Avantgarde Senior Living of La Jolla

Allegation investigated: Staff do not prevent resident from urinating and defecating in other residents' beds. Staff do not prevent resident from making racist, sexist comments to other residents.

Licensing Program Analyst(LPA) Janet Ngallo conducted an unannounced subsequent visit to deliver findings regarding the above mentioned complaint allegations. LPA was greeted by, introduced themselves to, and discussed the purpose of the visit with Administrator Susan Caccam. On 05/27/2026, it was alleged that staff do not prevent resident from urinating and defecating in other residents' beds, and that staff do not prevent resident from making racist, sexist comments to other residents. The department's investigation consisted of interviews and records review. [Cont. from LIC 9099-C] Unsubstantiated [Cont. from LIC 9099] Regarding the allegation that staff do not prevent resident from urinating and defecating in other residents' beds, staff interviews revealed that R1 exhibits dementia related behaviors including wandering, incontinence, confusion regarding personal space, and episodic agitation. Staff consistently reported redirecting R1, providing incontinence care, removing R1 from other residents’ rooms when behaviors occurred, and administering PRN medication when appropriate. While staff acknowledged that R1 has soiled their own room or bedding, interviews did not confirm that R1 urinated or defecated in other residents’ beds. Resident interviews did not corroborate that R1 was observed urinating or defecating in other residents’ beds. Residents acknowledged R1’s behavioral symptoms but stated that staff consistently intervened and redirected R1 when needed. Records review showed that R1 has dementia with behavioral disturbances, including incontinence, confusion, and wandering, and that R1’s behaviors are being clinically managed by the facility’s psychiatrist. Records also indicated that staff are to participate in frequent wellness checks, behavioral monitoring, and interventions for incontinence and agitation. Regarding the allegation that staff do not prevent a resident from making racist or sexist comments to other resident, staff interviews confirmed that R1 exhibits episodic inappropriate verbal comments associated with dementia and behavioral diagnoses. Staff consistently reported redirecting R1, notifying supervisory staff, coordinating with the psychiatrist, administering PRN medication as appropriate, and removing R1 from situations involving other residents. Staff stated they intervene promptly and attempt to deescalate when verbal behaviors occur. Resident interviews acknowledged that R1 makes inappropriate or disruptive comments, however, residents reported that staff routinely step in, redirect R1, and remove R1 from situations involving other residents. Residents expressed that staff respond appropriately and that staff are the main reason why residents are kept safe and free from R1's behaviors. [Cont. on LIC 9099-C pg. 1] [Cont. from LIC 9099-C] Records review indicated that R1’s behavioral symptoms are longstanding, clinically documented, and actively monitored. R1 receives medication for agitation, anxiety, and psychosis, and the facility’s psychiatrist is adjusting R1’s regimen to manage verbal outbursts. Documentation reflected interventions, behavioral monitoring, and structured care approaches appropriate for R1’s condition. Based on interviews, and records review, the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. An exit interview was conducted with Administrator Susan Caccam and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided. Their signature confirms receipts of these documents.the state’s words, verbatim · CDSS document, Aug 20, 2026 · control 08-AS-20260527151209

Allegation investigated: Staff did not prevent a resident from sustaining a fracture while in care.

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced subsequent visit to deliver findings regarding the above‑mentioned allegation. LPA identified themselves and met with Administrator Susan Caccam to discuss the purpose of the visit and elements of the complaint. On 05/07/2026, it was alleged that staff did not prevent a resident(R1) from sustaining a fracture while in care. The department's investigation consisted of interviews and records review. [Cont. on LIC 9099-C] Unsubstantiated [Cont. on LIC 9099] Regarding the allegation, R1 was sent to the hospital upon the request of their responsible party, and was found to have a displaced femoral fracture. Interviews revealed that since R1 was admitted to the facility, R1 frequently cried, expressed distress, and exhibited facial grimacing as part of their baseline behavior, making it difficult for staff to distinguish baseline emotional behaviors from potential pain. Interviews stated anytime staff asked R1 if they were experiencing any pain or if the behavior was anxiety-related, R1 would respond that they were anxious. Multiple staff stated that R1 did not report any fall, and no fall was witnessed in the days prior to hospitalization and the day of hospitalization. Staff reported that R1 ambulated with both wheelchair and walker depending on preference, and that R1 had no visible injuries or complaints of hip pain prior to the incident. Interviews consistently stated that camera footage was reviewed and showed no fall or incident in monitored areas. Staff stated that R1 spent time in common areas and was monitored regularly. Staff interviews revealed that when R1 exhibited baseline behavior on the day of hospitalization, emergency services were called at the request of the responsible party. Staff confirmed that R1 had previously been hospitalized from an unrelated health matter days earlier and had continued showing facial expressions that were described as consistent with their baseline. No staff reported observing a fall or any event that could clearly or consistently be associated with a new injury. Records review revealed that R1’s service plan and medical records documented dementia, anxiety, muscle weakness, and a prior displaced femur fracture before admission to the facility. Records also documented that R1 required assistance with all ADLs and used both a wheelchair and walker. Records review of the incident report on 05/03/2026 revealed that R1’s responsible party observed R1 to be expressing pain and requested emergency services, and R1 was transported to the hospital and admitted with a displaced right femoral fracture. Based on interviews and records review, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated. An exit interview was conducted with Administrator Susan Caccam and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided. Their signature confirms receipts of these documents.the state’s words, verbatim · CDSS document, Aug 3, 2026 · control 08-AS-20260507052039

Allegation investigated: Due to staff neglect, resident was left in wheelchair for an extended amount of time.

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced subsequent visit to deliver findings regarding the above mentioned allegation. LPA identified themselves and met with Administrator Susan Caccam to discuss the purpose of the visit and elements of the complaint. On 03/03/2026, it was alleged that due to staff neglect, resident(R1) was left in wheelchair for an extended amount of time. The department's investigation consisted of interviews, records review, and LPA observations. (Cont. on LIC 9099-C) Unsubstantiated (Cont. from LIC 9099) Regarding the allegation, the reporting party stated that R1 was left in a wheelchair for what was believed to be an extended amount of time, however, the reporting party also acknowledged being unable to determine exactly how long R1 remained in the wheelchair. Interviews with staff and outside sources provided inconsistent information, with some interviews recalling R1 using a wheelchair temporarily and others reporting primarily assisting R1 with walking. No interviews reported that R1 was left in a wheelchair for a prolonged or inappropriate amount of time. Interview with R1 reported having used a wheelchair only occasionally, and that they were always up and walking and did not stay in the wheelchair for long periods of time. During a facility visit, LPA observed R1 clean, well-groomed, and ambulating with standby assistance from a private caregiver. Records reviewed showed that R1 experienced changes in mobility status over time. R1's initial appraisal dated 11/17/2025 documented slow gait, and the ability to sit in a wheelchair without support, while also noting R1 walked well alone with some balance support. R1's medical assessment dated 08/24/2025 listed R1 as ambulatory. A reappraisal dated 03/18/2026 showed a documented change of condition, indicating R1 had become non-ambulatory, used a wheelchair, and required full assistance with mobility due to weakness. Based on interviews, records review, and LPA observation, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated. An exit interview was conducted with Administrator Susan Caccam and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided. Their signature confirms receipts of these documents.the state’s words, verbatim · CDSS document, May 21, 2026 · control 08-AS-20260303103418

Allegation investigated: Staff do not ensure that resident hygiene needs are met. Staff does not keep the facility clean and sanitary. Staff did not adequately address a pest infestation. Staff did not follow protocols to prevent the spread of scabies. Staff did not implement prescribed medical treatment in a timely manner. Staff are not following reporting requirements.

