Braswell's Chateau Villa

Allegation investigated: Staff did not safeguard residents personal property Staff are not allowing residents to have visitors

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Melanie Niez, and discussed the purpose of the visit. Regarding Allegation #1: Staff did not safeguard residents’ personal property. Interviews with staff indicate that the personal item in question did not belong to Resident #1 (R1) but instead belonged to R1’s former roommate. The roommate was relocated from the facility on 03/01/2025, and all belongings were collected at the time of discharge. LPA interviewed four (4) staff members, all of whom stated that residents’ personal belongings are safeguarded. LPA also interviewed five (5) residents, all of whom reported that their belongings are safeguarded from staff. Unsubstantiated Regarding Allegation #2: Staff are not allowing residents to have visitors. Staff interviews and record review reveal that Resident #2 (R2) has visitation restrictions imposed by their conservator. LPA interviewed five (5) staff members, all of whom stated that residents are not restricted from receiving visitors unless such restrictions are specified through a court order. LPA also interviewed five (5) residents, all of whom stated they have not been restricted from receiving visitors and have no knowledge of other residents being denied visitation. Based on observation, record review, and interviews; there is insufficient evidence to prove the alleged allegations did or did not occur. Therefore, the allegation above are Unsubstantiated. An Unsubstantiated complaint means, that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with Administrator Melanie Niez and a copy of this report was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 14, 2026 · control 56-AS-20260512103456

Allegation investigated: Staff did not prevent resident from developing pressure injuries while in care Staff did not ensure residents’ incontinence needs are met. Staff are "double diapering" residents. Staff did not ensure to provide resident with medical care. Resident room is malodorous. Staff do not ensure that the facility is maintained in good repair. Staff did not ensure that resident's hygiene needs were met.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Melanie Niez, and discussed the purpose of the visit. Regarding Allegation #1: Staff did not prevent a resident from developing pressure injuries while in care.Interviews with staff indicate that Resident #1 (R1) did not have any open pressure injuries but instead has a pre-existing skin condition. Interviews with an additional three (3) staff members confirm that R1 is routinely monitored and repositioned to prevent pressure injuries. Staff also reported that when a resident shows signs of early-stage pressure injuries, medication technicians (med techs) are notified and appropriate procedures are followed. LPA interviewed four (4) residents, all of whom stated that staff take measures to prevent residents from developing pressure injuries. Unsubstantiated Regarding Allegation #2: Staff did not ensure residents’ incontinence needs are met. LPA conducted interviews with four (4) staff members, all of whom stated that residents’ incontinence needs are being met. Staff reported that residents requiring incontinence care are checked every two (2) hours, and often more frequently as needed. LPA also interviewed six (6) residents. Three (3) of the six (6) stated that staff adequately ensure their incontinence needs are met, while the remaining three (3) reported that they do not require assistance with incontinence care. Regarding Allegation #3: Staff are “double diapering” residents. LPA interviewed four (4) staff members. Two (2) staff stated that residents are not permitted to be double diapered and confirmed that this practice is not occurring. The remaining two (2) staff reported having observed instances of residents being double diapered; however, one (1) of these staff members stated that after reporting the issue, the practice ceased. LPA also interviewed six (6) residents. Three (3) of the six (6) reported that they do not require diapers, while the other three (3) stated they have not are not double diapered. Regarding allegation #4, Staff did not ensure to provide resident with medical care. LPA conducted interviews with four (4) staff all of whom state the residents are provided with medical care. LPA conducted interviews with four (4) residents all of whom state staff provide them with medical care if needed. Regarding Allegation #5: A resident’s room is malodorous. An interview with the Administrator revealed that Resident #1 (R1) previously shared the room with a roommate who had significant incontinence needs. R1 has since been relocated, and during the LPA’s observation, the room was found to be free of odors. LPA interviewed an additional three (3) staff members; two (2) reported that they take all necessary measures to prevent rooms from becoming malodorous, while one (1) staff member stated that some rooms do remain malodorous at times. LPA also interviewed four (4) residents. Three (3) residents stated that staff make efforts to prevent rooms from smelling malodorous, while one (1) resident reported that rooms continue to have unpleasant odors. Regarding Allegation #6: Staff do not ensure that the facility is maintained in good repair. LPA interviewed four (4) staff members, all of whom stated that the facility is maintained in good repair. LPA also interviewed six (6) residents, all of whom reported that the facility is consistently being maintained and kept in good repair. Regarding Allegation #7: Staff did not ensure that residents’ hygiene needs were met. LPA interviewed four (4) staff members, all of whom stated that residents’ hygiene needs are being met. LPA also interviewed six (6) residents. Three (3) of the six (6) reported that they do not require assistance with hygiene, two (2) residents stated that staff adequately meet their hygiene needs, while one (1) resident states their hygiene needs are not being met. Based on observation, record review, and interviews; there is insufficient evidence to prove the alleged allegations did or did not occur. Therefore, the allegations above are Unsubstantiated. An Unsubstantiated complaint means, that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with Administrator Melanie Niez and a copy of this report with Appeal Rights was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 14, 2026 · control 56-AS-20250924091624

Allegation investigated: Facility staff is having resident open up mail in front of them Facility staff is making copies of residents mail Facility staff are not properly addressing bed bugs in the facility

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Melanie Niez and explained the purpose of the visit regarding the allegations stated above. First allegation: Facility staff is having resident open up mail in front of them. Regarding the allegation stated above, LPA conducted an interview with Resident #1 regarding the alleged allegation Resident #1 informed LPA that facility staff was having all residents make copies of a social security letter. Resident #1 further explained that when staff asked Resident #1 that a copy of residents Cost of Living Adjustment (COLA), needs to be placed on file Resident #1 refused. Resident #1 informed LPA that staff did not open or make copies of resident’s mail after residents’ refusal. LPA conducted an interview with Staff #1 and Staff #2 regarding the alleged allegation Staff #1-2 informed LPA that staff were not opening residents mail or making copies of resident’s mail without residents’ consent. Unsubstantiated Staff #1 and Staff #2 informed LPA that all residents under programs such as ALW and InnoVage/Pace were sent a Notice of Cost-of-Living Adjustment (COLA) form which facility was responsible to make copies of the adjustment form and send each form to accounting so that accounting can follow the financial guidelines and process each Notice according to State Programs. Staff #1 and Staff #2 informed LPA that notices to all residents and residents responsible party were sent informing every resident about the collecting of the Notice of Cost-of-Living Adjustment. Staff #1 and Staff #2 informed LPA that mail was not being opened or made copies without the residents’ knowledge and approval. Second allegation: Facility staff is making copies of residents mail. Regarding the allegation stated above, LPA conducted an interview with Resident #1 regarding the alleged allegation Resident #1 informed LPA that facility staff was having all residents make copies of a social security letter. Resident #1 further explained that when staff asked Resident #1 that a copy of residents Cost of Living Adjustment (COLA), needs to be placed on file Resident #1 refused. Resident #1 informed LPA that staff did not make copies of resident’s mail after residents’ refusal. LPA conducted an interview with Staff #1 and Staff #2 regarding the alleged allegation Staff #1 and Staff #2 denied the allegation and informed LPA that staff did not make copies of Resident #1 mail because Resident #1 refused and did not want to provide a copy of their Cost-of-Living Adjustment form for accounting to process. Third Allegation: Facility staff are not properly addressing bed bugs in the facility. Regarding the allegation stated above, LPA conducted an interview with Staff #1 regarding the alleged allegation Staff #1 informed LPA that currently the facility has no reports concerning bedbugs. Staff #1 provided LPA with an Orkin Service Report during the review of the report LPA observed that last treatment was made on 4/11/2026 report indicated that no bedbug activity was found. LPA collected Orkin service report for review. Based on corroborating evidence LPA has determined that the above allegation is Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Melanie Niez.the state’s words, verbatim · CDSS document, Apr 27, 2026 · control 56-AS-20251212114826

Allegation investigated: Staff does not ensure facility is free of pests. Staff does not ensure facility is free of rodents. Staff does not ensure facility is free of mold. Staff does not ensure facility vents are clean. Staff does not ensure resident's garbage has lining.

