Bright Star Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced, met with Administrator Jennifer Serrano and explained the purpose for the visit. The facility is licensed to serve 70 Ambulatory (which 50 may be Non-Ambulatory) residents ages 60+, with a approved hospice waiver for 20. This is a two-story facility located in Bellflower, Ca. A tour of the facility includes: First Floor: Front Office, Conference Room with Storage Room and File Room, Activity Room, Storage Closets Under Parking Port, Laundry Room, Dining Hall, Kitchen, Medication Room, Linen Closet and Outdoor Patio Areas. There are 3 buildings on first floor (A,B,F&G) totaling 16 Resident Rooms, 6 Full Bathrooms, 4 Half Bathrooms. Second Floor: 3 buildings totaling 28 Resident Rooms, 8 Full Bathrooms, 4 Half Bathrooms, Patio Area and Storage Closets. There are call buttons in and smoke detectors in each unit and there is an emergency sprinkler system throughout facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility maintains the required Infection Control Plan. Operational Requirements: The facility maintains an approved Fire Clearance and the required Liability Insurance which is valid until 11/17/26. Physical Plant & Environment Safety: LPA toured facility, a total of 10 residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably available. The resident rooms each had a signal system with call buttons that were tested an operating properly. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. (Continued on 809C) Physical Plant & Environment Safety (continued): The fire extinguishers were observed and are fully charged. No bodies of water were observed at facility. Hot water temperature was tested throughout the facility and measured outside the required range of 105-120 degrees, measurements were between 125.1-141.1 citation issued. The passageways are free of debris/hazards and are free of obstruction All storage areas for cleaning solutions, toxins, knives, and hazardous items are properly stored are inaccessible to residents. Staffing & Personnel Records-Training: There appears to be sufficient staffing at all times. Staff files are maintained in a secure location. Staff files observed during today’s visit have criminal record clearance, health screening and current First Aid/CPR/AED certificates. Administrator Jennifer Serrano certificate expires on 3/12/2027.(3 of the 6 files reviewed during visit were missing proof of completed trainings citation issued) Resident Rights-Information: Personal Rights and Complaint signage are posted within the Dining Hall. Resident Records-Incident Reports: Resident files are maintained in the Administrators Office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan (Technical Violation given for Appraisal Needs and Services Plans for R1 & R2 that were missing resident signatures, details provided on LIC 9102TV Form that was provided during visit). Planned Activities: LPA observed the Activity Schedule posted in the Dining Hall and toured the Activity Room, there were books, magazines, supplies for activities, board games and puzzles readily available for residents. The facility has a designated Activity Director. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medications are centrally stored in locked Medication Room and in their original containers. LPA reviewed 7 residents medications with no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Facility maintains documentation of the required emergency drills, last drill conducted on 8/5/26. Residents with Special Health Needs: The facility is in communication with the Home Health agency to ensure the needs of residents are being met. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the LIC809D page. Exit interview was held and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 25, 2026

Allegation investigated: Staff did not allow resident to return to the facility.

On 07/09/2026, Licensing Program Analyst (LPA) Jewel Baptiste conducted an initial 10-day complaint investigation in conjunction with case management. LPA met with the Administrator, Jennifer Serrano, and discussed the purpose of today's visit. During the initial visit, LPA interviewed the Administrator and one (1) staff member who shall be known as S2. S1 is not at the facility, and LPA attempted to contact them three (3) times. LPA interviewed a total of seven (7) residents who shall be known as (R1-R7). LPA also interviewed three (3) Deparment of Mental Health services employees/ Case workers for R1, who shall be referred to as W1- W3. R1’s family members were also interviewed, who shall be known as W4. LPA obtained the current Resident roster, staff roster, R1 appraisal/Needs and Services plan, R1’s physicians' report, Incident report dated 6/22/2026, Exit form from DMH/HSH, R1’s admission agreement, and R1 Identification and Emergency Information. Report continued on 9099c Unsubstantiated The investigation reveals the following: " Staff did not allow resident to return to the facility”. It is alleged that the facility did not allow R1 to return following their hospital stay. During the interview with the Administrator, they stated that R1 went to the hospital on 6/22/2026 and was discharged on 7/5/2026. On Wednesday, 7/1/2026, the hospital nurse contacted R2 and stated R1 is ready for discharge. R2 gave the phone to S1, who then gave the phone to S2. S2 stated that they told the nurse the hospital usually gives them 24 hours' notice before discharge to get R1 reassessed, and R1 was still feeling weak. All staff denied telling the hospital that R1 can not return to the facility. R1 and W4 stated that the administrator told them that they must be reassessed. All residents stated that the facility has never denied them access to return to the facility, nor have they heard any complaints from other residents regarding that topic. Interviews with all witnesses indicated it was a misunderstanding, and the facility never denied the resident's return. There were no eviction notices given. Based on LPA's interviews, the investigation revealed that although the allegation may have occurred or is valid, there is not a preponderance of evidence to prove whether the alleged violation occurred; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted with Administrator Jennifer Serrano and a copy of this record provided.the state’s words, verbatim · CDSS document, Jul 9, 2026 · control 28-AS-20260702094442