Licensing Program Analyst(LPA) Janet Ngallo conducted an unannounced subsequent visit to deliver findings regarding the above-mentioned complaint allegations. LPA introduced themselves and disclosed the purpose of the visit and elements of the complaint to Administrator Susan Caccam. On 02/07/2026, it was alleged that staff do not ensure that resident hygiene needs are met, staff does not keep the facility clean and sanitary, staff did not adequately address a pest infestation, staff did not follow protocols to prevent the spread of scabies, staff did not implement prescribed medical treatment in a timely manner, and that staff are not following reporting requirements. The department's investigation consisted of observations, interviews and records review. (Cont. on LIC 9099-C) Unsubstantiated (Cont. from LIC 9099) Regarding the allegation that staff do not ensure that R1's hygiene needs are met, interviews revealed that R1 was originally independent with bathing, and staff initially provided only standby assistance. Staff reported that R1 had a skin condition, and observed that R1 was not showering effectively, which contributed to worsening of the condition. Interviews revealed that once these concerns were identified, staff began providing increased assistance, transitioning from standby to full shower assistance, and increased shower frequency. Staff also confirmed that daily showers were provided in collaboration with home health when medically recommended for aid in treatment of R1's skin conditions. Staff interviews consistently reported efforts to support R1’s hygiene and compliance with updated care needs. Interview with R1 revealed that R1 previously showered on their own but staff decided to begin helping R1. R1 stated that staff "always" give them showers. Records review of shower logs from September 2025 through February 2026 showed that R1 consistently received the documented showers, including daily showers throughout February 2026. Records further showed that R1’s care plan was formally updated during a care conference on 02/25/2026 to include daily showers per medical recommendations. During the visit, LPA observed R1 to be clean and well groomed. Regarding the allegation that staff does not keep the facility clean and sanitary and that staff did not adequately address a pest infestation, interviews consistently reported that they had not observed cockroaches or other pests inside resident rooms, including R1’s previous room. Housekeeping staff stated that rooms and bathrooms are cleaned on a rotating schedule throughout the week and that additional cleaning is provided as needed. Staff also reported that the facility contacted pest control when R1’s POA reported seeing a bug in R1's previous room. Multiple staff reported that pest control inspected the room and did not find evidence of pests/infestation. R1 reported that their room was clean, that they never saw any pests, and that they were moved to another room because of a loud roommate, not due to pests. Records review of Pest control invoices showed routine monthly prevention services throughout 2025, and a February 2026 inspection report indicated no pests were found in R1's previous room. Facility pest-control maps showed bait stations already in place as preventive measures. Review of housekeeping schedules confirmed that rooms and common areas are cleaned regularly, with 3–4 rooms cleaned daily and all rooms completed weekly. During a facility visit, LPA observed the facility without pests, and rooms and common areas were clean and observed being cleaned by housekeeping staff. (Cont. on LIC 9099-C pg. 1) (Cont. from LIC-9099-C) Regarding the allegation that staff did not follow protocols to prevent the spread of scabies and that staff are not following reporting requirements, interviews reported that R1 was isolated each time scabies was suspected or diagnosed, and that staff followed infection control procedures including PPE use, and additional cleaning. Staff stated that no other residents developed scabies, and that another resident(R2) who was evaluated for a rash tested negative for scabies. Interviews reported that the administrator notified the public health department regardless of only one case of scabies, and that the department stated that this was not an outbreak case. Records review of the facility’s infection control policy included clear scabies prevention protocols such as isolation, laundry procedures, PPE use, and environmental cleaning. Review of email correspondence showed that the facility reported scabies concerns to the Department of Public Health. Records review revealed that the facility sent incident reports for R1 and R2 sent to CCLD regarding rash/scabies and follow up for the conditions of both residents. Medical records confirmed that R1 received prescribed treatments, and documentation showed that the second resident tested negative for scabies following a skin scrape. Regarding the allegation that staff did not implement prescribed medical treatment in a timely manner, interviews reported following physician orders as they were received and administering treatments accordingly. Staff stated that one prescription was delayed over a weekend because the pharmacy did not process it, and the facility was not notified until the following Monday. Staff reported following up immediately upon returning, and the pharmacy acknowledged and apologized for the delay. The reporting party confirmed that the delay was caused by the pharmacy rather than the facility. Staff also reported that oral medications, creams, and antibiotic treatments were administered according to medical instructions, and that home health supported wound care and daily bathing when needed. Records review of R1's medication prescriptions and medication administration record revealed that the delayed prescription was later processed and administered, and all other ordered treatments were provided as directed. The Department has investigated the above-mentioned allegations and based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed unsubstantiated. An exit interview was conducted with Administrator Susan Caccam, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.the state’s words, verbatim · CDSS document, Apr 29, 2026 · control 08-AS-20260207112654

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced, required Annual Inspection. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Administrator Susan Caccam. The facility is approved for a capacity of forty-five (45) non-ambulatory residents, all of which may be bedridden. The facility also has a hospice waiver for twenty (20). During today’s inspection there were thirty-eight (38) residents in care. LPA and Administrator Caccam toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to residents were compliant. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Caccam, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [Continued on LIC 809-C] [Continued from LIC 809] LPA reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator Caccam to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 23, 2026

Allegation investigated: Staff did not provide a healthful accommodation to the residents

This report supersedes the report created 4/11/26 and the findings will remain unchanged. On 4/12/2026, at approximately 11:30 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Susan Caccam/Facility Administrator. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: conducting a health and safety check of the facility, including a random selection of ten (10) residents’ rooms. Evaluation Report continues LIC 9099-C Substantiated This report supersedes the report created 4/11/26 and the findings will remain unchanged. Investigation Revealed the Following: Allegation: Staff did not provide a healthful accommodation to the residents The details of the complaint alleged that facility was not clean and sanitary On April 11, 2026, at approximately 9:00 a.m., during a health and safety inspection of the facility, the Department conducted a random check of ten (10) resident rooms. The Department observed that (10) out of (10) rooms had carpet stains and trash scattered throughout. During this investigation, LPA found sufficient evidence to support the above-mentioned allegation. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D). An exit interview was conducted, and a copy of the Complaint Report was given to Susan Caccam/Facility Administrator. This report supersedes the report created 4/11/26 and the findings will remain unchanged. Investigation Revealed the Following: Allegation: Staff did not properly groom a resident The details of the complaint alleged that facility staff did not properly dress (R#1) with the appropriate clothes On April 11, 2026, at approximately 10:00 am, during an interview with (R#1), the Department observed that (R#1) was dressed in clean clothing appropriate for the day’s weather. The Department asked (R#1) who selected the clothing they were wearing, and (R#1) stated that they chose the clothing themselves. On April 11, 2026, during an interview with the facility administrator (A#1), (A#1) stated that facility staff are trained to select appropriate clothing for residents based on current weather conditions. (A#1) further stated that when residents have the ability to choose their own clothing, staff allow them to do so while providing guidance as needed. In addition, (A#1) was also asked about the systems in place to ensure residents have access to their personal clothing and that staff utilize clothing provided by family members. (A#1) stated that each resident has their own closet where personal clothing is stored. According to (A#1), facility staff place clean clothing in the residents’ closets after laundering to ensure items are available and accessible. On April 11, 2026, during interviews with residents in care (R#1 through R#7), residents were asked whether staff assist them regularly with grooming, including dressing, brushing hair, and bathing, and whether the assistance is appropriate for their needs. (3) out of (7) Residents stated that they perform their own dressing and grooming; however, they observed that staff assist other residents who require help. In addition, residents were also asked if they had ever been dressed in clothing that felt uncomfortable or inappropriate for the weather. (7) out of (7) residents stated that they had no concerns and that everything was appropriate. Evaluation Report continues LIC 9099-C This report supersedes the report created 4/11/26 and the findings will remain unchanged. On April 11, 2026, during interviews with facility staff (S#1 through S#3),(3) out of (3) facility staff stated that they assist residents with showers, changing clothes, and escorting residents to the dining room as part of their grooming and dressing responsibilities. Staff reported that the level of assistance provided varies depending on each resident’s needs and level of independence. In addition, staff were also asked how they ensure that residents are dressed in a manner that is comfortable and appropriate for their needs, including weather-appropriate clothing. (3) out of (3) staff stated that they offer residents multiple clothing options and encourage residents to choose their preferred items when possible. Allegation: Staff mishandled a resident's personal belongings The details of the complaint alleged that facility staff did safeguard (R#1)’s personal belongings On April 11, 2026, at approximately 2:00 pm, during the records review, the department observed a copy of (R#1) client/resident personal property and valuables or LIC 621 dated 9/26/23. The department noted that (R#1) had listed on the form (4) shirts, (4) pants, (1) purse, (1) pair of glasses, (1) jacket, and (1) blanket. During the health and safety of (R#1)’s room, the department observed the items listed on the LIC 621 in (R#1)’s dresser. On April 11, 2026, during an interview with the facility administrator (A#1), (A#1) stated that the resident’s clothing was not missing. (A#1) explained that due to (R#1)’s cognitive impairment, the facility keeps additional clothing for (R#1) stored in another section of the building. (A#1) reported that staff maintain a rotation system in which a portion of (R#1)’s clean clothing is placed into (R#1)’s chest of drawers and closet, and once those items are used, staff replenish the drawers and closet with more clean clothing from the stored supply. In addition, when asked how the facility ensures residents consistently have access to their personal clothing and how staff maintain accountability for resident property, (A#1) stated that (R#1) has a chest of drawers and a closet inside the resident room. Evaluation Report continues LIC 9099-C This report supersedes the report created 4/11/26 and the findings will remain unchanged. (A#1) further stated that staff are responsible for placing an adequate amount of clothing in these areas and refilling them as needed after items are worn or laundered. On April 11, 2026, during interviews with residents in care (R#1 through R#7), (7) out of (7) residents stated that had not experienced issues with personal clothing or belongings going missing. When asked, “Have you ever had any personal clothing or belongings go missing or not returned to you?” each resident responded with statements such as, “Not that I can think of.” Residents were also asked whether they felt staff keep track of their belongings and return clothing after it is washed. (7) out of (7) residents stated that they believed staff manage clothing appropriately. On April 11, 2026, during interviews with facility staff (S#1 through S#3),(3) out of (3) facility staff stated that that they follow established procedures to keep track of residents’ clothing and personal items. When asked, “What steps do you take to keep track of residents’ clothing and personal items?” staff reported that during the admission process, an inventory list is completed which documents the residents’ personal belongings, including clothing. In addition, when asked how staff handle situations where a resident’s belongings cannot be located, (3) out of (3) stated that, due to serving residents with cognitive impairment, the facility often keeps residents’ clothing in the laundry room to ensure clothing does not become misplaced. Staff reported that when a resident needs clothing, they provide the items directly from the supply kept in the laundry area. During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Susan Caccam/ Facility Administrator.the state’s words, verbatim · CDSS document, Apr 12, 2026 · control 08-AS-20250910102455