On 04/6/2026, Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to deliver findings on allegations stated above. LPA Singh met with front staff and was granted entry into the facility. LPA Singh was greeted by facility administrator Melanie Niez and stated the purpose of this visit. The investigation conducted by LPA Singh consisted of observations, interviews and records review. First Allegation:- Staff does not ensure facility is free of pests. Regarding the allegation stated above, LPA conducted a walk through the facility and did not see any cockroaches or any other pests in residents rooms or in the facility. Facility is conducting regularly pest control by Orkin company. LPA Singh interviewed residents and staff, Five (5) out of Five (5) residents and Five(5) out of Five(5) Staff stated that there is ongoing issues with cockroaches/pests in the facility administrator stated the facility has a contract with pest control company and they come monthly to do pest spray control and Staff also ensures facility is clean and sanitary. Unsubstantiated Therefore, based on the evidence gathered during the investigation, the allegations listed above is deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means 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 this report (LIC9099) LIC 9099C were discussed and provided to Facility Administrator Melanie Niez at the conclusion of the visit. Second allegation: Staff does not ensure facility is free of rodents. Regarding the allegation stated above, LPA conducted a walk through the facility, pertaining to allegation above, LPA Singh did not see any rodents inside or outside of the facility, LPA interviewed residents and staff, Five (5) out of Five(5) residents and Five(5) out of Five(5)Staff stated that there are no rodents in the facility and staff keep facility clean. Third allegation: Staff does not ensure facility is free of mold. Regarding the allegation stated above, LPA conducted a walk through the facility, pertaining to allegation above, inside and outside perimeter of the facility and found that there is no mold on the walls of the facility. LPA Singh interviewed residents and staff, Five (5) out of Five(5) residents and Five(5) out of Five(5)Staff stated that there are no mold in the facility. Fourth Allegation:-Staff does not ensure facility vents are clean. Regarding the allegation stated above, LPA conducted a walk through the facility, pertaining to allegation above, inside and outside perimeter of the facility and found that facility vents are clean. LPA Singh interviewed residents and staff, Five (5) out of Five(5) residents and Five(5) out of Five(5)Staff stated that Staff ensures facility vents are clean. Fifth allegation: Staff does not ensure resident's garbage has lining. Regarding the allegation stated above, LPA conducted a walk through the facility, pertaining to allegation above, LPA Singh observed resident’s garbage has lining. LPA Singh interviewed residents and staff, Five (5) out of Five (5) residents and Staff stated that staff ensures resident’s garbage has lining. LPA Singh interviewed residents and staff and the investigation did not provide any evidence or witnesses that indicated that the facility is not clean or sanitary. Also LPA Singh was unable to corroborate the allegations that there is insufficient evidence to prove that Staff does not ensure facility is free of pests, Staff does not ensure facility is free of rodents, Staff does not ensure facility is free of mold and Staff does not ensure resident's garbage has lining. thus, the allegation is Unsubstantiated. Based on the evidence the allegation that Staff does not ensure facility flooring is in good repair, Kitchen is not in clean and sanitary condition. A substantiated finding means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted, and this report LIC9099A, LIC9099C, LIC9099D and Appeal Rights were discussed and provided to Facility Administrator Melanie Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Apr 6, 2026 · control 56-AS-20251023193220

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(1) · Plan of correction due date: Apr 24, 2026

(a) The facility shall be clean, safe, sanitary and in good repair at all times.... (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition Based on observation the licensee did not ensure that the facility Staff ensured kitchen flooring is in good repair and clean and sanitary condition, which poses an immediate health, safety, or personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Apr 6, 2026

Plan of correction: Licensee has agreed to read over the Maintenance and Operation regulation and provide training to all staff regarding the regulation of maintaining the facility Kitchen clean and sanitary. The Licensee will send the pictures of clean and sanitary kitchen, repaired floor by the Plan of Correction due date-04/24/2026.

Allegation investigated: Staff administered resident a nonprescribed medication

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to investigate allegations above. LPA met with Administrator Melanie Niez and explained the purpose of the visit. The investigation consisted of facility tour, resident interviews, and staff interviews. On 07/02/2025, the licensing department received a complaint in regards to staff administering residents a nonprescribed medication. LPA conducted (8) resident interviews. 8 out of the 8 residents stated facility staff have not administered any nonprescribed medications. Also, LPA conducted (6) staff interviews. 6 out of the 6 staff stated they have not and or witnessed any staff administer a nonprescribed medication. Based on the evidence gathered during today’s investigation, the allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and this report (LIC9099) were discussed and provided to Administrator Melanie Niez. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 24, 2026 · control 56-AS-20250702143431

Allegation investigated: Staff do not respond to residents' calls for assistance Staff are mismanaging resident's medication

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to investigate allegations above. LPA met with Administrator Melanie Niez and explained the purpose of the visit. The investigation consisted of facility tour, resident interviews, and staff interviews. On 06/30/2025, the licensing department receieved a complaint regarding staff not responding to resident's calls for assistance. Per interviews, LPA conducted (6) staff interviews and (8) resident interviews. 6 out of the 6 staff stated call lights are responded to within 10-20 minutes. In regards to resident interviews, 6 out of the 8 residents stated staff do respond to call lights when assistance is needed. 2 out of the 8 stated staff do respond to call lights for assistance, however, may take longer than half an hour. Based on interviews, there was not enough evidence to corroborate that staff are not responding to residents calls for assistance. Unsubstantiated Additionally, on 06/30/2025 the licensing department received an additional allegation that alleges staff are mismanaging medications. Per interviews, 6 out of the 6 staff stated all medications are dispensed and given as needed to residents in care. Interviews with residents revealed 8 out of the 8 residents stating they have no issues with their medication administration or medications in general. Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and this report (LIC9099) were discussed and provided to Administrator Melanie Niez.the state’s words, verbatim · CDSS document, Mar 24, 2026 · control 56-AS-20250630110325

Allegation investigated: Staff are not mitigating the spread of scabies in the facility Staff are not meeting residents’ showering needs

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to investigate allegations above. LPA met with Administrator Melanie Niez and explained the purpose of the visit. The investigation consisted of facility tour, resident interviews, and staff interviews. On 05/06/2025, the licensing department received a complaint regarding staff not being able to mitigate the spread of scabies in the facility. LPA conducted (6) staff interviews. 6 out of the 6 staff stated they have not witnessed scabies being at the facility or have contracted scabies. LPA conducted (8) resident interviews. 8 out of the 8 stated they were not diagnosed with scabies nor have they witnessed other residents contract scabies. Unsubstantiated Additionally, licensing department received an additional allegation in regards to staff not meeting residents showering needs. LPA received documentation of facility shower schedule. LPA conducted (8) resident interviews. (4) out of the (8) residents interviewed do not require assistance bathing and stated to not have witnessed other residents have issues with showers. (1) out of the remaining eight refused to corroborate with LPA interview and the remaining (3) stated to not have any issues with facility staff providing showers. LPA conducted (6) staff interviews. Based on staff interviews, there was not enough evidence to corroborate staff not meeting residents showering needs. Based on the evidence gathered during today’s investigation, the allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and this report (LIC9099) were discussed and provided to Administrator Melanie Niez.the state’s words, verbatim · CDSS document, Mar 24, 2026 · control 56-AS-20250506140259

Allegation investigated: Staff does not ensure facility floors are kept in clean sanitary conditions

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Melanie Niez and explained the purpose of the visit regarding the allegation stated above. First allegation: Staff does not ensure facility floors are kept in clean sanitary conditions. Regarding the allegation stated above, LPA conducted a walkthrough of the interior premises of the facility, during the walkthrough of the second floor LPA observed that the floor was not kept in clean conditions. In addition, during the walkthrough of the second floor LPA observed insects (cock roaches) crawling on facilities walls. LPA inspected rooms located on the second floor and observed that the rooms were free of cock roaches and bedbugs. LPA conducted an interview with Staff #1 who informed LPA that the facility has a contract with pest control. During review of records LPA observed that on March 3,2026 Orkin conducted a standard/monthly treatment service however, service report did not indicate if the treatment was to treat the issue concerning cock roaches. Substantiated Second allegation: Licensee does not ensure facility has adequate night supervision at all times. Regarding the allegation stated above, LPA conducted an interview with Staff #1, Staff #2, Staff #3, and Staff #4, regarding the alleged allegation stated above Staff #1-4 informed LPA that currently the facility has enough care supervision for all shifts. Staff #1-4 informed LPA that care support is needed during the times that the facility receives unexpected call-offs along with unexpected resignations. However, Staff #1-4 stated that facility is currently staffed. LPA conducted interviews with Resident #1, Resident #2, Resident #3, Resident #4, and Resident #5, regarding the allegation stated above and all residents informed LPA that they have no concerns pertaining to their care and informed LPA that caregivers respond to their calls on a timely manner. Resident#1-5 informed to LPA that currently there is enough staff support; however, there has been times where staff been over worked during staff shortage. Based on corroborating evidence LPA has determined that the above allegation is Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Melanie Niez. Staff #1 informed LPA that the facility will be contacting Orkin to conduct a treatment to target the issue concerning cock roaches. Based on the evidence gathered during the investigation, the above allegations are Substantiated. A finding that the complaint is Substantiated means that the findings are valid because the preponderance of the evidence standard has been met. Title 22 regulations Maintenance and Operation 87303 (a)(1), from division 6, chapter, article 6, is, cited on the attached LIC 9099 D. An exit interview was conducted where this report, appeal rights, and LIC9099-D was discussed, and a copy of the report was provided to Facility Administrator Melanie Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 21, 2026 · control 56-AS-20251014081814

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(1) · Plan of correction due date: Mar 31, 2026

Maintenance and Operation 87303...(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors...(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidence by: Based on observation the licensee did not ensure that the facility is maintained free from insects, which poses an immediate health, safety, or personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Mar 21, 2026

Plan of correction: Licensee has agreed to read over the Maintenance and Operation regulation and provide training to all staff regarding the regulation of maintaining the facility clean and sanitary. The Licensee will contact Orkin to provide treatment and address the issue concerning cock roaches. The Licensee will provide LPA with a copy of the training addressing housekeeping. In addition, the Licensee with provide LPA with a Service Report stating the treatment for roaches. By POC 3/31/2026.

Allegation investigated: Staff do not keep the facility free from pests.

Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Melanie Niez, and discussed the purpose of the visit. First Allegation:-Facility is not kept free of bed bugs. LPA Singh reviewed records, interviewed staff and observation. The investigation conducted by Department staff consisted of interviews and reviews of pertinent records. Seven (7) out of Seven (7) facility staff members interviewed stated facility has an ongoing issue with pests-cockroaches and bed bugs, facility has changed the pest control services but need to do it more frequently. Eleven (11) out of Eleven (11) residents stated facility has pest issues and cockroaches are every where in the room, dining hall, facility do have pest control coming to the facility but it is ongoing problems and need to do an aggressive treatment to get rid of the cockroaches from the facility. LPA Singh also saw cockroaches in the facility and in the residents bedrooms. Substantiated Based on observations, interviews, record reviews, and the totality of evidence gathered, there is sufficient evidence to support the allegation. The preponderance of evidence standard has been met, leading to the substantiated finding of Staff/Licensee is not keeping facility free of pests which poses An exit interview was conducted, and this report (LIC809) LIC 809C, LIC809D and Appeal Rights were discussed and provided to Facility Administrator Melanie Niez. Therefore, based on the evidence gathered during the investigation, the allegations listed above is deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means 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 this report (LIC809) LIC 809C were discussed and provided to Facility Administrator Melani Niez.the state’s words, verbatim · CDSS document, Feb 10, 2026 · control 56-AS-20250411133127

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80087(a) · Plan of correction due date: Feb 10, 2026

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.(1) The licensee shall take measures to keep the facility free of flies and other insects/pest. The licensee stated there is a possibility pest are in the home. This requirement was not met as evidenced by: This poses a potential health and safety risk to clients in care. and the administrator Melanie Niez has agreed to schedule an appointment for pest control and provide proof of service by the poc date of 02/16/2026.the state’s words, verbatim · CDSS document, Feb 10, 2026

Plan of correction: The Facility administrator Melanie Niez has agreed to schedule an appointment for pest control and provide proof of service by the poc date of 02/16//2026.

Allegation investigated: Staff does meet the residents incontinence needs. Staff do not provide adequate food service. Staff do not properly maintain the facility grounds.

Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Melanie Niez, and discussed the purpose of the visit. First Allegation:- Staff does meet the residents incontinence needs. LPA Singh reviewed records and interviewed staff. The investigation conducted by Department staff consisted of interviews and reviews of pertinent records. Seven (7) out of Seven (7) facility staff members interviewed stated facility does meet residents incontinence needs. Eleven (11) out of Eleven (11) residents stated facility staff members does meet residents incontinence needs and have no issues. Unsubstantiated Second Allegation:-Staff do not provide adequate food service. LPA Singh reviewed records and interviewed staff. The investigation conducted by LPA Singh consisted of interviews and reviews of pertinent records. Seven (7) out of Seven (7) facility staff members interviewed stated facility Staff do provide adequate food service and also Staff ensures residents have different meal options and work with residents dietary needs. Eleven (11) out of Eleven (11) residents interviewed stated that facility staff member do provide adequate food service and always provide alternate options. Third Allegation:-Staff do not properly maintain the facility grounds. LPA Singh reviewed records and interviewed staff. The investigation conducted by LPA Singh consisted of interviews and reviews of pertinent records. Seven (7) out of Seven (7) facility staff members interviewed stated facility maintain the facility grounds and also worked with the city to get three dumping trash cans which are locked and clean and staff ensures facility is clean from inside and outside and keeping rodents away. Eleven (11) out of Eleven (11) residents interviewed stated that facility staff maintain the facility grounds clean and staff ensures facility is clean from inside and outside and keeping rodents away. LPA Singh toured the facility and facility was kept clean and the facility grounds has been maintained. The investigation did not provide any evidence or witnesses or LPAs observation indicated that above allegations that Staff does not meet the residents incontinence needs, Staff do not provide adequate food service or Staff do not properly maintain the facility grounds. There is insufficient evidence to prove above allegations, the allegations are Unsubstantiated Therefore, based on the evidence gathered during the investigation, the allegations listed above is deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means 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 this report (LIC809) LIC 809C were discussed and provided to Facility Administrator Melani Niez.the state’s words, verbatim · CDSS document, Feb 10, 2026 · control 56-AS-20250411143953

Allegation investigated: Facility is not kept free of bed bugs

Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Melanie Niez, and discussed the purpose of the visit. First Allegation:-Facility is not kept free of bed bugs. LPA Singh reviewed records, interviewed staff and observation. The investigation conducted by Department staff consisted of interviews and reviews of pertinent records. Seven (7) out of Seven (7) facility staff members interviewed stated facility has an ongoing issue with pests-cockroaches and bed bugs, facility has changed the pest control services but need to do it more frequently. Eleven (11) out of Eleven (11) residents stated facility has pest issues-bed bugs and cockroaches are every where in the room, dining hall, facility do have pest control coming to the facility but it is ongoing problems and need to do an aggressive treatment to get rid of the bed bugs/cockroaches from the facility. Substantiated Based on observations, interviews, record reviews, and the totality of evidence gathered, there is sufficient evidence to support the allegation. The preponderance of evidence standard has been met, leading to the substantiated finding of Staff/Licensee is not keeping facility free of pests which poses a potential health and safety risk to clients in care. An exit interview was conducted, and this report (LIC809) LIC 809C, LIC809D and Appeal Rights were discussed and provided to Facility Administrator Melanie Niez. Third Allegation:- Facility does not respond to call buttons in a timely manner. LPA Singh reviewed records and interviewed staff. The investigation conducted by Department staff consisted of interviews and reviews of pertinent records. Seven (7) out of Seven (7) facility staff members interviewed stated Facility does respond to call buttons in a timely manner and been checked in the office too where office staff talk to staff/carers on walkie-talkie to send the message to staff helping other residents and assist resident in a timely manner. Eleven (11) out of Eleven (11) residents stated facility staff members interviewed stated Facility does respond to call buttons in a timely manner and responds to residents. LPA Singh was in one of the rooms of the resident and resident press the call button and staff did come on time to assist resident immediately. Therefore, based on the evidence gathered during the investigation, the allegations listed above is deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means 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 this report (LIC809) LIC 809C were discussed and provided to Facility Administrator Melanie Niez.the state’s words, verbatim · CDSS document, Feb 10, 2026 · control 56-AS-20250307102314

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80087(a) · Plan of correction due date: Feb 10, 2026

a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.(1) The licensee shall take measures to keep the facility free of roaches and other insects/pest/bed bugs. The licensee stated there is a possibility pest are in the home. This requirement was not met as evidenced by: This poses a potential health and safety risk to clients in care. and the administrator Melanie Niez has agreed to schedule an appointment for pest control and provide proof of service by the poc date of 02/16/2026.the state’s words, verbatim · CDSS document, Feb 10, 2026

Plan of correction: The Facility administrator Melanie Niez has agreed to schedule an appointment for pest control and provide proof of service by the poc date of 02/16/2026.

Allegation investigated: Staff did not safeguard residents personal property Staff did not allow resident to return to their previous apartment Resident’s room does not meet their individual needs and preferences

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Administrator Melanie Niez. On January 22, 2024, it was alleged that staff did not safeguard resident’s personal property, staff did not allow resident to return to their previous apartment, and resident’s room does not meet their individual needs and preferences. The Department’s investigation consisted of unannounced facility visits, records review, and staff and resident interviews. According to the allegations received staff threw away Resident #1 (R1)’s personal couch, took away their bed, and threw out their clothing due to bugs. It was also alleged R1 was unable to return to their previous apartment due to the bugs and R1’s new bedroom’s shower does not fit R1’s shower chair. Unsubstantiated Interviews with staff and residents revealed that R1 had bed bugs in their previous room and was asked to move rooms in order to fumigate. Interviews revealed that R1’s personal couch was infested past the point of recovery and thus was thrown away. Interviews revealed that the personal couch was replaced by staff with a different piece of furniture and R1’s clothing was not thrown away but rather gave back in increments after fumigation. Interviews did not reveal that R1’s new bedroom’s shower did not fit R1's shower chair. Review of facility records revealed that R1 was back in their original room. Based on interviews and records review, the investigation did not yield a preponderance of evidence to conclude that that staff did not safeguard resident’s personal property, staff did not allow resident to return to their previous apartment, and resident’s room does not meet their individual needs and preferences. Based on the foregoing, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Administrator Melanie Niez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 1, 2026 · control 56-AS-20240122114507

Allegation investigated: Staff are not administering medication to resident as prescribed.

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Melanie Niez, and discussed the purpose of the visit. An allegation was made that Staff are not administering medication to resident as prescribed, it is alleged Resident 1 (R1) did not receive their prescribed antibiotic. Review of R1’s LIC 602A confirmed that R1 requires medication assistance per physician’s orders. Based on interviews, on 1/22/26 R1 could not be found when medication was being administered. R1 states they were in their room the entire day. Based on record review, R1 was not in the dining room or their room at the time of afternoon administration. There is not enough evidence to prove whether R1 was in their room or not Unsubstantiated LPA interviewed ten (10) residents, 8 of the 10 residents interviewed confirmed they receive their medication as prescribed per physician’s orders. 1 of the 9 residents stated they do not receive their medication as prescribed as physician. 1 of the 9 residents stated they do not take medication only vitamins. LPA interviewed two (2) staff, all whom confirm residents medication is administered as prescribed by physician’s orders. One (1) staff informed LPA the only time residents do not receive their medication is when they are unable to be located, when administering medication staff start in the dining room, if resident is not eating, their room is checked, as well as the smoking area and activities room. When all locations have been checked and the resident is still not found the MAR is then noted the medication was not administered. There is no evidence to support the allegation, therefore, the allegation above is Unsubstantiated. An Unsubstantiated complaint means, that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with Administrator Melanie Niez and a copy of this report was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 30, 2026 · control 56-AS-20260123114555

Allegation investigated: Staff not giving medication to resident as prescribed Staff not ordering medication in a timely manner Staff violating resident personal rights

