answer and would digress to unrelated topics. Resident R6 declined to be interviewed. On August 7, and September 10, 2024, LPA interviewed staff S1-S8. 8 Out of 8 staff interviewed stated staff don’t lock residents inside their bedrooms. 8 Out of 8 staff interviewed stated residents can twist the doorknob and the door can open. On September 20, 2023, LPA Monter toured the Memory care unit. LPA observed resident bedroom doorknobs can unlock from the inside by twisting the doorknob. LPA did not observe any other locking mechanism on the door besides the doorknob. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 3 Out of 3. Based on a Review of R1’s Physicians Report, dated July 19, 2022, resident R1 does not have bowel or bladder impairment. Furthermore, the report states R1 is able to care for his/her own toileting needs. The Department reviewed R1’s Resident Functional needs Assessment, dated October 18, 2022. The assessment states R1 requires limited assistance, wherein the facility would escort R1 to the bathroom 6 times per day. Based on a review of Facility Progress Notes, dated October 5, 2022, stated R1 is now incontinent. The Note states the facility implemented 3-hour toileting but R1 would be placed on the toilet but R1 would did not have a bowel/bladder movement. The note stated R1 would then use the restroom on the floor 10 minutes later. The Department was unable to interview Resident R1, who no longer lives at the facility. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Staff do not monitor resident for change in condition On March 16, 2023, the Department received a complaint alleging Staff do not monitor resident for change in condition. Its been alleged that the facility staff did not know R1 had a Urinary Tract Infection (UTI). On December 22, 2022, LPA Marrufo interviewed Witness (W1). W1 stated he/she was informed by the facility regarding the UTI. W1 stated, the director told him/her a care giver had observed blood in R1’s urine. On August 7, 2024, LPA interviewed staff S1-S6. 4 Out of 6 staff interviewed (S1, S2, S4, S5) stated when shifts change, the leaving shift informs the upcoming shift of any changes of conditions they observed during their shift. 5 Out of 6 staff interviewed stated when they observe a change of condition, they will inform the medtech/Memory care director. Staff S1-S3 stated they remember R1 but do not remember working with him/her. S4-S6 stated they are new employees and had no interactions with R1. Page 2 Out of 3. Based on record review, there is no incident report regarding R1 having a UTI. Based on a review of R1’s Resident Diagnosis Management form, dated September 23, 2024, the form does not indicate that R1 had a diagnosis of a UTI, during his/her stay at the facility. According to Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447), UTIs don't always cause symptoms. When they do, they may include: … Urine that appears red, bright pink or cola-colored — signs of blood in the urine. The Department was unable to interview Resident R1, who no longer lives at the facility. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Page 3 Out of 3. END OF REPORT.the state’s words, verbatim · CDSS document, Oct 16, 2024 · control 26-AS-20221220120523

Allegation investigated: A resident's toilet is in disrepair Neglect/lack of supervision resulted in resident eloping. Facility door alarm is in disrepair Facility did not notify residents responsible party/CCLD regarding an elopment

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegations. LPA met with Trever Treadwell, Resident Services Director. On July 30, 2024, the Department received a complaint alleging a resident’s toilet is in disrepair. On August 7 and September 10, 2024, LPA Monter interview Staff S1-S6. All staff interviewed stated if an issue arises regarding a resident’s toilet, the maintenance director will resolve the issue the same day. 3 Out of 6 staff (S1, S2, S6) stated R1’s toilet had an issue because R1 would clog it from using too much toilet paper. S1 stated the moment the staff are informed about an issue with the toilet, then maintenance will fix it by the end of the day. Page 1 Out of 5. Unfounded On August 22, 2024, LPA Monter interviewed R1. R1 stated he/she doesn’t remember if his/her toilet in his/her bedroom was working. LPA interviewed R1’s Family Member (FM). FM stated it was possible that R1 was flushing too much toilet paper. FM stated every time an issue regarding the toilet would arise, staff S2 would fix it him/herself. On September 10, 2024, LPA Monter interviewed Residents R2-R5. 