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Apr 24, 2026

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement was not met as evidence by: Based on observations and interview, the licensee failed to ensure resident’s rooms are clean and sanitary, the department observed stains on carpeting and trash on it. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 12, 2026

Plan of correction: Licensee will adhere to Title 22 at all times. As plan of correction, the licensee will increase housekeeping rounds in the residents rooms until they change the carpet for vinyl floors. A proof of correction will be sent to LPA Iniguez via email before POC due date.

Allegation investigated: Staff do not provide activities to residents.

On 4/12/2026, LPA Alfonso Iniguez conducted an unannounced initial complaint visit. LPA Iniguez met with Susan Caccam/Facility Administrator. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: the department conducted the following interviews: Facility Administrator interview (A#1). The department gathered the following documents: copy of personnel schedule dated 4/6/26, copy of resident roster dated:4/6/26, and copy of facility activities calendar from November 2025 to April 2026 and copies of (15) residents's Medical Assessment for Residential Care Facilities for the Elderly or LIC 602A, various dates. Evaluation Report continues LIC 9099-C Substantiated Investigation Revealed the Following: Allegation: Staff do not provide activities to residents. The details of the complaint alleged that facility does not provide activities that offer cognitive stimulation for residents in care. On April 12, 2026, at approximately 10:00 a.m., during the records review process, the Department reviewed copies of the facility’s activity calendars from November 2025 through April 2026. The review indicated that, while the calendars included routine social, recreational, and physical activities, they did not comply with all the elements required under Title 22, Section 87219. Specifically, the calendars did not show activities related to daily-living skills training, sensory-based programs, resident participation in the planning or evaluation of activities, utilization of community resources, or dedicated free-time periods that allow residents to choose activities independently. In addition, the department reviewed copies of the Medical Assessment for Residential Care Facilities for the Elderly or LIC 602A, dated variously, and noted that (15) has cognitive impairment. These missing activities are particularly significant as they are specifically designed to improve the quality of life of the (15) residents with cognitive impairment currently living at the facility, supporting their independence, engagement, and overall, well-being. On April 11, 2026, during an interview with the facility administrator (A#1), (A#1) stated that that (15) residents at the facility have a cognitive impairment and are dependent on facility staff for all aspects of care, supervision, and stimulation. During this investigation, LPA found sufficient evidence to support the above-mentioned allegation. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D). An exit interview was conducted, and a copy of the Complaint Report was given to Susan Caccam/Facility Administrator.the state’s words, verbatim · CDSS document, Apr 12, 2026 · control 08-AS-20250707092727

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(a)(b)(c) · Plan of correction due date: Apr 27, 2026

87219 Planned Activities (a)(b)(c) Residents shall be encouraged to maintain and develop their quality of life through participation in a variety of planned activities. The activities made available shall include… This requirement was not met as evidence by: Based on observations, interviews, and record review, the licensee failed to ensure that the facility’s activity calendars from November 2025 through April 2026 included all required planned activities for the (15) residents with cognitive impairment. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 12, 2026

Plan of correction: Licensee will adhere to Title 22 at all times. As a plan of correction, the licensee will add to the activities calendar the missing areas focused on increasing engagement with residents with cognitive impairments. Proof of correction will be emailed to LPA Iniguez before the POC due date.

Allegation investigated: Staff did not provide a healthful accommodation to the residents