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to conclude the complaint investigation and deliver findings on the above allegations. LPA met with Administrator, Melanie Niez, who was informed of today’s visit. The investigation consisted of LPA observations, reviewing pertinent records, and interviews with residents and staff. Regarding the allegation, staff not giving medication to residents as prescribed, four (4) out of six (6) residents interviews indicate that staff are giving them their medications as prescribed. Four (4) staff interviews indicate that they are giving medications to residents at prescribed. LPA’s audit of resident medications indicates medications are properly dispensed and documented. Regarding the allegation, staff not ordering medication in a timely manner, four (4) out of six (6) resident interviews indicate that staff do order their medications in a timely manner. ***continued on LIC9099C*** Unsubstantiated Four (4) staff interviews indicate that they order medications in a timely manner. LPA’s audit of resident medication records and staff documentation, indicates not enough evidence to corroborate the allegation that staff are not ordering resident's medication in a timely manner. Regarding the allegation, staff violating resident personal rights, five (5) out of six (6) residents interviews indicate that staff did not violate their personal rights. Four (4) staff interviews indicate that they have not violated resident’s personal rights. Based on the Department’s investigation, the allegations mentioned in this report are Unsubstantiated. Unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy provided with appeal rights to Administrator Niez at the conclusion of the visitthe state’s words, verbatim · CDSS document, Jan 21, 2026 · control 56-AS-20231128152625

Allegation investigated: Staff do not ensure resident's incontinence needs are met Staff do not ensure that resident's dietary needs are met Staff do not regularly observe resident for change in condition

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to conclude the complaint investigation and deliver findings on the above allegations. LPA met with Administrator, Melanie Niez, who was informed of today’s visit. The investigation consisted of LPA observations, reviewing pertinent records, and interviews with relevant parties. Regarding the allegation, staff do not ensure resident's incontinence needs are met, interviews with four (4) staff revealed that they ensure residents' incontinence needs are met. Interviews with five (5) residents indicated that staff are meeting their incontinence care needs. Regarding the allegation, staff do not ensure that resident's dietary needs are met, interviews with four (4) staff revealed that they do ensure resident’s dietary needs are met. Interviews with five (5) residents indicated that the meals provided do meet their dietary needs. **continued on LIC9099-C*** Unsubstantiated Regarding the allegation, staff do not regularly observe resident for change in condition, interviews with four (4) staff revealed that they do regularly observe residents for changes in condition. Interviews with five (5) residents indicated that staff observe them for condition changes. Based on the Department’s investigation, the allegations mentioned in this report are Unsubstantiated. Unsubstantiated meaning that although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy provided with appeal rights to Administrator Niez.the state’s words, verbatim · CDSS document, Dec 11, 2025 · control 56-AS-20231013145010

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced follow-up facility visit to gather information pertaining complaint # 56-AS-20231013145010 and 56-AS-20231128152625. LPA met with Administrator, Melanie Niez, and discussed the purpose of the visit. During today’s visit, LPA conducted interviews and obtained copies of relevant documents. An exit interview was conducted where this report was discussed and a copy of this report was provided to Administrator Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Dec 3, 2025

Allegation investigated: Facility did not notify staff of PPE protection to care for contagious resident. Resident's room is not sanitized. Staff do not assist resident with incontinence needs. Staff do not prevent residents room from malodorous. Residents room have parasites.

On 11/21/2025 at 12:15 PM, Licensing Program Analysts (LPAs) Eldin Serrano and Sarina Ramirez made an unannounced visit to the facility to investigate and deliver the findings of the above allegations. LPAs met with administrator Melanie Niez to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation. Allegation #1: Facility did not notify staff of PPE protection to care for contagious resident. – Based on information received during staff interviews, 7 out of 8 staff stated that the facility notified staff to use PPE protection to care for contagious resident. Staff #1 (S1) stated that the hospital has the resident confined on 9/3/2023 and cannot return to the facility until the resident is cleared with CDC. The facility is unaware that the resident has contagious infection until they were notified by the hospital. The facility posted a sign not to go to the resident room on 9/14/23. The facility would not have known at the date of the incident. The facility did the necessary precaution to mitigate spreading of the disease. LPA was unable to corroborate the allegation. *** Continuation in LIC9099C *** Unsubstantiated Allegation #2: Resident's room is not sanitized. - Based on interviews with residents and staff. 7out of 8 staff and 8 out of 8 residents stated that the resident’s room was cleaned and sanitized. Facility also provided the housekeeping schedule. LPA was unable to corroborate the allegation Allegation #3 Staff do not assist resident with incontinence needs .- Based on interviews and information received during the investigation 7 out 8 staff and 8 out 8 residents stated that the staff assisted residents with incontinence needs. LPA is unable to corroborate the allegation. Allegation #4 Staff do not prevent residents room from malodorous. – During interview with staff and residents, LPA observed that the facility does not have a foul smell at the time of the visit. The housekeeping staff and caregivers coordinate the cleaning of the residents’ rooms to prevent the room from having an odor. Every resident interview revealed that their room smells good according to them. Allegation #5 Residents room have parasites.- – Based on interviews and information received during the investigation 7 out 8 staff and 8 out 8 residents stated that there are no pests, bed bugs or parasites in the residents’ room. It was revealed that if there are any ants and roach activities, the maintenance staff will address it right away and they will coordinate it with the pest control company that they are in contract with. Facility provided the contract with Orkin Pest Control company. Information received during investigation LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to administrator Melanie Niezthe state’s words, verbatim · CDSS document, Nov 21, 2025 · control 56-AS-20230918124418

Type of visit: Annual/Random

Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano made an unannounced visit to the facility to conduct a required annual inspection. LPAs met Administrator Melanie Niez, and discussed the purpose of the visit. The facility is a Residential Care Facility for Elderly (RCFE) with a license capacity of (156), and a current census of (103). LPAs conducted a general inspection of the facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways were kept free of obstruction. The facility has no swimming or similar bodies of water. The facility has sufficient space for resident activities. Ten (10) resident bedrooms were inspected. Ten (10) resident’s bathrooms were inspected, hot water temperatures measured 106.2 degrees F. The facility is equipped with operating smoke alarms, the facility was recently inspected by DC Electronics on 11/15/25. Carbon Monoxide alarms were not observed, deficiency issued. Facility has operating laundry equipment, and telephone service. The facility has posted in a common area, personal rights, facility sketch, the Community Care Licensing complaint poster, Ombudsman poster, menu, activities, and license. Cleaning supplies were kept locked inaccessible to residents in care. Sharps were not locked in the facility kitchen, deficiency issued. Food Service: Kitchen and dining areas were maintained cleaned. Non-perishable and perishable food supply is sufficient for number of residents in care. Facility refrigerators and freezers were maintained in operating condition. Health Related services: LPA Serrano reviewed (5) resident medications. Resident’s medications are labeled and centrally stored in a locked room. Continuation on LIC 809-C... Record Review: Five (5) resident files reviewed were observed to be complete. Five (5) staff files reviewed were observed to be complete, The facility has an emergency and disaster plan on file; last disaster drill was completed on 10/16/25 and Fire drill services was conducted on 11/03/25. S6 had an expired food handlers card, technical violation issued. First aid manual was not observed, technical violation issued. Based on LPAs observations and records reviewed, deficiencies and technical violations are being issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report (LIC809), LIC 809D, and LIC 9102 was discussed to Administrator Melanie Niez . Copies of the reports were provided with appeal rights to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 21, 2025

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff do not distribute resident's medications as prescribed

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Melanie Niez, and discussed the purpose of the visit. An allegation was made that staff failed to administer medications as prescribed, it is alleged Resident 1 (R1) did not receive their prescribed inhaler. Review of R1’s LIC 602A confirmed that R1 requires medication assistance per physician’s orders. Although the inhaler was received around October 16, 2025, staff awaited formal approval from the physician to allow R1 to keep the inhaler at bedside. Following receipt of that approval, the inhaler was provided to R1 on October 31, 2025. Unsubstantiated LPA interviewed nine (9) residents, 7 of the 9 residents interviewed confirmed they receive their medication as prescribed per physician’s orders. 1 of the 9 residents stated they receive their medication as prescribed; however, they have problems with receiving their inhaler in a timely manner. 1 of the 9 residents interviewed stated they do not receive their medication as prescribed by their physician. LPA interviewed three (3) staff, all whom confirm residents medication is administered as prescribed by physician’s orders. Therefore, the allegation above is Unsubstantiated. An Unsubstantiated complaint means, that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with Administrator Melanie Niez and a copy of this report with Appeal Rights was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 31, 2025 · control 56-AS-20251027114103

Allegation investigated: Staff not being properly trained to perform emergency services Staff did not summon emergency services in a timely manner

On 10/13/2025 at 12:30 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to investigate and deliver the findings of the above allegations. LPA Serrano met with administrator Melanie Niez to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation. Allegation #1: Staff not being properly trained to perform emergency services – Based on record review and information received during interviews LPA was unable to corroborate the allegation. The facility provided the staff/caregivers with CPR online training and certifications. Allegation #2: Staff did not summon emergency services in a timely manner- Based on interview and information received during interviews LPA was unable to corroborate the allegation. Staff and residents stated that the staff called 911 while they were doing the Heimlich maneuver/ CPR and the paramedics were giving the staff directions over the phone. Paramedics arrived between 8-10 minutes. *** Continuation in LIC9099C *** Unsubstantiated Information received during investigation LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to administrator Melanie Niez.the state’s words, verbatim · CDSS document, Oct 13, 2025 · control 56-AS-20230918132111

Allegation investigated: Staff did not ensure carpets in residents rooms were not malodorous

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Administrator, Melanie Niez, and informed the purpose for the visit. The investigation consisted of LPA observations, interviews with staff and residents. Regarding the allegation, staff did not ensure carpets in residents’ rooms were not malodorous, LPA conducted a tour of ten (10) resident rooms and did not observe malodorous odors. Interviews with five (5) staff reveal that they have not observed malodorous odors coming from the carpets or flooring in residents’ rooms. Interviews with six (6) residents reveal they have not observed malodorous odors from the carpet or flooring in their rooms. Additionally, resident interviews reveal that the carpet or flooring is vacuumed or swept on a weekly basis. Based on the department's investigation, the allegation above is Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Unsubstantiated An exit interview was conducted where this report was discussed and a copy of this report was provided with appeal rights to Administrator Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 26, 2025 · control 56-AS-20231129135101

Allegation investigated: Facility staff mismanaging residents' medication Facility staff not giving residents medication on a timely basis.