3 Out of 4 residents interviewed (R2, R4, R5) stated their toilet is functional and has not given them any issues. 1 Out of 4 residents interviewed (R3) stated he/she did an issue with his toilet, but it was fixed the same day by the maintenance director. LPA Monter interviewed facility Maintenance Director (MD). MD stated he/she has gotten a work order for R1’s toilet. MD stated he/she uses a snake “Augger” to unclog it. MD stated when he/she gets notified of an issue with a toilet, he/she will address it the same day as it’s a health and safety issue for the residents. MD stated he/she has several spares in storage that he/she can just replace if the actual toilet is damaged. On August 7, September 10, 2024, LPA made the following observations. LPA toured the following resident bedrooms: CE1, CE5, CE5, 5, CE9, 9, 20, 21, CE23, CE24, 24, 25, CE25, 29, 30. All resident toilets inspected were observed as clean and functional. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Neglect/lack of supervision resulted in resident eloping. On July 30, 2024, the Department received a complaint alleging Neglect/lack of supervision resulted in resident eloping. It has been alleged on June 17, 2024, Resident R1 had eloped. On August 5, 2024, the Department interviewed R1’s family member (FM). FM stated R1 never had a problem with wandering before moving to the facility. FM stated R1 has never wandered when he/she lived with him/her. FM stated wandering was not a concern before moving in. Page 2 Out of 5 On August 7, 2024, LPA Monter interviewed ADM and staff S1. ADM and S1 confirmed that on June 17, 2024, R1 had exited the assisted living building (Cedar) around 5am and had walked to the Monterey building. R1 then proceed to throw a flowerpot at the door of the Monterey building. S1 stated R1 then proceeded to knock on room 28’s door. (Independent living.) S1 stated R1 did not enter that resident’s bedroom. On August 22, 2024, LPA Monter interviewed resident R1. R1 stated regarding June 17, 2024, that he/she does not remember the details. R1 stated he/she went out for a short walk in the morning, but then couldn’t go inside the building. R1 stated he was frustrated that he could not enter the building, so he/she threw something. R1 stated he/she just wanted to walk by him/herself. R1 stated he/she thinks this is the first time this has happened but doesn’t remember. Based on a review of R1’s Physician Report dated April 21, 2024, R1 has a neurocognitive disorder. The Report also states R1 does not have wandering behavior. Based on a review of R1’s needs and services plan, dated May 9, 2024, R1 requires 2-hour status checks. Based on a review of R1’s 2-hour status checks log, R1 was last checked at 4am, on June 17, 2024. R1 was then checked again the same day at 6am. Based on a review of the facility’s sketch, the Monterey building is part of the facility grounds. Based on the totality of this investigation, R1 did exit the assisted living building and walk to the Monterey independent living building. Since the Monterey building is part of the facility grounds, R1 did not elope from the facility. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 3 Out of 5. Facility did not notify residents responsible party/CCLD regarding an elopement On July 30, 2024, the Department received a complaint alleging Facility did not notify residents responsible party/CCLD regarding an elopement. On July 30, 2024, the Department interviewed R1’s family Member (FM). FM stated was he/she was called and informed on June 17, 2024, at 5:30 am R1 left the assisted living building (Cedar) and had thrown a potted plant into the building door. On August 7 LPA Monter interviewed ADM and staff S1. ADM and S1 confirmed that on June 17, 2024, R1 left the assisted living building (Cedar) around 5am and had walked to the Monterey building. ADM and S1 stated R1 then proceed to throw a flowerpot at the door of the Monterey building then proceeded enter the building and knock on room 28’s door (Independent living.) S1 and ADM stated R1 did not enter that independent living resident’s bedroom. ADM stated he had a discussion with S1 and R1’s family member about R1’s change of condition. On August 22, 2024, LPA Monter interviewed resident R1. R1 stated on June 17, 2024, he/she went out that morning to take a short walk. R1 stated he/she was finished with the walk, he/she could not re-enter his/her building and became frustrated. R1 stated he/she threw something. R1 stated he/she just wanted to have a walk by him/herself. R1 stated he/she did not have an injury that day and states this is the first time something like this happened. On October 8, 2024, LPA Monter interviewed staff S1. S1 stated R1's family and physician was notified. S1 stated it was no injury to R1 or other residents because there was no other residents in area at the time of the incident. S1 stated this was a new behavior that was discussed with FM. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 4 Out of 5. Facility door alarm is in disrepair On July 30, 2024, the Department received a complaint alleging the facility door alarm is in disrepair. It has been alleged the door alarm in the assisted living building was in disrepair. On August 7, and September 10, 2024, LPA Monter interviewed staff S1-S6. 4 Out of 6 staff (S3-S6) interviewed stated the door alarm works and has not had any issue. 2 Out of 6 staff (S1, S2) stated the door alarm had an issue where the door alarm would be keeping ringing during the day, past 6am. S2 stated when the door open, it pages the NOC (Night) shift staff and notifies them that the door had been opened. S1 stated the issue was resolved the same day. On August 7, and September 10, 2024, LPA Monter interviewed residents R1-R5. R1 stated he/she doesn’t remember if the door alarm was functional. 4 Out of 5 residents (R2-R5) stated the door alarm works and stated there hasn’t been a time when it was not functional. On September 10, 2024, LPA Monter interviewed the Maintenance Director (MD). MD stated there was an issue with the door alarm. MD stated the if the door opens at 10pm-6am, then the NOC shift’s pager will buzz to notify them that the door had been opened. MD stated the issue was that the door alarm would stay on and keep buzzing even after 6am. MD stated the issue was resolved the same day. Based on interviews conducted, the door alarm in the assisted living unit was not in disrepair, rather it’s settings were not calibrated correctly. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 5 Out of 5. END OF REPORT On August 22, 2024, LPA Monter interviewed Resident R1’s Family Member. (FM). FM stated after the incident on June 17, 2024, FM stated he/she was informed by the ADM and S1 that R1 would require a higher level of care. FM stated he/she didn’t want R1 in memory care. FM stated he/she was told that R1 would require a 1 on 1. FM stated he/she was told that R1 will need to be moved as quickly as possible. LPA requested FM any documentation from the facility stating R1 was being evicted. FM did not provide LPA with any documentation. On October 16, 2024, LPA Monter interviewed staff S1.S1 stated he/she and the facility ADM were both there during the conversation with FM. S1 reiterated that the facility did not evict R1. S1 stated that FM told ADM and S1, after the conversation about R1's change of condition, that if he/she needs to give the facility a 30 day notice to vacate. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that R1 was evicted from the facility. Staff did not follow a licensed physician's order On July 30, 2024, the Department received a complaint alleging staff did not follow a licensed physicians order. It has been alleged R1’s medication 1 was not given. On August 5, 2024, resident R1’s Family Member (FM) stated, R1 was taken to the hospital to see his/her physician. FM stated R1’s physician gave 2 sample medications for R1 to use on May 23, 2024. FM stated he/she brought the medications to the facility and they informed her that they could not give R1 the inhaler since it was a sample even though FM had written a prescription. FM stated he/she administered R1’s medication him/herself, so there would be no delay in R1 receiving the prescription. On October 2, 2024, LPA Monter interviewed ADM. ADM stated the facility did not administer the medication because the medication did not contain the proper labeling requirements. ADM stated FM did not authorize the pharmacy to fulfill the prescription order. Page 2 Out of 3. On October 8, 2024, LPA Monter interviewed Staff S1. S1 stated the medication bottle FM brought did not have the state required labeling. S1 stated he/she was going to order the prescription but FM refused. S1 stated, FM only wanted to use the sample due to the cost of the medication. S1 stated FM told him/her that he/she would administer the medication and took the sample medication with him/her. Based on a review of R1’s needs and Services Plan, dated May 9, 2024, stated R1 receives assistance with self-administration of medications up to 2 times a day. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that R1 was evicted from the facility. Page 3 Out of 3. END OF REPORT.the state’s words, verbatim · CDSS document, Oct 16, 2024 · control 26-AS-20240730121919

Type of visit: Case Management - Incident