On 4/11/2026, at approximately 8:30 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Susan Caccam/Facility Administrator. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: conducting a health and safety check of the facility, including a random selection of ten (10) residents’ rooms. Evaluation Report continues LIC 9099-C Substantiated Investigation Revealed the Following: Allegation: Staff did not provide a healthful accommodation to the residents The details of the complaint alleged that facility was not clean and sanitary On April 7, 2026, at approximately 9:00 a.m., during a health and safety inspection of the facility, the Department conducted a random check of ten (10) resident rooms. The Department observed that (10) out of (10) rooms had carpet stains and trash scattered throughout. During this investigation, LPA found sufficient evidence to support the above-mentioned allegation. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D). An exit interview was conducted, and a copy of the Complaint Report was given to Susan Caccam/Facility Administrator. Investigation Revealed the Following: Allegation: Staff did not properly groom a resident The details of the complaint alleged that facility staff did not properly dress (R#1) with the appropriate clothes On April 7, 2026, at approximately 10:00 am, during an interview with (R#1), the Department observed that (R#1) was dressed in clean clothing appropriate for the day’s weather. The Department asked (R#1) who selected the clothing they were wearing, and (R#1) stated that they chose the clothing themselves. On April 11, during an interview with the facility administrator (A#1), (A#1) stated that facility staff are trained to select appropriate clothing for residents based on current weather conditions. (A#1) further stated that when residents have the ability to choose their own clothing, staff allow them to do so while providing guidance as needed. In addition, (A#1) was also asked about the systems in place to ensure residents have access to their personal clothing and that staff utilize clothing provided by family members. (A#1) stated that each resident has their own closet where personal clothing is stored. According to (A#1), facility staff place clean clothing in the residents’ closets after laundering to ensure items are available and accessible. On April 11, during interviews with residents in care (R#1 through R#7), residents were asked whether staff assist them regularly with grooming, including dressing, brushing hair, and bathing, and whether the assistance is appropriate for their needs. Evaluation Report continues LIC 9099-C (3) out of (7) Residents stated that they perform their own dressing and grooming; however, they observed that staff assist other residents who require help. In addition, residents were also asked if they had ever been dressed in clothing that felt uncomfortable or inappropriate for the weather. (7) out of (7) residents stated that they had no concerns and that everything was appropriate. On April 11, 2026, during interviews with facility staff (S#1 through S#3),(3) out of (3) facility staff stated that they assist residents with showers, changing clothes, and escorting residents to the dining room as part of their grooming and dressing responsibilities. Staff reported that the level of assistance provided varies depending on each resident’s needs and level of independence. In addition, staff were also asked how they ensure that residents are dressed in a manner that is comfortable and appropriate for their needs, including weather-appropriate clothing. (3) out of (3) staff stated that they offer residents multiple clothing options and encourage residents to choose their preferred items when possible. Allegation: Staff mishandled a resident's personal belongings The details of the complaint alleged that facility staff did safeguard (R#1)’s personal belongings On April 7, 2026, at approximately 2:00 pm, during the records review, the department observed a copy of (R#1) client/resident personal property and valuables or LIC 621 dated 9/26/23. Evaluation Report continues LIC 9099-C The department noted that (R#1) had listed on the form (4) shirts, (4) pants, (1) purse, (1) pair of glasses, (1) jacket, and (1) blanket. During the health and safety of (R#1)’s room, the department observed the items listed on the LIC 621 in (R#1)’s dresser. On April 11, during an interview with the facility administrator (A#1), (A#1) stated that the resident’s clothing was not missing. (A#1) explained that due to (R#1)’s cognitive impairment, the facility keeps additional clothing for (R#1) stored in another section of the building. (A#1) reported that staff maintain a rotation system in which a portion of (R#1)’s clean clothing is placed into (R#1)’s chest of drawers and closet, and once those items are used, staff replenish the drawers and closet with more clean clothing from the stored supply. In addition, when asked how the facility ensures residents consistently have access to their personal clothing and how staff maintain accountability for resident property, (A#1) stated that (R#1) has a chest of drawers and a closet inside the resident room. (A#1) further stated that staff are responsible for placing an adequate amount of clothing in these areas and refilling them as needed after items are worn or laundered. On April 11, during interviews with residents in care (R#1 through R#7), (7) out of (7) residents stated that had not experienced issues with personal clothing or belongings going missing. When asked, “Have you ever had any personal clothing or belongings go missing or not returned to you?” each resident responded with statements such as, “Not that I can think of.” Residents were also asked whether they felt staff keep track of their belongings and return clothing after it is washed. (7) out of (7) residents stated that they believed staff manage clothing appropriately. Evaluation Report continues LIC 9099-C On April 11, 2026, during interviews with facility staff (S#1 through S#3),(3) out of (3) facility staff stated that that they follow established procedures to keep track of residents’ clothing and personal items. When asked, “What steps do you take to keep track of residents’ clothing and personal items?” staff reported that during the admission process, an inventory list is completed which documents the residents’ personal belongings, including clothing. In addition, when asked how staff handle situations where a resident’s belongings cannot be located, (3) out of (3) stated that, due to serving residents with cognitive impairment, the facility often keeps residents’ clothing in the laundry room to ensure clothing does not become misplaced. Staff reported that when a resident needs clothing, they provide the items directly from the supply kept in the laundry area. During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Susan Caccam/ Facility Administrator.the state’s words, verbatim · CDSS document, Apr 11, 2026 · control 08-AS-20250910102455

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87304(a) · Plan of correction due date: Apr 24, 2026

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services... This requirement was not met as evidence by: Based on observations and interview, the licensee failed to ensure resident’s rooms are clean and sanitary, the department observed stains on carpeting and trash on it. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 11, 2026

Plan of correction: Licensee will adhere to Title 22 at all times. As plan of correction, the licensee will increase housekeeping rounds in the residents rooms until they change the carpet for vinyl floors. A proof of correction will be sent to LPA Iniguez via email before POC due date.

Allegation investigated: Neglect/lack of supervision resulting in a burn. Neglect resulting in a resident being drugged. Staff did not assist resident with medication. Staff did not treat resident with dignity. Staff did not provide food of good quality.

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to deliver findings regarding the above mentioned allegations. LPA identified themselves and met with Administrator Susan Caccam to discuss the purpose of the visit and elements of the complaint. On 07/11/2023, it was alleged that neglect/lack of supervision resulted in a burn, neglect resulted in a resident being drugged, staff did not assist resident with medication, staff did not treat resident with dignity, and staff did not provide food of good quality. The department's investigation consisted of interviews and records review. Regarding the allegation that neglect/lack of supervision resulted in a burn, the resident(R1), stated that they woke up to a burn on their nose. R1 stated that they did not feel anything throughout the night and reported it to staff. (Cont. on LIC 9099-C) Unsubstantiated (Cont. from LIC 9099) Interviews with staff reported that they could not recall the resident ever sustaining an injury of this nature and stated that the resident did not report a burn or similar injury to them at the time. Records review of a photograph provided to the department showed a small mark on the top of R1’s nose that appeared consistent with a mole, however, the image was not clear enough to determine whether the mark was a burn or another type of skin irregularity. No evidence corroborates that R1 sustained a burn due to neglect/lack of supervision. Regarding the allegation that neglect resulted in a resident being drugged, R1 stated that the facility cook placed laxatives in R1’s food, though R1 could not recall the date and believed this occurred because the cook did not like R1. R1 also stated that on a separate occasion an unknown staff member put something in R1’s food that caused R1 to “pass out,” and believed the food had been drugged based on similar experiences at a previous facility. Interviews with staff did not corroborate the allegation, as staff stated that medications are never added to meals and that no staff were observed engaging in inappropriate food handling. Interviews reported that they believed R1 did not prefer specific staff members to prepare meals for R1, and that R1 may have disliked certain staff members. Staff stated that no residents, including R1, reported food tampering after meals, and that any adverse reactions would have been coincidental rather than the result of intentional actions by staff. Regarding the allegation that staff did not provide food of good quality, R1 stated that on one occasion, a hamburger patty appeared undercooked and that the cook served a burned grilled-cheese sandwich to another resident. Staff reported no complaints of undercooked or burned food from other residents, and stated that residents are always able to request preferred meals directly from the kitchen and are not required to eat only what is on the menu. Staff further reported that the kitchen makes efforts to adjust or substitute meals whenever possible to accommodate resident preferences. Resident interviews consistently stated that the food quality was acceptable, that meals were not undercooked or burned, and that they were able to request alternative meals from the kitchen when preferred. (Cont. on LIC 9099-C pg. 1) (Cont. from LIC 9099-C) Regarding the allegation that staff did not assist R1 with medication, interviews did not corroborate the allegation, as staff stated that medications were sometimes delayed only when R1 returned late from outings, but otherwise the resident routinely requested medications and declined to sign medication logs when offered. Interviews with residents reported receiving their medications consistently and did not experience any missed or withheld doses. Records review of R1's Physician’s Report (LIC 602) revealed that R1 is permitted to leave the facility unassisted and is able to manage their own medications, including administering and storing medications independently. Review of R1's medication list signed off by a physician revealed that multiple medications were authorized for R1 to self-administer. Regarding the allegation that staff did not treat R1 with dignity, R1 stated that staff made racial and demeaning comments, but R1 could not provide specific statements made by staff. R1 stated that staff had called law enforcement and told them that R1 had several diagnoses. Interviews with staff stated they did not recall any incidents in which police were called regarding R1 and reported that they had not observed any staff speaking to the resident disrespectfully or inappropriately. Records review of R1’s Individual Service Plan indicated that R1 is moderately impaired, is usually unable to make independent decisions, and has judgment that is frequently impaired, requiring cues and supervision for daily functioning. Based on interviews and records review, the department has determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator Susan Caccam, whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Feb 26, 2026 · control 08-AS-20230711162806

Allegation investigated: Staff did not follow reporting requirements.