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Administrator, Melanie Niez, and informed the purpose for the visit. The investigation consisted of pertinent document review, interviews with staff and residents. Regarding the allegation, facility staff mismanaging residents' medication, LPA medication record review, interviews with staff and residents reveal not enough evidence to corroborate the allegation. Interviews with four (4) staff deny that they mismanage residents' medications and deny refusing resident's their medications. Interviews with five (5) out of six (6) residents deny that their medications are mismanaged and staff have not refused to provide them their medications. Regarding the allegation, facility staff not giving resident their medications on a timely basis. Interviews with four (4) staff deny not giving residents their medications on a timely bases. Interviews with five (5) out of six (6) residents deny not receiving their medications on a timely bases. Unsubstantiated Based on the department's investigation, the allegations are Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy of this report was provided with appeal rights to Administrator Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 26, 2025 · control 56-AS-20230801093037

Allegation investigated: Resident's privacy was invaded by staff Resident was not treated with dignity

Licensing Program Analyst (LPA) Magda Malcore conducted an announced visit to the facility to conclude the investigation on the above allegations. LPA identified self and met with Administrator, Melanie Niez. LPA discussed the purpose of the visit with Administrator Niez. Regarding the allegation, resident’s privacy was invaded by staff, four (4) staff interviews reveal they have not invaded a resident’s privacy. Five (5) out of six (6) resident interviews reveal staff have not invaded their privacy. Regarding the allegation, resident is not treated with dignity, four (4) staff interviews reveal they treat residents with dignity. Five (5) out of six (6) resident interviews reveal staff treat them with dignity. Unsubstantiated Based on interviews with staff and residents, the allegations are Unsubstantiated. An Unsubstantiated finding means 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. An exit interview was conducted where this report was discussed and provided with appeal rights to Administrator Niez at the conclusion of the visit. Based on LPA record review and staff interviews, the allegation is Substantiated. A Substantiated finding means that the allegation(s) is valid because the preponderance of the evidence standard has been met. An immediate civil penalty of $500 is assessed for background check violation. An exit interview was conducted where reports (LIC9099, LIC9099-C, LIC9099-D, LIC421bg) were discussed and copies provided with Appeal Rights to Administrator Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 14, 2025 · control 56-AS-20230803164853

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jul 15, 2025

87355(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: (2)Obtain a California clearance or a criminal record exemption as required by the Department…this requirement is not met as evidenced by The Licensee did not comply with section cited above by S1 working at the facility from July 2023 until August 6, 2023 without a criminal record clearance or exemption, which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 14, 2025

Plan of correction: Staff #1 (S1) no longer is employed at the facility. The Administrator/Licensee shall submit a statement of understanding on the regulation cited by POC due date.

Type of visit: Collateral

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility obtain addition information regarding complaint control #56-AS-20230801093037. LPA identified self, met with Administrator Melanie Niez and discussed the purpose of the visit. During today's visit LPA conducted an inspection of resident medications and records for further review. An exit interview was conducted were this report was discussed and a copy provided to Administrator Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 14, 2025

Allegation investigated: Staff are inappropriately taking resident's service animals away

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Melanie Niez, and discussed the purpose of the visit. It is alleged staff is inappropriately taking resident 1 (R1) service animals. Staff have informed R1 two months prior the service animals are required to be vaccinated and provide proof of immunization. R1's animals are not being taken away, staff suggested a foster home for the animals in the meantime R1's room to be treated. R1 is stating she can not afford to vaccinate animals, and can not provide certification stating her animals are service animals. There is not enough evidence to support the allegation, therefore the allegation is unsubstantiated. An Unsubstantiated complaint means, that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with Administrator and a copy of this report was provided to Administrator Melanie Niez at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 19, 2025 · control 56-AS-20250617103211

Allegation investigated: Facility staff left resident covered in feces

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Administrator, Melanie Niez, who was informed of today’s visit. The investigation consisted of LPA observations, pertinent record review and interviews with relevant parties. Regarding the allegation, facility staff left resident covered in feces, interviews with staff and outside parties corroborate the allegation. On 7/24/23, R1 was observed to be in soiled diapers with feces on bedding and clothing. Staff assisted R1 with changing and bed cleaning. Interviews also reveal that the facility had been short staffed. Based on this investigation, the above allegation is Substantiated. Substantiated meaning that the allegation(s) is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to the Administrator at the conclusion of the visit. Substantiatedthe state’s words, verbatim · CDSS document, May 22, 2025 · control 56-AS-20230726133755

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: May 23, 2025

Additional Personal Rights of Residents in Privately Operated Facilities(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have... following personal rights:(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by resident needs were not met and found in feces. Staff interviews reveal facility was short staffed;posing an immediate health,safety,and personal rights risk to persons in carethe state’s words, verbatim · CDSS document, May 22, 2025

Plan of correction: As of September 2023, the Licensee/Administrator implemented a system of support caregivers to assist with the of the residents needs. On 5/22/25, LPA was provided documents reflecting this change.

Allegation investigated: Staff did not prevent residents from smoking in the facility Staff are not providing a comfortable environment for residents Staff did not ensure the facility was kept clean Staff did not ensure there was an activities director Staff are not properly communicating with residents Staff are not providing activities for residents

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to deliver findings on a complaint investigation regarding the above allegations. LPA met with Administrator Melanie Niez and discussed the purpose of the visit. Regarding Allegation #1, LPA interviewed nine (9) residents, all of whom confirmed that smoking is not allowed in the facility. They reported not having seen or smelled residents smoking in rooms. LPA observed a designated smoking area for residents. LPA interviewed five (5) staff members, who all stated that smoking is prohibited in the facility and that residents are redirected to the designated smoking area. Unsubstantiated Regarding allegation #2, LPA interviewed nine (9) residents. Eight (8) residents reported that the staff provides a comfortable environment, and they feel safe. One (1) resident mentioned discomfort due to constant arguments among residents. LPA interviewed five (5) staff members, who all stated that they provide a comfortable environment, treat residents like family, and constantly work on improvements. Regarding allegation #3, LPA interviewed nine (9) residents. Seven (7) residents reported that the staff ensures the facility is kept clean. Two (2) residents mentioned that the facility is sometimes dirty. LPA interviewed five (5) staff members, who all stated that they ensure the facility is kept clean, with housekeepers and caregivers assisting in cleaning. A deep cleaning has been added on weekends. Regarding allegation #4, LPA interviewed nine (9) residents. Two (2) residents reported that the facility did not have an activities director for a couple of months. One (1) resident was unsure of the duration. Six (6) residents reported that the facility was without an activities director for a short period. LPA interviewed five (5) staff members. Three (3) staff members stated that an activities director was hired within about a week and that staff always stepped in to cover daily activities. Two (2) staff members reported that the facility always had an activities director. Regarding allegation #6, LPA interviewed nine (9) residents, all of whom reported that staff members communicate properly with residents. LPA interviewed five (5) staff members, who all stated that they communicate effectively with residents, treat them like family, and that the Administrator maintains an open-door policy allowing residents to communicate freely. Regarding allegation #6, LPA interviewed nine (9) residents. Eight (8) residents reported that staff provides activities for residents. One (1) resident mentioned that activities were not provided. LPA interviewed five (5) staff members, who all stated that activities have always been provided. With the new activities director, changes have been implemented, and additional activities have been added. Based on LPA's observations, record reviews, and interviews, the above allegations are unsubstantiated. This means 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. An exit interview was conducted where this report was discussed, and a copy was provided to Administrator Melanie Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 4, 2025 · control 56-AS-20250226102920

Allegation investigated: Staff neglect resulted in Resident #1 (R1) sustaining a severe burn. Staff did not seek medical attention for the resident in a timely manner.