Type of visit: Case Management - Other

On 07/09/2026, Licensing Program Analyst (LPA) Jewel Baptiste conducted an initial 10-day complaint investigation in conjunction with case management. LPA met with the Administrator, Jennifer Serrano, and discussed the purpose of today's visit. LPA Baptiste stated to the facility that they need to ensure the facility understands that, although they must adhere to the Department of Mental Health's program, compliance cannot come at the expense of Title 22 regulations. The facility will conduct staff training to ensure all staff know how to answer questions whenever the hospital calls. Exit interview conducted with the Administrator, Jennifer Serrano, and a copy of the report provided.the state’s words, verbatim · CDSS document, Jul 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Daniel Konishi conducted the required annual inspection. LPA arrived unannounced and met the Administrator, Jennifer Serrano and the LPA explained the purpose of the visit. The facility is licensed to serve 70 Ambulatory (of which 50 may be Non-Ambulatory) residents ages 60 and over. With an approved hospice waiver for 20. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. The facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility maintains a current Plan of Operation and an approved Fire Clearance. The facility maintains the required Liability Insurance. Physical Plant & Environment Safety: This is a two-story facility includes: First Floor: Front Office, Conference Room with Storage Room and File Room, Activity Room, Storage Closets Under Parking Port, Laundry Room, Dining Hall, Kitchen, Medication Room, Linen Closet and Outdoor Patio Areas. There are 3 buildings on the first floor (A, B, F&G) totaling 16 Resident Rooms, 6 Full Bathrooms, 4 Half Bathrooms. Second Floor: 3 buildings totaling 28 Resident Rooms, 8 Full Bathrooms, 4 Half Bathrooms, Patio Area and Storage Closets. There are call buttons in and smoke detectors in each unit and there is an emergency sprinkler system throughout the facility. LPA toured facility, a total of 11 residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably available. Physical Plant & Environment Safety (continued): LPA observed two (2) evacuation chairs that were mounted nearby the stairways. The residents’ rooms each had a signal system with call buttons that were tested and operating properly. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. The fire extinguishers observed are fully charged and last inspected on 11/22/2024. No bodies of water were observed at the facility. Hot water temperature was tested in 11 bathrooms throughout the facility and measured from 105.2 degrees F to 118.4 degrees F which are within the required range of 105-120 degrees F. The passageways are free of debris/hazards and are free of obstruction. All storage areas for cleaning solutions, toxins, knives, and hazardous items that are properly stored are inaccessible to residents. Staffing: There appears to be sufficient staffing at all times with at least one night-time staff that is able to operate the facility signal system, is familiar with emergency procedures and has current CPR and First Aid training on file. Personnel Records-Training: LPA reviewed five (5) staff files which includes personnel record, criminal record clearance, health screening, TB clearance, valid First Aid/CPR/AED training, Employee Rights, dementia training, and sufficient on-going training. Administrator’s certificate expired on 03/12/2027. Resident Rights-Information: Personal Rights and Complaint signage are posted within the Dining Hall. Resident Records-Incident Reports: LPA reviewed seven (7) resident files that include: Admission Agreements, Identification & Emergency Information, current Physician's Report, TB Clearance, Ambulatory Status, Pre-admission appraisal/Appraisal Needs & Services Plan, and Personal Rights. Planned Activities: LPA observed the Activity Schedule posted in the Dining Hall and toured the Activity Room, there were books, magazines, supplies for activities, board games and puzzles readily available for residents. The facility has a designated Activity Director. Food Service: The kitchen was observed for its ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medications are centrally stored in locked Medication Room and in their original containers. LPA reviewed seven (7) residents’ medications and there were no issues. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. The facility maintains documentation of the required emergency drills. The last Fire Drill was conducted on 07/24/2025. Residents with Special Health Needs: The facility is in communication with the Home Health agency to ensure the needs of residents are being met. There are currently no residents under hospice service. LPA observed half bed rails in Resident #4 (R4's) bedroom and physician's order for a half bed rail for Resident #4 (R4) was not in file. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on 809D. Exit interview was held and a copy of the report and appeal rights were provided Administrator Jennfier Serrano.the state’s words, verbatim · CDSS document, Sep 15, 2025