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced visit to deliver findings regarding the above mentioned allegation. LPA identified themselves and met with Administrator Susan Caccam to discuss the purpose of the visit and elements of the complaint. Regarding the allegation of staff did not follow reporting requirements, an incident was reported to a lead staff but was not reported to licensing.The incident was regarding a staff member(S1) that walked in on a resident (R1) doing something inappropriate with their roommate (R2). The department has not received any report regarding this incident and the facility is not able to provide a report stating that it was sent to Licensing. Based on interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099D. Substantiated (Cont. from LIC-9099) On the evening of August 26th, 2024, R1 was found lying next to R2 in R2s single bed. Interviews conducted with witnesses, S2 reported that S2 walked in on R2 and R1 without their briefs on, lying next to each other. S2 called caregiver, S1 for assistance. Staff, S1, S2, S3 revealed that R2 did not have the capacity to remove his/her own briefs, therefore, suspecting that it was R1 that removed it. However, other staff (S4 & S5) reported that R2 had a history of randomly removing his/her own briefs. S1 & S2 denied they saw something happened between the residents. S1 and S2 reported the incident to the lead staff, S4. Interviews with S1, S2 and S4 confirmed that R1 was removed from sharing the same room with R2 to prevent another incident. All staff reported that R1 did not have a history of sexually assaulting R2 or other residents. Furthermore, all staff interviews reported that, specifically for R1 and R2, checking on them every 30 minutes to bihourly suffices as there were no history of sexual or suspicious activity between the two. R1 & R2 were also interviewed, and both could not recall the incident and could not provide relevant statements due to neurocognitive condition. Other residents R3 & R4 and both denied having experienced any sexual abuse from staff or residents. All residents reported feeling safe and did not express concerns about staff supervision. For the allegation of staff did not follow COVID-19 protocols, RP was alleging that staff were forced to come to work even though, they were positive. During the interviews, staff mentioned that any staff that tested positive is to isolate for 5 days or more depending on the symptoms. No staff was forced to work if they tested positive. S7 mentioned that agency caregivers were hired so that there is coverage in the facility. (Cont. on LIC-9099-C pg, 1) (Cont. from LIC 9099-C) Regarding the allegation of staff did not seek medical attention for resident (R3), RP stated that R3 reported he/she was not feeling well and asked to go to the hospital, Administrator told R3 a mobile doctor would be coming in to check, but that did not happen. Based on staff interviews, R3 did not request any transport to go to the hospital, nor any resident during this time. It was alleged that Staff did not keep the facility clean, RP stated that facility floors are often dirty, housekeeping and maintenance do not work on the weekends. Facility provided records showing that an outside agency is hired to keep the facility clean when there is no staff available. S6 stated that the facility is always kept clean. For the allegation of Staff did not keep facility equipment clean, RP stated that the water container was not cleaned regularly. Staff mentioned that kitchen staff regularly clean the equipment and puts fresh water every day. Regarding the allegation of Staff did not provide adequate food service, RP stated that food provided to residents was not in the menu. The food would sometimes change from what was on the menu. S6 stated that they try to stick as much as possible on the menu but if anything doesn't get delivered on time then they have to substitute. LPA reviewed the menu, and it showed a variety of dishes served. Also, annual visits done by the department show that the facility always has 2 days’ perishable and 7 days non-perishable food supply available. (Cont. on LIC-9099-C pg. 2) (Cont. from LIC 9099-C pg. 1) For the allegation of Staff mismanaged a resident's medication, RP stated that on multiple occasions medications was seen in R5s room. According to staff members, all medications are centrally stored. There are no medications in residents bedrooms, and no concerns of staff mismanaging residents medication. Based on interviews and records review, the department has determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator Susan Caccam, whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Feb 26, 2026 · control 08-AS-20240926131110

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211 · Plan of correction due date: Mar 20, 2026

(a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to.. of a resident by staff or other residents, or unexplained absence of any resident. This was not met as evidenced by: Based on interviews and records review, Licensee did not submit any incident report regarding S1 walking in on R1 and doing something inappropriate with R2, which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 26, 2026

Plan of correction: Licensee to submit proof of reporting requirments in-service training sign-in sheet with training topic clearly noted for all staff to LPA via email by 03/20/2026.

Allegation investigated: Unlawful Eviction

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced visit for a complaint investigation and delivered findings regarding the above mentioned allegation. LPA was welcomed by, identified themselves to, and discussed the purpose of their visit to Activities Director Gabriela Ortiz. Administrator Susan Caccam arrived later during the visit. On 10/08/2025, the Department received a complaint where it was alleged that the facility issued a 30-day notice to a resident, identified as R1, for the reason of failure to comply with house rules. Additionally, the complaint alleges the eviction also listed supplemental reasons for eviction as R1's inability to operate their wheelchair and leaving a hospital stay early. The Department’s investigation consisted of unannounced facility visits, records review, and interviews with staff, residents, and outside sources. [Continued on LIC 9099-C] Substantiated [Continued from LIC 9099] R1 is a non-ambulatory resident at the facility who utilizes a motorized wheelchair. Per R1's physician's report, they are able to leave the facility unassisted and have no diagnosis of Mild Cognitive Impairment (MCI) or Dementia. On 10/7/25 the facility issued a 30-day notice to R1, and a copy was shared to the Department. Per review of the notice, it was discovered that the a phone number on the notice for appeals information was incorrect. LPA informed the facility of the technicality and that the notice was now invalid. On 11/10/25, the facility issued a new and corrected 30-day notice to R1, the reasons remaining the same: 1. Failure to comply with the house rules and policies of the facility 2. Engaging in behavior which is a threat to the mental and/or physical safety of others in the facility 3. Noncompliant with recommended medical treatment 4. Methamphetamine abuse per discharge papers for a hospital stay in September 2025 5. Suspected camera in R1's room 6. Resident cannot operate well in their electric wheelchair. Per the notice, sections 11 (house rules/policies) and 20 (conditions for eviction) of R1's admissions agreement contract were specified. Review of R1's admissions agreement revealed that under section 20 (conditions for eviction), subsection (D)(1): " The reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons." Additionally, under section 11 (house rules/policies) it is noted that "failure to comply may result in a written warning. After sufficient warning, a notice of eviction will be given to the resident and/or responsible person." The notice itself did not supply specific incidents or information regarding the reasons for eviction. Per interview with administrative staff, it was revealed that no written documentation of incidents or previous meetings with R1 regarding their alleged misbehavior/facility concerns were held. It was revealed that verbal warnings were issued, but no documentation of such was able to be provided. An outside source interviewed revealed that they had received no supporting documentation from the facility for the reasoning for eviction. Another outside source interviewed revealed concerns that there was no substantial basis for the eviction in the first place, labeling it "suspicious." [Continued on LIC 9099-C] [Continued from LIC 9099-C] Per interviews with administrative staff, the main reasoning for the eviction was drug use, R1 leaving the facility and coming back "late at night," R1 having a camera in their room, and concerns about R1's ability to operate their wheelchair properly. Per review of medical discharge papers for R1's hospital stay in September 2025, one of the discharge diagnoses was "methamphetamine abuse." However, review of facility rules do not include anything against the use of drugs in the facility, only that smoking must be done outside the facility and in designated areas. One (1) staff member interviewed revealed that they have observed R1 smoking outdoors and down the street. Interview with R1 also corroborated that they smoke outside of the facility. In regards to coming and going from the facility, file review of R1's physician's report reveal that R1 is able to leave the facility unassisted, therefore the facility cannot necessarily restrict R1 from coming and going as they please. Additionally, staff interviews and file review of resident sign-in/out records corroborated that R1 does inform staff when they leave and that they sign out at the front desk. While multiple staff interviews corroborated that R1 does often return late at night, R1 is not disruptive when they return. However some staff interviews revealed that R1 does return appearing intoxicated at times. Several staff members interviewed revealed that R1 was in possession of the secured door code and is able to let themselves in at night, which again is not specifically outlined in the admissions agreement to be against house rules/policies. In regards to R1 having a camera in their room, again the facility rules do not include rules or policies regarding a resident setting a personal camera in their room. Staff interviews revealed concern for the privacy of R1's roommate. Interview with R1's roommate revealed that they were alright with the presence of the camera so long they were not included in the frame. Interview with R1 revealed the camera only records video and not audio, thus complying with applicable California State laws. Additionally, a notice was placed outside R1's room, providing notice of recording in progress inside. [Continued on LIC 9099-C] [Continued from LIC 9099-C] Regarding concerns with R1's ability to utilize their wheelchair, per R1's admissions agreement, all residents with motorized wheelchairs must have a doctor's note certifying the resident can operate it safely. Administrative staff confirmed R1 had a doctors note certifying approval upon move in. Staff interviews revealed mixed sentiments regarding R1's wheelchair use. While most acknowledged R1 has bumped and scraped doorways and corners with their wheelchair, two (2) stated that damages were not done on purpose, mentioning that R1 does try to be careful but that their wheelchair is wide, leading to occasional scrapes when navigating. Another two (2) staff interviewed revealed they believed the damages to be attributed to R1 being intoxicated and thus unable to steer correctly. File review of photos documented by the facility of property damage depict horizontal scrapes/markings on the lower half of R1's unit door. One additional photo of the exit door near R1's room also to have several scrapes, less in amount than shown on R1's door. Based on LPA's review of records, interviews with staff, residents, and outside sources, the preponderance of evidence standard has been met, therefore the above allegation of unlawful eviction is found to be SUBSTANTIATED. A deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached 9099D. An exit interview was conducted with Administrator Caccam to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Dec 4, 2025 · control 08-AS-20251008141157