On 03/03/2025 at 03:30 PM, Licensing Program Analyst (LPA) Melody Brown, visited the facility to deliver the investigative findings for the above allegations. LPA Brown identified herself and discussed the purpose of the visit with Office Manager Maria Cervantes. The investigation consisted of file review, interviews with residents and staffs as well as observation. First allegation: Staff neglect resulted in Resident #1 (R1) sustaining a severe burn. The investigation was conducted by Department staff which consisted of file review and interviews with relevant parties. The first allegation indicates that staff neglect resulted in Resident #1 (R1) sustaining a severe burn. During the investigation, Department staff reported that there was insufficient evidence to support staff neglected Resident #1 (R1). Department staff interviewed R1 and R1 denied any neglect from the staffs at the facility. R1 revealed that R1 likes to do things without assistance which includes transferring to/from bed and make R1's own coffee. Moreover, R1 indicated the burn injury resulted from R1 accidentally hitting R1's wheelchair's cupholder that held the hot coffee. ***Continuation in LIC9099C*** Unsubstantiated R1 did not report R1's burn wound to facility staff until days later. Second allegation: Staff did not seek medical attention for the resident in a timely manner. The investigation was conducted by Department staff which consisted of file review and interviews with relevant parties. During the investigation, Department staff was not able to obtain evidence to corroborate the allegation. Department staff indicated that R1 denied neglect and R1 stated that R1 did not request earlier medical attention as R1 informed department staff that R1 did not say anything about the incident to the staffs at the facility. Department staff interviews with staffs revealed that R1 likes to complete several of R1's Activities of Daily Living (ADLs) without staff assistance. To add to that, interviews with staffs indicated that R1 has a coffee pot in R1's room and R1 prefers to make coffee without staff assistance and when R1 decided to disclose R1's burn wound, they were more concerned with getting R1 immediate medical care than asking R1 why R1 did not report R1's burn injury sooner. Therefore, based on the evidence obtained during the Department's investigation, there is insufficient evidence to prove that staff neglect resulted in Resident #1 (R1) sustaining a severe burn (Allegation #1), and staff did not seek medical attention for the resident in a timely manner (Allegation #2) are UNSUBSTANTIATED at this time. Although the allegation of staff neglect resulted in Resident #1 (R1) sustaining a severe burn (Allegation #1), and staff did not seek medical attention for the resident in a timely manner (Allegation #2) 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 at this time. An exit interview was conducted where this report (LIC9099), was discussed and provided to Office Manager Maria Cervantes.the state’s words, verbatim · CDSS document, Mar 3, 2025 · control 56-AS-20240701105144

Allegation investigated: )-Facility staff did not follow isolation guidelines for staff with COVID-19 infection. 2)-Facility staff did not follow isolation guidelines for residents with COVID-19 infection. 3)-Facility staff do not seek timely medical care for residents. 4)-Facility staff do not ensure residents receive meals that meet their dietary needs. 5)-Facility staff do not ensure residents have clean drinking water. 6)-Facility staff do not regularly assist residents requiring oxygen with putting oxygen on at bedtime. 7)-Facility staff did not dispense medications are prescribed 8)-Facility staff left medications in resident's room. 9)-Facility staff yell at the residents. 10)-Facility staff stole from resident. 11)-Facility staff did not assist resident with appointments. 12)-Facility staff did not prevent resident from verbally abusing another resident. 13)-Facility staff did not provide clean bedding to residents. 14)- Facility staff did not provide clean towels to residents. 15)-Facility staff did not repair broken call button. 16)-Facility staff did not repair ceiling leak.

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the facility to initiate a complaint investigation and deliver the findings. LPA Allen met with Melanie Niez Administrator who was informed of the purpose of the visit and the allegations. Allegation 1 and Allegation 2: The interviews conducted with staff members who confirmed that during the Covid-19 pandemic, isolation protocols have been and are being followed for both staff and residents. Allegation 3 and Allegation 4: Staff members and residents stated that they receive timely medical care, and meals are provided that meet their dietary needs daily. Allegation 5: The interviews with staff and residents stated clean drinking water is provided throughout the day in their rooms and throughout the facility. During tour of the facility LPA observed clean water being provided to the residents in care. Unsubstantiated Allegation 6: The staff and residents have stated help is provided when oxygen is needed at bedtime and throughout the day. Allegation 7 and Allegation 8: Residents and staff have also stated medications are given as prescribed and not left in their room. Allegation 9: Staff members reported that they have not experienced or observed staff yelling at residents and the residents have stated the staff members treat them with dignity and respect. Allegation 10: Both staff and residents stated they have not currently experienced or heard of staff stealing from clients; however, there were rumors of such incidents in the past. Based upon the Departments investigation, which included interviews with staff and residents as well as a records review, there was no corroborative evidence found to support the allegation of fiduciary abuse by a staff member at the facility. It is alleged that a facility staff stole resident #1 (R1’s) debit card and spent over $1,000 from their account, there was no corroborating evidence to support this claim. The review of records obtained does not indicate any open case or claims regarding fiduciary abuse at this facility. Allegation 11: Residents and staff have stated they are assisted with appointments and visits to the doctor office as needed. Allegation 12: Staff members reported that they have not observed residents yelling at each other, and when aggressive behavior does occur, residents are redirected. Residents have also stated if altercations occur staff will separate them as needed. Allegation 13 and Allegation 14: Staff members have stated residents are provided with clean linen and towels as needed and during the tour LPA observed a supply of clean linens and towels. Allegation 15: Interviews with staff, residents, and LPA observations during the visit the call button was working and when it is not, the maintenance team is informed, and repairs are promptly made. Allegation 16: Interviews with staff, residents stated there were currently no leaks in the building and during the tour of the facility LPA didn’t observe any leaks. Based on the evidence gathered during the investigation, the above allegation is found to be Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted where this report was discussed and provided to Melanie Niez Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 26, 2025 · control 56-AS-20221223154904

Allegation investigated: Staff did not treat resident with respect Staff handled resident roughly

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Melanie Niez and explained the purpose of the visit. The investigation consisted of observation and interviews with relevant parties. Allegation #1 indicates that staff did not treat resident with respect. During the investigation, LPA did not find evidence to corroborate the allegation. The incident in question was due to R1 being intoxicated, Interviews with Four (4) staff indicated they treated R1 with respect. R1 was unable to be interviewed due to taking a nap and refused to speak with LPA, however LPA left a business card to speak with R1 at a later time. LPA spoke with Nine (9) residents who witnessed the incident, 8 out of 9 residents indicated staff treat all residents with respect and did not treat R1 disrespectfully. 1 out of 9 residents indicated staff have been harrassing R1. Unsubstantiated Regarding allegation #2, It is alleged that facility staff handled resident in a rough manner. Interviews with 9 residents revealed 8 out of 9 staff have never handled them in a rough manner nor did staff treat R1 in a rough manner. 1 out of 9 residents indicated staff treated R1 in a rough manner. Interviews with Four (4) staff revealed that they did not handle R1 in a rough manner and have not witnessed other staff handle residents in a rough manner. Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated. A finding that complaints are UNSUBSTANTIATED means 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 this report was discussed and a copy was provided to Administrator Melanie Niez.the state’s words, verbatim · CDSS document, Feb 13, 2025 · control 56-AS-20250210083855

Allegation investigated: Staff did not afford the residents privacy while in care Staff did not keep the facility free from pests Staff mishandled the residents personal belongings Staff did not provide an appropriate sleeping arrangement for a resident

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Administrator Melanie Niez and discussed the purpose of the visit. Regarding allegation #1, LPA Ramirez conducted 3 staff interviews. 2 out of 3 staff informed LPA a memo was sent out in advance indicating their rooms will be checked, 1 out of 3 staff informed LPA most residents were in their rooms to grant entry, some gave verbal permission to enter if they were not in their room, and the ones who were not in their rooms were found to enter their rooms with staff. LPA conducted 10 resident interviews. 5 out of 10 residents stated they are provided with privacy. 2 out of 10 residents stated no they do not have privacy. 3 out of 10 residents did not provide an answer. Regarding allegation #2, LPA Ramirez conducted 3 staff interviews. 3 out of 3 staff informed LPA Unsubstantiated the facility has pests and they are in the process of dealing with it. LPA conducted 10 resident interviews. 1 out of 10 residents were not aware of pests in the facility. 8 out of 10 residents were aware of pests in the facility. 1 out of 10 residents did not answer. Regarding allegation #3, LPA conducted 3 staff interviews. 3 out of 3 staff informed LPA they did not mishandle residents belongings. LPA conducted 10 residents interviews. 6 out of 10 residents stated their belongings are not being mishandled. 1 out of 10 residents stated their belongings are being mishandled. 1 out of 10 residents stated they don't know if their belongings are being mishandled. 2 out of 10 residents did not answer. Regarding allegation #4, LPA conducted 3 staff interviews. 3 out of 3 staff informed LPA they provide appropriate sleeping arrangements for residents if needed. LPA conducted 10 resident interviews. 3 out of 10 residents were provided appropriate sleeping arrangements when needed. 1 out of 10 resident could not provided information due to being in the hospital. 1 out of 10 resident stated they did not receive appropriate sleeping arrangements. 5 out of 10 residents did not need sleeping arrangements. Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated. A finding that complaints are UNSUBSTANTIATED means 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 this report was discussed and provided to Administrator Melanie Niez.the state’s words, verbatim · CDSS document, Jan 14, 2025 · control 56-AS-20241218104715

Allegation investigated: Facility staff are not providing non-slip mats for resident shower Facility staff are not providing nutritious meals Facility staff do not meet residents dietary needs

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Aministrator Melanie Niez and discussed the purpose of the visit. Regarding allegation #1. LPA Ramirez conducted 2 staff interviews. 2 out of 2 staff informed LPA the tile in resident showers are non slip. LPA conducted 10 resident interviews. 3 out of 10 residents indicated non slip mats are provided in the showers. 1 out of 10 resident stated showers do not have non slip mats. 6 out of 10 residents receive assistance in the showers to prevent them from slipping. Regarding allegation #2, LPA conducted 3 staff interviews. 3 out of 3 staff indicated the facility provides nutritious meals. Unsubstantiated LPA conducted 10 resident interviews. 5 out of 10 residents indicated the facility provides nutritious meals. 2 out of 10 residents indicated the facility does not provide nutritious meals. 2 out of 10 residents stated the facility somewhat provides nutritious meals. 1 out of 10 residents did not answer. Regarding allegation #3, LPA conducted 3 staff interviews. 3 out of 3 staff stated they meet residents dietary needs. LPA conducted 10 resident interviews. 7 out of 10 residents do not have special diets. 3 out of 10 residents indicated their dietary needs are being met. Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated. A finding that complaints are UNSUBSTANTIATED means 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 this report was discussed and provided to Administrator Melanie Niez.the state’s words, verbatim · CDSS document, Jan 14, 2025 · control 56-AS-20250106112523