Licensing Program Analyst Manuel Monter conducted an unannounced case management- Incident visit, regarding an incident report, which reported a resident elopement. LPA with with administrator Ugur (Kurt) Gursu. On September 12 2024, the Department received an incident report, regarding resident R1. The incident report (IR) stated on September 11, 2024, at 8:30am resident R1 had exited thru the delayed egress in the courtyard. The incident report stated that staff responded to the alarms and began a search. The IR also stated, that while the search was underway, the community received a call at 8:50am, that R1 was on a bus. Staff picked up R1 and returned him/her back to the community. On September 16, 2024, LPA's interviewed 4 staff, the facility administrator and resident R1. LPA requested copies of R1's progress notes. LPA also requested a copy of R1's Centrally stored medication record and Medication Administration Log. LPA requested a copy of the delayed egress notification. LPA determined that the above incident requires further investigation. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Ugur (Kurt) Gursu. and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 16, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Marcela Yanez and Manuel Monter conducted an unannounced annual inspection visit, and met with Trevor Treadwill Resident Services Director. LPA explained the purpose of the visit. LPA toured the facility inside out with Resident Service Director Trevor Treadwill which included the activity, kitchen, dining room, restrooms in Assisted Living CE1, CE9, CE5, CE25, CE24, and Memory Care MC22-25. The staff area of the facility was also inspected. The Facility grounds were inspected. There was no obstruction to block the walkways. While touring the memory care unit, LPA's observed residents in a circle in the backyard doing exercises with staff. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was a 72 degrees F, and hot water temperature was measured to range 106-114 degrees F in Memory Care and Assisted Living bathrooms. Fire extinguisher was serviced in August, 2024. The facility was equipped with Centralized Sprinkler System was tested on 06/24/2024 and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on 08/28/2024. LPA reviewed facility records for 4 staff and 5 residents. LPAs reviewed 4 resident medications and centrally stored medication records. LPA conducted interviews with 4 staff and 5 residents. No deficiencies cited during today's visit. This report was reviewed with Administrator Ugur (Kurt) Gursu and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Sep 10, 2024

Allegation investigated: Staff inappropriately touched resident in care

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegations. LPA met with Administrator Kurt Gursu. On March 16, 2023, the Department received a complaint alleging Staff inappropriately touched resident in care. On March 16, 2023 Local Law Enforcement interviewed R1 regarding the allegations of staff inappropriately touching him/her. R1 stated when he/she first arrived at the facility, he/she was advised he/she needed a bath by a staff member. R1 stated the staff member used soap and was scrubbing all over R1’s body, including R1’s genitals and chest. R1 stated he/she didn’t know if the staff member did it for their gratification and stated nothing else happened. R1 stated he/she would not be able to recognize the staff member. Page 1 Out of 2. Unsubstantiated On August 7, 2024, LPA Monter interviewed staff S1-S6. 6 Out of 6 staff interviewed denied the allegation that staff were touching residents inappropriately, when given showers. LPA Monter interviewed residents R2-R6. 4 Out of 6 residents (R2-R4) interviewed stated staff do not touch residents in an inappropriate manner when given showers. Resident R5 was unable to respond to LPA's questions due to neurocognitive disorder. Resident R6 stated he/she declined to be interviewed. A review of R1’s physicians report dated, December 13, 2022, states R1 has a neurocognitive disorder, with intermittent confusion. A review of R1’s Needs and Services Plan (ANS), dated January 6, 2023, states R1 R1 requires limited assistance 2 times per week. (Limited being defined by the Needs and services plan as; “requires extensive assistance for all bathing/showering needs.”). The ANS also states R1 has a neurocognitive disorder. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. This report was reviewed with Administrator Kurt Gursu and a copy of the report was provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Aug 7, 2024 · control 26-AS-20230316164952