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Dec 24, 2025

87224(a): "The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5).Thirty (30) days written notice to the resident is required [...]" This requirement was not met as evidenced by: Based on records review and interviews the licensee did not comply with the section cited above as R1 was not issued a lawful eviction notice which posed a potential personal rights risk to one (1) out of thirty-seven (37) residents in care.the state’s words, verbatim · CDSS document, Dec 4, 2025

Plan of correction: Licensee agreed to conduct training/review with staff on eviction procedures and submit proof to LPA by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to follow up on an incident reported to Community Care Licensing. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Activities Director Gabriela Ortiz. Community Care Licensing received an Incident Report on 8/14/25 in which it was reported that staff responded to a call for help and found Resident #1 (R1) on the floor. Per the report, R1 stated they tried to pick up their phone from the floor and fell, sustaining a scratch to the head. R1 was assisted back into bed by staff and PRN (as needed) medications were administered per resident request for pain. Later that night, R1 reported severe pain in their hip and staff contacted emergency services who transported R1 to the hospital where they were treated for a hip fracture. R1's Responsible Party and Primary Care Physician (PCP) were notified. During today's visit, LPA conducted interviews, file review, a health and safety visit with R1, and consultation with Activities Director Ortiz. No Deficiencies were cited during the visit. An exit interview was conducted with Activities Director Ortiz to whom a copy of this report was provided. Their signature below confirms receipt of this document.the state’s words, verbatim · CDSS document, Sep 19, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to follow up on an incident reported to Community Care Licensing. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Activities Director Gabriela Ortiz. Community Care Licensing received an Incident Report on 9/17/25 in which it was reported that Resident #1 (R1) had eloped from the facility and was found by a passerby down the road outside the community. Per the report, staff had observed R1 to be anxious and repeatedly attempting to leave the facility during that evening. Staff redirected resident back to their room and approximately 30 minutes later, staff received a call from R1's responsible party stating R1 was found along the street. The passerby had contacted emergency services and R1 was taken to the hospital and returned the same night to the facility. Per review of security cameras, R1 had eloped from an exterior door leading to the trash bins. The report states that staff did not hear the door alarm. R1's Responsible Party and Primary Care Physician (PCP) were notified. During today's visit, LPA conducted interviews, file review, a health and safety visit with R1, and consultation with Activities Director Ortiz. Activities Director Ortiz informed LPA that the facility implemented increased status checks for R1 and also that the facility was planning to conduct an in-service staff training to ensure a similar incident does not occur in the future. One Deficiency was cited during the visit for lack of secured perimeter resulting in resident elopement. An exit interview was conducted with Activities Director Ortiz to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Sep 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(d) · Plan of correction due date: Oct 3, 2025

87705(d): "The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement [...]" This requirement is not met as evidenced by: Based on LPA observations and interview, the licensee did not comply with the section cited above in ensuring all exterior exit doors were secured and alarms were activated, which poses an immediatel health and safety risk to 37 out of 37 persons in care.the state’s words, verbatim · CDSS document, Sep 19, 2025

Plan of correction: Licensee will conduct an inservice training for staff on wandering and sundowning behaviors, as well as maintaining a secured perimeter and submit proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

On 9/19/25 Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to the facility. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Activities Director Gabriela Ortiz. While conducting file review of staff records, LPA noted that four (4) current staff members were not associated to the facility. Further review revealed that the three (3) of those staff members had eligible background clearances with previously conducted background checks, however their clearances were not transferred over to this facility. The remaining staff member was a new employee and had undergone a background check, however, the California Department of Social Services (CDSS) had not yet fully cleared the individual for an eligible determination. Therefore, the individual had been working at the facility without an approved background clearance, resulting in a Type A violation. Two Type A Deficiencies cited during the visit per California Code of Regulations, Title 22, Division 6 on the attached LIC 809-D. In addition, a Civil Penalty for each of the two Type A violations are being assessed for Zero Tolerance Violations regarding Criminal Record Clearances and are noted on the two (2) attached LIC 421BG forms in the combined amount of $1,900.00 Two deficiencies were cited during the visit. An exit interview was conducted with Activities Director Ortiz to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Sep 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Oct 10, 2025

87355(e)(2) "All individuals subject to a criminal record review [...] shall prior to working, residing or volunteering in a licensed facility: (2)Obtain a California clearance or a criminal record exemption as required by the Department" This requirement is not met as evidenced by: Based on LPA file review and interview, the licensee did not comply with the section cited above in ensuring that all staff, prior to employment, have obtained a criminal background check which poses an immediate health and safety risk to 37 out of 37 persons in care.the state’s words, verbatim · CDSS document, Sep 19, 2025

Plan of correction: Licensee was informed of S1 being unable to work or be present at the facility until their criminal records clearance letter from the Department is recieved. Once obtained, Licensee will submit a copy to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(3) · Plan of correction due date: Oct 10, 2025

87355(e)(2) "All individuals subject to a criminal record review [...] shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c)" This requirment is not met as evidenced by: Based on LPA file review and interview, the licensee did not comply with the section cited above in ensuring that 3 staff did not have their clearances transfered, which poses an immediate health, safety, and personal rights risk to 37 out of 37 persons in care.the state’s words, verbatim · CDSS document, Sep 19, 2025

Plan of correction: Licensee will submit proof of S2, S3, and S4 having been associated to the facility to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Office Manager Carolina Diaz. Administrator Susan Caccam arrived later in the visit. The facility is approved for a capacity of forty-five (45) non-ambulatory residents, all of which may be bedridden. The facility also has a hospice waiver for twenty (20). During today’s inspection there were thirty (30) residents in care. LPA and Administrator Caccam toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were compliant: Bathroom sink was in one client bedroom was 107F. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. [Continued on LIC 809-C] [Continued from LIC 809] No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Caccam, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed one (1) staff and (2) clients, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records. The files reviewed by LPA contained required documents, aside from two (2) staff files missing required health screenings and Tuberculosis testing. A deficiency was cited per California Code of Regulations 87411(f). Confidential records were stored in locked areas. A deficiency was cited during the inspection. An exit interview was conducted with Administrator Caccam to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Apr 29, 2025