Allegation investigated: Staff do not prevent residents from using illegal drugs.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent compliant visit to investigate the above allegation. LPA met with Assistant Administrator Jennifer Serrano, and the purpose for todays visit was explained. The investigation consisted of the following: During the initial visit dated 2/20/25 LPA obtained copies of Staff/Resident Rosters and toured facility. During todays visit LPA toured facility, LPA obtained Surveillance Videos via email, interviewed 3 Staff (S1-S3) and 6 Residents (R1-R6). (Continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff do not prevent residents from using illegal drugs. It is alleged that residents are doing crystal meth in the bathrooms. LPA toured facility and a total of 6 restrooms were inspected during the tour, smoking areas and patios were observed and there were no signs of drugs or drug use during the tour. Surveillance footage was also shared with LPA via email from dates 2-28-25,3-1-25 and 3-5-25 LPA reviewed videos and did not observe any unusual activity in the footage. LPA interviewed 3 staff and 3 out of 3 staff denied the above allegation and stated that they have not seen any of the residents using drugs in the facility and residents have not brought it to their attention. LPA interviewed 6 residents and 5 out of 6 residents denied the above allegation and stated the new administration has a zero tolerance for drug use at the facility, 2 residents stated that they did observe some residents doing drugs over a year ago, they never reported it and have not seen any of this happening since the new administration started a little over a year ago. Based on statements and interviews conducted with staff/residents, tour of facility, review of surveillance videos, and LPA’s observations, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was emailed to Jennifer at brightstarassistedliving@gmail.com.the state’s words, verbatim · CDSS document, Jul 8, 2025 · control 28-AS-20250219085029

Allegation investigated: Facility illegally evicted a resident in care.