Allegation investigated: Resident not receiving medications as prescribed Facility did not refill residents medication as required

Licensing Program Analysts (LPAs) Sarina Ramirez and Becky Mann conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPAs met with Administrator Melanie Niez, and discussed the purpose of the visit. Allegation #1 Resident not receiving medications as prescribed. The allegation is alleging that on 11/18/2024, facility staff did not administer one of R1’s medications as prescribed. Based on review of facility medications log, interviews with facility staff and residents in the facility the allegation is unsubstantiated. Facility staff interviews state the medication was dispensed as prescribed. Review of resident records reveals no evidence to support the allegation. Interviews with 6 residents in the facility could not corroborate the allegation. Unsubstantiated Allegation #2 Facility did not refill residents medication as required. The allegation is alleged that R#2 has not received their pain medication for a month. Based on review of facility medication log, interviews with facility staff and residents in the facility the allegation is unsubstantiated. Facility staff interviews state the refills are processed by the physicians authorization serviced by Innovage, VA, or Yucaipa care. Review of resident records reveals no evidence to support the allegation. Interviews with 6 residents in the facility could not corroborate the allegation An Unsubstantiated complaint means, 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. An exit interview was conducted with Administrator Niez and a copy of this report was provided to Administrator Melanie Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 27, 2024 · control 56-AS-20241119094936

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Becky Mann and Sarina Ramirez made an unannounced visit to the facility to conduct an annual inspection. LPAs met with Melanie Niez, Administrator and explained the purpose of the visit. During the visit, LPAs observed residents throughout the common areas, walking around the facility, in their designated rooms and/or participating in activities. Facility: Facility has a capacity of 156 residents and a current census of 113. Physical Plant: The facility is operating in the capacity and conditions approved by Community Care Licensing Division (CCLD). Linens and hygiene items are sufficient for residents. LPAs tested 9 residents bathrooms and the hot water temperature were measured between 108.5 to 118 degrees Fahrenheit. LPAs observed 10 bedrooms were equipped with lamps and appropriate lighting to ensure residents comfort and safety. Showers and toilets are equipped with grab bars. Fire alarms and smoke detectors are in working order. There is a signal system installed that is in operating order. The facility consists of: Library, Media/TV Room, Lounge, Laundry Rooms, Kitchen, Dining Area, Front Lobby, Med-Tech Room, Patio, Staff Break Area, Reception, and all other common areas. Food Service: The facility has a variety of food available for residents. Non perishable and perishable food is sufficient for the number of residents in care. Pesticides and other toxic chemicals are not stored in food areas, and the kitchen is accessible to residents. Care & Supervision: Facility has sufficient staff in care for the residents. Toxic items are inaccessible to residents in care. Record Review: Current staff has Criminal Clearance, CPR and updated training. Resident records are complete with updated physician reports, admission agreement, and needs and services plan. Medication: LPAs observed medication room and medications are locked and centrally stored. Medication room has a small refrigerator for medication that require refrigeration. LPAs reviewed 7 resident medications and all meds are taken as prescribed by a physician. Medications matched the Medication Administration Record (MAR) on file. MISCELLANEOUS: Company transportation is available to residents in care. Fire extinguishers were inspected. Ombudsman poster, CCLD Complaint poster, evacuation plan, activities schedule, resident rights, and Facility license are posted in public view. There were no deficiencies issued per Title 22. An exit interview was conducted, and a copy of this report, LIC809, and LIC809C were given to Administrator Melanie Niez at the end of the inspection.the state’s words, verbatim · CDSS document, Nov 27, 2024

Allegation investigated: Staff did not keep facility free from roaches. Staff did not assist resident with basic needs.

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the facility to initiate the complaint investigation and deliver findings on the allegations above. LPA met with administrator Melanie Niez who was informed of the purpose of the visit. The investigation consisted of interviews with the residents, staff, and record review. The interviews with the staff members and residents stated they have seen roaches in the facility. Melanie Niez have stated and provided records that corroborated extermination services have been conducted at the facility. Staff members have stated the residents’ needs are being met, and the residents interviewed have also stated their needs are being taken care of by the staff members. Based on interviews with staff, residents and records the above finding is Unsubstantiated. A finding of unsubstantiated means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Unsubstantiated An exit interview was conducted where this report was discussed and provided to Melanie Niez with appeal rights.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 56-AS-20241029151800

Allegation investigated: Resident has wounds due to staff neglect Staff are not feeding resident Staff are refusing to give resident their prescribed medication Staff are not meeting residents’ hygiene needs

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the investigation on the above allegations. LPA met with Administrator Melanie Niez, who was informed of today’s visit. The investigation consisted of LPA observations and LPA interviews with pertinent parties. Regarding the allegation, resident has wounds due to staff neglect, interviews with five (5) staff and six (6) residents reveal, not enough witnesses to corroborate that a resident has wounds to due staff neglect. Regarding the allegation, staff are not feeding resident, five (5) staff interviews reveal residents are being fed. Five (5) out of (6) resident interviews reveal they are being fed and provided breakfast, lunch, and dinner. Regarding the allegation, staff are refusing to give resident their prescribed medication, five (5) staff interviews reveal staff are providing residents their prescribed medications. Six (6) resident interviews reveal, staff do not refuse to give them their prescribed medications. Unsubstantiated Regarding the allegation, staff are not meeting residents’ hygiene needs, five (5) staff interviews reveal, staff are meeting the needs of the residents. Six (6) resident interviews reveal staff are meeting their hygiene needs. Based on evidence obtained during this investigation, the allegations mentioned in this report are Unsubstantiated; meaning that although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. An exit interview was conducted with where this report was discussed. A copy of this report was provided with appeal rights to Administrator Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 23, 2024 · control 56-AS-20240603143519

Allegation investigated: Staff are not administering resident's medications.

Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPAs met with Administrator Melanie Niez and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and facility tour. For the allegation, Staff are not administering resident's medications. LPA Rico and LPA Hernandez conducted six (6) staff interviews and seven (7) resident interviews.During staff interviews 6 out of the 6 staff stated that residents receive their medication. 6 out of the 6 staff also stated they have not witness other staff members refuse to provide residents medication. Unsubstantiated In addition, 7 out of the 7 residents stated they receive their medications. 7 out of the 7 residents also stated they have not been denied. During medication audit, LPA Rico observed medications to be dispensed properly. Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Melanie Niez.the state’s words, verbatim · CDSS document, Sep 20, 2024 · control 56-AS-20240625091930

Allegation investigated: Staff did not ensure the facility was free of bed bugs. Resident is suffering emotional distress due to staff neglect

Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPAs met with Administrator Melanie Niez and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and facility tour. For the allegation, Staff did not ensure the facility was free of bed bugs. LPA Rico and LPA Hernandez conducted six (6) staff interviews and seven (7) resident interviews. During staff interviews, 6 out of the 7 staff stated they have not seen bed bugs. The Administrator stated that R1 has bed bugs. The administrator informed LPAs that the facility has ordered a new bed frame and bed mattress for R1. In addition, the facility hired pest management to spray products inside R1 room. Unsubstantiated During resident interviews, 5 out of the 7 residents stated they have not seen bed bugs in the facility. 2 out of the 7 stated they have seen bed bugs at the facility. In addition, R1 stated the facility will be replacing their bed frame and bed mattress. During record review, LPAs observed the pest control management came to the facility on 5/7/2024 and 6/12/2024 for bed bugs. In addition, LPAs received a copy of R1 new bedframe and bed mattress. For the allegation, Resident is suffering emotional distress due to staff neglect. LPA Rico and LPA Hernandez conducted six (6) staff interviews and seven (7) resident interviews. During staff interviews 6 out of the 6 staff stated they have not neglected their residents. In addition, 7 out of the 7 residents stated they have not been neglected from staff. Based on the evidence found during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Melanie Niez.the state’s words, verbatim · CDSS document, Sep 20, 2024 · control 56-AS-20240621102213

Allegation investigated: Staff hit resident

Licensing Program Analysts (LPAs) Magda Malcore and Becky Mann conducted an unannounced visit to the facility to conclude the complaint investigation on the above allegation. LPAs met with Administrator, Melanie Niez, who was informed of today’s visit. Regarding the allegation, staff hit resident, interviews with facility staff, resident #1(R1), and an outside party corroborate the allegation. Staff #1 admitted tapping R1 on the head during a disagreement. R1’s interview reveals they were hit on the head by S1. LPA record review and the Administrators’ interview reveals, S1 received a write-up and suspension for inappropriate conduct towards R1. Based on interviews and record review, the allegation is Substantiated. A Substantiated finding means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to the administrator at the conclusion of the visit Substantiatedthe state’s words, verbatim · CDSS document, Aug 9, 2024 · control 56-AS-20240506155415

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: Aug 12, 2024

Personal Rights of Residents in All Facilities.(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3)To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature…this requirement is not met as evidenced by: Based on interviews and record review, S1 admitted tapping R1 on the head during a disagreement, which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 9, 2024

Plan of correction: The Administrator terminated S1 on 5/21/24. No futher action is required.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced follow-up facility visit to gather information pertaining complaint # 56-AS-20240506155415 investigation. LPA met with Administrator, Melanie Niez, and discussed the purpose of the visit. During today’s visit LPA conducted interviews and obtained copies of relevant documents. An exit interview was conducted where this report was discussed and a copy of this report was provided to Administrator Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 16, 2024

Allegation investigated: Staff did not provide filtered water to drink to a resident per Admission Agreement

Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Melanie Niez, Administrator, and discussed the purpose of the visit. Regarding the allegation, staff did not provided filtered water to drink to a resident per Admission Agreement. LPA review of resident #1 (R1's) admission's agreement reveals no documentation of an agreement to provide filtered water. Based on interviews and record review, the above allegation is Unfounded. An Unfounded finding means, the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted where this report was discussed and a copy of this report was provided to the Administrator at the conclusion of the visit. Unfoundedthe state’s words, verbatim · CDSS document, Mar 21, 2024 · control 56-AS-20240314112044

Allegation investigated: Staff does not ensure facility is free of pests and rodents.