Allegation investigated: Staff did not assist resident with incontinence care

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced complaint investigation visit to deliver findings. The LPA introduced himself and disclosed the purpose of visit to Administrator Susan Caccam. Throughout the investigation, the Department secured pertinent records and conducted interviews with external and internal sources, including staff and residents. It was alleged staff did not assist a resident with incontinence care. On September 19th, 2024, it was reported to the Department Resident #1 (R1) often had to wait thirty to forty minutes before being assisted with incontinence brief changes. During mealtimes, R1 was allegedly told R1 needed to wait until a staff was available. Review of R1’s records, including a physician’s report, preplacement appraisal, and Assisted Living Waiver (AWL) assessment, revealed R1 was diagnosed with bladder and bowel impairment. Substantiated Chronic/ intermittent diarrhea was noted in these documents. An interview with an external source revealed the concern of lack of incontinence care was discussed during resident council meetings. This source addressed this concern with management, but it was not addressed. Interviews with internal sources, including R1, revealed there were instances when R1 had to wait up to forty minutes to be assisted with brief changes. Each shift had two caregivers and one medication technician on duty. The two caregivers were assigned to respond to resident calls and assist residents with incontinence care. The medication technician was assigned to pass medications. These sources also corroborated that during mealtimes R1 had to wait until caregivers were available. Interviews revealed there were approximately six to seven residents who required assistance with feeding, which required both caregivers to assist those residents during mealtimes. Interviews consistently disclosed most of the residents in care required assistance with incontinence care. Although there were contradicting statements on if medication technicians, kitchen staff, and administrative staff assisted the caregivers, there was enough evidence to substantiate the allegation. The deficiency was cited in accordance with California Code of Regulations, Title 22, and listed on the LIC 9099D. A plan of correction was jointly formulated with Administrator Caccam. An exit interview was conducted with Administrator Caccam, to whom a copy of this report, LIC 9099D, and Licensee/Appeals Rights (LIC 9058), were provided via email. An email read receipt confirmed the documents were received by the administrator.the state’s words, verbatim · CDSS document, Feb 28, 2025 · control 08-AS-20240919132510

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87425b(3) · Plan of correction due date: Feb 28, 2025

87425 (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by: Based on review of records, the Licensee did not ensure one incontinent resident was kept clean and dry, which posed a potential health, safety, and personal rights risk to 1 of 30 persons in care.the state’s words, verbatim · CDSS document, Feb 28, 2025

Plan of correction: Administrator agreed to train all staff on managed incontinence and submit proof to the LPA by 3/28/2025.

Allegation investigated: Staff did not safeguard resident's personal belongings

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced follow up complaint investigation visit. The LPA introduced himself and discussed the purpose of the visit to Activities Director Gabriela Ortiz. Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents. It was alleged staff did not safeguard a resident's personal belongings. On August 21st, 2023, it was reported to the Department the facility did notvreturn Resident # 1 (R1)’s belongings, after R1 moved out. Some of these belongings included personal clothing items, food, personal documents, and Ambulatory Assistive Devices (ADDs). (See LIC 9099-C for continuation of report.) Unsubstantiated Interviews with several sources revealed facility staff inventoried R1’s belongings and delivered these belongings to R1. Internal and external sources confirmed R1 accepted these belongings but refused to acknowledge receipt by declining to sign the inventory sheet. A review of R1’s initial inventory sheet, and discharge inventory sheet did not note any of the reported missing items, except two (2) ADDs. During a visit to the facility, the LPA witnessed the two ADDs in question. Staff confirmed the ADDs belonged to R1. During a subsequent visit, the LPA reviewed a record confirming staff had delivered the ADDs to R1 and R1 signed accepting receipt of such items. Multiple interviews with residents revealed they did not have any concerns with personal items no being safeguarded by staff. An interview with the administrator confirmed R1’s personal belongings were packaged by staff, were delivered to R1, and R1 declined to acknowledge receipt of the belongings. The administrator did not have any knowledge of the additional missing items. There was not enough evidence to determine the facility did not safeguard R1 personal belongings, therefore, the allegation was unsubstantiated. An exit interview was conducted with Administrator Susan Caccam, to whom a copy of this report, and Licensee Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Feb 25, 2025 · control 08-AS-20230821162518

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sabel Martinez conducted a Case Management – Deficiencies visit. The LPA introduced himself and disclosed the purpose of the visit to Front Desk Manager Yasmin Perez and Activities Director Gabriela Ortiz. During a complaint investigation visit conducted on 9/26/2024, it was revealed Staff # 1 (S1) and Staff # 2 (S2) did not have approved background clearances. This was confirmed through a review of staff records and a review of the Department's Background Guardian system. This deficiency was cited in an LIC 809D form and a civil penalty of $1,000 was assessed in an LIC 421 BG form. A Plan of Correction POC was jointly formulated with Staff Perez. An exit interview was conducted with Perez and Ortiz to whom a copy of this report, a copy of the LIC 811 Confidential names list, LIC 421 BG, and Licensee Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Sep 26, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Sep 26, 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: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement was not met as evidenced by: Based on review of records, the Department's Background Guardian system, and interviews, the Licensee did not ensure S1 and S2 had criminal background clearances prior to working at the facility, which posed an immediate health, safety, and personal rights risk to 36 residents in care.the state’s words, verbatim · CDSS document, Sep 26, 2024

Plan of correction: Front desk Manager and Actitvies DIrector agreed to not have S1 and S2 work at the facility until S1 and S2 obtained California background clearances.

Allegation investigated: Wrongful Eviction.

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced complaint investigation visit to deliver findings. The LPA introduced himself and disclosed the purpose of the visit to Wellness Director Susan Caccam. Throughout the investigation, the Department secured pertinent records and conducted interviews with external and internal sources. It was alleged the facility wrongfully evicted a resident. On 06/05/2024, it was reported to the Department Resident #1 (R1) was transported to a hospital and discharged from the facility. The facility’s Regional Executive Director indicated R1 was not evicted, that R1’s responsible party/ Durable Power of Attorney (DPOA) had agreed to transfer R1 to a hospital for more aggressive treatment, as R1 was receiving hospice services. (See LIC 9099-C for continuation of report.) Substantiated The hospice agency was allegedly notified of this change in care. Interviews with said responsible party and hospice agency declined having any knowledge of R1’s transfer to a hospital, and only found out of the transfer once it had occurred. Differing statements from interviews with internal and external sources revealed R1 was R1 own responsible party, that R1 was no longer able to pay R1’s monthly fees, that R1 was transported to a hospital to be transferred to a skilled nursing facility, and that R1 was not provided a 30-day eviction notice for lack of payment. These sources also revealed R1 would be accepted back to the facility once R1 was accepted to the Assisted Living Waiver Program. Additionally, the facility was not able to produce records indicating R1 had a DPOA, nor that R1’s said responsible party had agreed for R1 to be transferred to a hospital. Based on evidence obtained, the allegation was Substantiated. The deficiency was cited in accordance with California Code of Regulations, Title 22, and listed on the LIC 9099D. A $1,000 civil penalty was assessed in an LIC 421IM form, for a repeat violation within the last twelve (12) months. A plan of correction was jointly formulated with Wellness Director Caccam. An exit interview was conducted with Caccam, to whom a copy of this report, LIC 9099D, LIC 811, LIC 421IM, and the Licensee/Appeals Rights (LIC 9058), were provided.the state’s words, verbatim · CDSS document, Jun 28, 2024 · control 08-AS-20240605121327

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Jun 28, 2024

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This requirement was not met as evidenced by: Based of interviews and review of records, the licensee did not ensure R1 was provided a 30 day written notice, which posed a potential health, safety, and personal rights risk to 1 of 38 residnets in care.the state’s words, verbatim · CDSS document, Jun 28, 2024

Plan of correction: Wellness Director agreed to have facility management staff trained in eviction procedures. This training wiill be provided by an outside vendor and documentation of training and participants will be sent to the LPA, by July 26, 2024.