Licensing Program Analysts (LPAs) Luis De Leon, Blanca Gonzalez, and Licensing Program Manager (LPM) Fernando Fierros conducted a follow up complaint investigation for the allegations listed above. LPA arrived unannounced and met with the Administrator Jennifer Serrano. The purpose for the visit was discussed. On 03/10/25, LPA DeLeon conducted the initial visit, during visit, LPA DeLeon owing on today’s visit: LPA along with Assistant Administrator and Operations Manager toured the kitchen and food pantry, including the common dining area. LPA toured kitchen and observed enough food, the meal being served during the lunch hour was also observed and appeared as a well-balanced meal: Baked Chicken, Rice, Mixed Green Salad, and mixed Vegetables. Serving portions were adequate for residents. LPA reviewed the food menu for January-February 2025. LPA obtained copies of the staff and resident roster, admission agreement, eviction letter, facility food menu and food supply orders. Report continues on page LIC9099-C Substantiated On today’s visit, LPA's De Leon, and Gonzalez and LPM Fernando Fierros met with Administrator Jennifer Serrano and assisted with the visit. The investigation consisted of LPAs obtaining copies of the staff and resident rosters, admission agreement, facility weekly menu for April, weekly food invoices for April, and eviction notice. LPA's toured the facility dining room, food pantry, and kitchen areas and observed food service for lunch. In regards to the allegation “Staff did not provide an adequate amount of food to a resident in care”. it is alleged that that facility serves sandwich and chip for dinner and residents are not provided with a sufficient amount of food. The investigation reveals the following: Seven (7) out of seven (7) staff denied that residents are not provided with an adequate portion of food during meals. Six (6) out of seven (7) residents denied receiving insufficient portions of food for each meals served at the facility, and, if seconds are requested or residents preferred not to have food from the menu, kitchen staff accommodated the residents by providing other food options. In addition, if residents were not able to have a meal at the schedule service time, the staff would store their meals for later. In addition, kitchen manager stated that if a resident prefers alternative meal other than the published meal on the food menu, the kitchen staff will prepare special meals per the resident's requests. The investigation revealed that residents are provided with adequate amount of food consisted of three meals a day and snack in between meals In regards to the allegation “Staff retaliated against a resident in care”. It is alleged that a resident is being evicted for filing a complaint. The investigation reveals the following: Seven (7) out of seven (7) staff denied knowledge of staff retaliating against residents for any reason. Six (6) out of seven (7) residents expressed being comfortable submitting a complaint to administration without fear of retaliation, none of the residents have heard of any residents being retaliated against for filing a complaint and expressed that staff treat residents with respect. Staff acts professionally even when residents do not follow facility rules, but none of the residents recall an incident where staff were disrespectful. The investigation revealed that residents are not retaliated against by staff and staff treat residents with respect, Based on statements and interviews conducted with staff/residents, review of R1's file and observations made during facility tour, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report and appeal rights were provided. On today’s visit, LPA's De Leon, and Gonzalez and LPM Fernando Fierros met with Administrator Jennifer Serrano who assisted with the visit. The investigation consisted of LPAs obtaining copies of the staff and resident rosters, Resident #1(R1's) admission agreement, facility weekly food menu for April, weekly food invoices, and R1's eviction notice. LPAs toured the facility dining room and kitchen. In regard to the allegation “Facility illegally evicted a resident in care”. It is alleged that a resident is being evicted for nonpayment for rent for basic services and for filing a complaint against the facility. The investigation reveals the following: One out of Seven staff were aware of a resident being evicted for non- payment of rent. Six (6) out of Seven (7) staff members were not aware of any resident being evicted from facility. Six (6) out of (7) residents are not aware of any evictions being issued to residents. Per Administrator the facility issued an eviction notice to a R1 on February 17, 2025 due to non payment of rent. Further review of eviction notice reveals that, although the reason of eviction is valid, the facility did not include information regarding resources available to assist with alternative housing or a referral for alternative housing. In addition, the facility did not include the resident's right to file a complaint with the State Long Term Care Ombudsman office and a message informing tenant that the facility must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. Therefore, the investigation revealed that the facility issued an illegal eviction notice to R1 on 02/17/25 and did not meet the required eviction guideline set forth by the California Code of Regulations, Title 22. Based on interviews conducted, observation and documents reviewed, the preponderance of evidence standard has been met, therefore the allegation is found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 8 are being cited on the attached LIC 9099-D. Exit interview held, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, May 1, 2025 · control 28-AS-20250303111044

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(d)(1)(B)(C)(D) · Plan of correction due date: May 8, 2025

87224 Eviction Procedures (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. (1) The notice to quit shall include the following information: This requirement is not met as evidenced by: During todays visit, LPA observed the Eviction Notice to R1 dated 02/17/25 was missing the following: Resources available, Referral Services, Right to file a complaint, unlawful detainer process and cross report to LTC0 Ombudsman isthe state’s words, verbatim · CDSS document, May 1, 2025

Plan of correction: Licensee will rescind the eviction notice issued to R1and copy licensing. Licensee will send a letter to licensing indicating the licensee has read and will comply with Section 87224 by POC due date.