****This report has been Amended for electronic signatures**** Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Administrator, Melanie Niez and discussed the purpose of the visit. The investigation consisted of observations, reviewing pertinent documents, and interviews with relevant parties. Regarding the allegation, Staff does not ensure facility is free of pests and rodents, it is alleged that the facility has a roach and mice infestation and the facility is not making efforts to treat the problem. LPA toured the kitchen and (5) resident bedrooms. Regarding the roach infestation, LPA did not observe a roach infestation and there is not enough evidence to corroborate this allegation. In regards to the rodents, LPA observed in bedroom 11A, two (2) rodent traps. LPA observed one of the traps had a dead rodent, in the trap closest to the sliding glass door. LPA observed in bedroom 33, several rodent traps which included traps in the resident's closet, bathroom, and corners of the bedroom. Substantiated ****This report has been Amended for electronic signatures**** LPA review of exterminator services performed from December 2023 through today reveal, that on 1/9/24 bait traps were set in the kitchen, on 2/14/24 rodent traps were set in bedroom 11A and 33, on 2/29/24 bedroom 33 was rebaited, and today (3/8/24) rodent traps were set in bedrooms 11A and 33. In addition, on 2/29/24, the exterminating company made a documented recommendation to have the facility seal the bottom of the hallway backdoor and seal the bottom of bedroom 33's door. LPA asked the Administrator if these recommendations have been addressed, the Administrator stated the facility has hired an outside contractor that will be fixing the doors. Based on observation and interviews, the allegation is Substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where the Licensing reports were discussed with Administrator Niez. Copies of the Licensing reports were provided with Appeal Rights to Administrator Niez at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 8, 2024 · control 56-AS-20240304085608

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Mar 9, 2024

***this is an Amended Report*** 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 and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: The Licensee did not comply with section cited by not aggressively addressing the pest and rodent issue; which poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Mar 8, 2024

Plan of correction: Licensee/Administrator shall submit to the Licensing Agency a self-certification within 24 hours that an exterminator inspection has been scheduled to have the facility inspected for possible structural holes and recommendations for aggressive treatments to help prevent rodent infestations. Licensee/Administrator shall also submit to the Licensing Agency receipts that an extermination service and inspection has been conducted by 3/15/24.

Allegation investigated: Resident is not accorded dignity in relationships with staff. Staff did not assist resident with medications as needed.

Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to commence a complaint investigation regarding the allegations listed above. LPA met with Administrator, Melanie Niez, and explained the purpose of the visit and the elements of the allegations. LPA Banrasavong conducted the investigation which consisted of observation, interviews, and record review. LPA attempted on numerous occasions to contact the Reporting Party (RP) The contact number provided was not valid. LPA attempted to do a search through multiple channels and found no contact information within Community Care Licensing’s database. LPA was unable to obtain any additional information at this time. On 09/18/2020, Community Care Licensing received a complaint stating that staff did not assist resident with medications as needed and Resident is not accorded dignity in relationships with staff. In regards to the allegation of Staff did not assist resident with medications as needed. The allegation was made that the med tech was late in giving Resident 1(R1) medication late or did not give the resident medication at all. The LPA interviewed previous residents and the med tech that lived and worked at the facility during the 2020 year, which revealed there was no issues with medication getting to the resident from the Med Tech. (Continued on 9099-C) Unsubstantiated (Continuation from 9099) The second allegation in regards to Resident is not accorded dignity in relationships with staff. The allegation was made in regards to the staff member closing the doors to the smoke section. R1 alleged that there is a certain time from 7AM- 8PM, where the doors are supposed to be kept open. R1 stated that the staff would close the door. Information obtained from the interview conducted with Administrator stated that Resident is not accorded dignity in relationships with staff. According to the Administrator the R1 moved out of the facility in January 2022 and the Administrator stated that she did not have any forwarding contact information. The information that the LPA obtained during the investigation, showed that residents that have resided during the 2020 year and current new residents state that there are no issues in regards to the residents getting locked out of the smoking section during the hours of 6AM-9PM. Based on LPAs observations and record review(s), the preponderance of evidence standard has not been met, therefore the above allegation(s) of Staff did not assist resident with medications as needed, Resident is not accorded dignity in relationships with staff, are found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. An exit interview was conducted, a copy of this report, appeal rights was provided to the Administrator, Melanie Niez, as evidenced by her signature.the state’s words, verbatim · CDSS document, Nov 29, 2023 · control 18-AS-20200918151847

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Melanie Niez, Administrator, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). License capacity of (156) with a current census of (106). Hospice waiver for (20). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: PHYSICAL PLANT/INDOOR: Indoor passageways are free of obstruction. The facility has sufficient indoor space for resident activities. The facility has sufficient lighting and is maintained at a comfortable temperature. LPA inspected (6) resident bedrooms. Bedrooms were equipped with sufficient furniture, lighting, and bed linen in good repair. LPA inspected (6) bathrooms and (1) central bathroom. Bathrooms were equipment with grab bars and maintained in operating condition. Bathroom hot water temperatures measured between 105 and 107 degrees F. The facility is equipped with operating carbon monoxide alarms, telephone service, and laundry equipment. The facility has sufficient blankets, towels, and hygiene products for residents in care. Resident activities, Licensing complaint poster, Ombudsman poster, emergency phone numbers, evacuation plan, and "No Smoking-Oxygen in Use" signs were posted in the appropriate areas. Sharps, disinfectants, cleaning solutions, and toxins were kept locked and inaccessible to residents. PHYSICAL PLANT/OUTDOOR: Outdoor passageways are free of obstruction. Facility has no outdoor bodies of water. Courtyard area is protected from traffic and sufficient for resident activities. CARE & SUPERVISION: Facility has 24-hour/7 days a week care staff. FOOD SERVICE: Facility has sufficient non-perishable and perishable food supply for residents in care. The refrigerator and freezer are operating in a healthful manner. Pesticides and other cleaning solutions were kept locked and stored away from food areas. MEDICAL RELATED SERVICES: Facility has complete first aid kits. Medications were observed locked and inaccessible to residents. Medications for (6) residents were inspected. Medications for resident #1 (R1) were not administered as prescribed as medications for days past were observed still in the bubble packet with no documentation to why medication was not given. Medications for resident #2 (R2) were not administered as prescribed as medications for days past were observed still in the bubble packet with no documentation to why medication was not given. Medications for resident #3 (R3) were observed to be in a zip lock bag without a prescription label. Medications for resident #4 (R4) were not administered as prescribed as medications for days past were observed still in the bubble packet with no documentation as to why medication was not given. RECORDS REVIEW: Administrator certification expires on 8/18/2024. The last emergency drill was conducted on 11/07/23. Records for (6) staff were reviewed. The facility did not maintain verification of food service training for staff #1(S1) on file. The facility did not maintain verification of staff #2 (S2) CPR/first aid training on file. Records for (6) residents were reviewed. The facility did not maintain record of R3's preadmission appraisal on file. Deficiencies are being cited during today's visit and a plan of correction was reviewed with the Administrator. Copies of licensing reports discussed were provided to the Administrator with appeal rights at the conclusion on the visit.the state’s words, verbatim · CDSS document, Nov 16, 2023

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: Staff did not clean residents room

On 11/6/2023, Licensing Program Analyst (LPA), Janette Romero arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA met with Administrator, Melanie Niez and explained the purpose of the visit. During the course of the investigation, LPA reviewed resident and staff interviews and conducted a facility file review. On 8/28/2020, Community Care Licensing, received a complaint investigation stating that "Staff did not clean residents room". It was reported that facility staff did not clean Resident 1’s (R1’s) room for over a week and a half in 2020. The four (4) staff interviewed corroborated that R1’s room had not been properly cleaned, due to the facility facing a housekeeping staffing shortage. Continued on LIC9099-C. Substantiated Continued from LIC9099. The facility reported that resident’s rooms were scheduled for daily cleaning, which included wiping the surfaces and removing the trash. The facility also reported that residents' rooms were scheduled for a deep cleaning weekly; however, one (1) housekeeper was terminated and another housekeeper was scheduled to be off for three consecutive days. As a result, the facility had one (1) housekeeper scheduled and was unable to clean all 70 rooms in one week. The facility reported temporarily reassigning staff to help clean rooms, until staffing was adequate. Due to the staff shortage, it was revealed that staff were unable to clean residents’ rooms. Based on interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegation above is found to be Substantiated. The facility will be cited per section 87303 of Title 22 regulations. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Niez along with LIC9099-D and Appeal Rights.the state’s words, verbatim · CDSS document, Nov 6, 2023 · control 18-AS-20200828161015

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 16, 2023

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 evidenced by: Based on interviews conducted, the facility reportedly did not clean R1's room due to a staffing shortage. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 6, 2023

Plan of correction: The facility generated house keeping checklists and added a weekend house keeper to ensure all rooms are cleaned in a timely manner. Administrator showed LPA the checklists and proof of correction.