Allegation investigated: Staff refused to help resident Untrained staff Staff failed to meet resident's needs

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out a complaint. LPA identified herself, was granted entry, and stated the purpose of the visit to Suzanne Caccam,Wellness Director. During the investigation, LPA toured the facility, conducted interviews and conducted a records review. It was alleged that staff refused to help resident. Interviews revealed that Resident 1 (R1) was having a difficult time breathing. Interviews revealed that R1 uses oxygen and when they sleep the oxygen canula falls out of their nose. R1s roommate noticed the oxygen canula falling out and watched R1 become very restless. R1 started to panic and so R1s roommate assited them with their breathing exercises and then called for staff. Interviews revealed that once staff was called and they came into the room, they called 911 for R1 and they went to the hospital. Staff acted promptly in getting assistance for R1 once they were made aware of the incident. Interviews did not reveal any evidence of staff refusing to help resident. Unsubstantiated It was alleged that there are untrained staff. Interviews with staff revealed that staff are trained at the time of hire and throughout the year on various topics. LPAs observations revealed proof of training's for the staff that are employed at the facility. Interviews did not reveal any evidence of the facility having untrained staff. It was alleged that staff failed to meet resident's needs. Interviews with staff revealed that the staff conduct rounds and check on the residents. Interviews also revealed the staff meet the residents needs when the residents request help they assist them. The staff assist them with medications, meals, toileting and activities of daily living. Interviews with staff revealed them denying them failing to meet the residents needs. Interviews did not reveal any evidence of staff failed to meet resident's needs. Based on the evidence obtained from the investigation, the above-mentioned allegations are unsubstantiated. An exit interview was conducted with Suzanne Caccam, Wellness Director and a copy of this report and Licensee Rights (LIC 9058 03/22) was provided at the end of the visit.the state’s words, verbatim · CDSS document, May 15, 2024 · control 08-AS-20230522144419

Allegation investigated: Staff did not meet resident’s dietary needs resulting in weight loss Resident was not assisted with getting in and out of bed Staff overmedicated resident Resident sustained an unexplained injury while in care Staff did not safe guard resident belongings

Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by Susan Caccam, Wellness Director. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Wellness Director. On October 17, 2023, the Department received a complaint regarding the following allegations: Staff did not meet resident's dietary needs resulting in weight loss, Resident was not assisted with getting in and out of bed, Staff overmedicated resident, Staff did not safeguard resident personal belongings, and Resident sustained an unexplained injury while in care. On October 19, 2023, the department conducted interviews with staff and residents, obtained records, and conducted a tour of the facility. Continuted on 9099C Unsubstantiated Resident 1 (R1) stated that they eat food in smaller portions and have not experienced any weight loss due to dietary negligence. The staff stated that R1 was on a liquid diet before living at the facility. LPA reviewed the physician's report that supports the dietary needs of the resident as "on a fortified diet with thin liquids for aspiration risks." Allegation 2: Resident was not assisted with getting in and out of bed. R1 expressed like to try to do it on their own and admitted to needing assistance but do not like to wait for staff. Allegation 3: Staff over medicated resident. Resident 1 denied being over medicated by the staff during the investigation. Medications are being administered as per the prescribed schedule. Allegation 4. Staff did not safeguard residents' personal belongings. Resident 1 confirmed that their glasses and cell phone were missing. Staff stated that R1 had broken their glasses and was waiting for the in-house Optometrist to prescribe new prescription for glasses and that R1 did not have a cell phone at the time of admission to the facility. A review of the LIC 621 indicated that R1 had 1 blue suitcase and declined to write the personal property inside. When LPA toured inside R1's room, 1 blue suitcase and clothing were inside the closet which coincided with the LIC621. Allegation 5. Resident sustained an injury while in care. Resident 1 mentioned that they sustained an injury due to falling when they attempted to get out of bed without assistance. R2 confirmed the fall by R1 and they called for assistance to help R1 when they fell. Based on the findings of the investigation, it is determined that the allegations against Avantgarde Senior Living of La Jolla: Staff did not meet resident's dietary needs resulting in weight loss, Resident was not assisted with getting in and out of bed, Staff over medicated resident, Staff did not safeguard resident personal belongings, and Resident sustained an unexplained injury while in care are Unsubstantiated. An unsubstantiated finding means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report along with the Licensee Rights (LIC 9058) was provided to the Wellness Director. Her signature on this form confirms receipt of the documents.the state’s words, verbatim · CDSS document, May 15, 2024 · control 08-AS-20231017141017

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Continuation Annual Inspection. The LPA identified himself to, and discussed the purpose of the visit with Office Manager Yasmin Perez. Wellness Director Susan Caccam arrived during the visit and assisted the LPA. The facility was licensed for a capacity of forty-five (45), of which all may be bedridden. The facility was also approved for delayed egress, and a hospice waiver for twenty (20). During the inspection the LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, and stored in a locked area. No pools or bodies of water were observed on the premises. Per staff, no firearms or ammunition were kept at the facility. Carbon monoxide detectors, facility telephone and a fire extinguisher were in working order. The LPA interviewed staff and reviewed multiple staff and client records/files. No deficiencies were cited during today's annual inspection. An exit interview was conducted with Wellness Director Caccam, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.the state’s words, verbatim · CDSS document, May 2, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced visit to initiate a Required Annual Inspection. The facility file was reviewed prior to the visit. The LPA introduced himself and disclosed the purpose of the visit to Wellness Director Susan Caccam. During today’s visit, The LPA toured the facility, and conducted several interviews. No deficiencies were cited during today’s visit. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection. An exit interview was conducted with Wellness Director Caccam, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were providedthe state’s words, verbatim · CDSS document, Apr 30, 2024

Allegation investigated: Licensee did not provide resident records to resident's authrorized representative.

Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to conduct an investigation into the above listed complaint allegation. LPA introduced herself, was granted entry into the facility, and met with Susan Caccam, Wellness Director, to whom LPA disclosed the reason for the visit. The facility's Regional Executive Administrator, Carolina Trejo, was contacted via telephone. It was alleged that a former resident’s, Resident 1 (R1) [LIC 811 Confidential Names List was provided to identity the resident], family requested copies of records maintained by the facility that relate to the resident; however, the licensee has not provided the requested records. Community Care Licensing (CCL) has investigated the above listed allegation. The investigation consisted of a tour of the facility, review of records, and interviews of facility staff. The investigation yielded that R1’s identified responsible party submitted a request, dated September 12, 2023, through a representative acting Substantiated on behalf of R1’s family, for copies of records maintained by the facility relative to R1. R1’s responsible party signed an Authorization to Release Information, dated August 30, 2023, which was submitted to the facility along with the written request for copies of R1’s records. The investigation revealed that the request was received by the facility on September 15, 2023, and the licensee was made aware at that time. As of the time of today’s visit, no evidence is maintained or has been provided to conclude that the requested records have been provided to R1’s responsible party. Accordingly, the allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. Deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D. An exit interview was conducted with Susan Caccam, Wellness Director, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to her at the conclusion of the visit. Susan Caccam’s signature on this report confirms receipt.the state’s words, verbatim · CDSS document, Dec 4, 2023 · control 08-AS-20231128125950

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(c)(1) · Plan of correction due date: Dec 11, 2023

The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This req't was not met as evidenced by: Based on interviews and records review, licensee did not provide resident records to responsible party of 1 of 35 residents, which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 4, 2023

Plan of correction: Wellness Director offered to ensure that all requested records that are maintained by the facility and are responsive to the request are provided to R1's responsible party/representative by the POC due date. Proof of correction will be provided to Community Care Licensing by the POC due date of 12/11/2023.