Allegation investigated: Staff did not address a resident's change in medical condition. Staff did not properly dispose a needle. Staff mishandled a resident's medication. Staff served uncooked food to a resident. Staff sexually harassed a resident while in care. Staff unlawfully evicted a resident. Staff mishandled a resident's personal belongings.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Silvia Vidal and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of the staff and resident rosters, reviewed R1's file and obtained copies of relevant documents, LPA toured medication room and reviewed 7 residnets medications, LPA toured kitchen and observed meal being served for lunch, and LPA interviewed 5 Staff (S1-S5) and 7 Residents (R1-R7). (continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff did not address a resident's change in medical condition. It is alleged that R1 sustained multiple falls at facility. LPA interviewed R1 and it was stated that they did sustained falls at facility and staff assisted them after their fall, they refused to be admitted to be sent to hospital for further treatment. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation and stated that when there are falls they tend to the resident immediately, offer check for bruising or cuts, offer if they would like to go to the hospital for further treatment, if they decline hospital they monitor the resident post fall, the fall is then documented and an incident report is filed. If there is a change in medical condition observed staff will ask resident if they would like to see a doctor to be assessed, if refusal staff will document changes and let their physician know of the changes with the resident. LPA interviewed 7 residents and 7 out of 7 residents denied the above allegation and stated that staff assists them in a timely manner with any medical needs. Allegation: Staff did not properly dispose a needle It is alleged that R1 fell and stepped on a needle after a nurse failed to dispose it correctly. LPA interviewed R1 and it was stated that the needle that they stepped on was in their room but did not show the staff the needle or get assistance from staff with this incident. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation and stated that all medications, including injections are kept in the medication room, administered in the medication room and have never seen any needles on the floor, all needles are disposed of in a specific box, which LPA also observed during visit. LPA interviewed 7 residents and 6 out of 7 residents denied the above allegation and stated that they have never seen a needle on the floor and confirmed all medication is given at the medication room. Allegation: Staff mishandled a resident's medication It is alleged that R1’s medication would frequently get mixed up with another resident’s. LPA toured medication room reviewed 7 residents medications with no issues observed. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation. S4 and S5 assist with administering medication and stated that they are careful with the medication to avoid situations like these, they also stated that although residents may sometimes question their medication they will take the resident to the medication room and show them the medication in original package to confirm medication is for the resident. LPA interviewed 7 residents and 6 out of 7 residents denied the above allegation stating that they have never had any issues with their medication. (Continued on LIC9099-C) Allegation: Staff served uncooked food to a resident It is alleged that R1 was served uncooked food while living here that resulted in R1 getting sick multiple times. LPA toured kitchen and meal being served for day, the meat appeared to be well cooked. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation and stated that they have never had a resident complain that the food is uncooked and have not witnessed any residents getting sick from the food. LPA interviewed 7 residents and 6 out of 7 residents denied the above allegation and stated that although the chicken may be a little overcooked they have never observed it to be undercooked nor have they gotten sick from the food at the facility. Allegation: Staff sexually harassed a resident while in care It is alleged that R1 was sexually harassed by S1 and S2. LPA interviewed R1 and it was stated that S1 and S2 would try to hug and kiss R1, and that S1 would open the door to R1’s room at different hours of the night and watch R1 from the doorway. During interview with S3 it was revealed that the night shift does rounds every 2 hours, where they open the residents room door check to see the resident is present and will leave once they can confirm movement or that the resident is breathing, S3 also stated that they have never had any complaints against S1 and S2 of sexual harassment. LPA interviewed 5 Staff and 5 out of 5 staff denied the above allegation and stated that they have never sexually harassed a resident nor have they ever heard of another staff sexually harassing a resident. LPA interviewed 7 residents and 6 out of 7 residents denied the above allegation stating they have never been sexually harassed by staff. Allegation: Staff unlawfully evicted a resident It is alleged that R1 was not given proper notice that they were going to be forced to leave facility after R1 was hospitalized. During interview with S3 it was explained that R1 was hospitalized on a psychiatric hold, once released from the hospital the facility was notified that the resident was going to be transferred to a different facility, S3 spoke with family of R1 and it was confirmed that R1 will be moving to a facility closer to them, R1 was never evicted from facility. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation and confirmed that residents are given warnings prior to any evictions and have never witnessed an unlawful eviction. LPA interviewed 7 residents and 6 out of 7 residents denied the above allegation and stated that although they haven’t been evicted they have not witnessed another resident be evicted without reason. (Continued on LIC9099-C) Allegation: Staff mishandled a resident's personal belongings It is alleged that R1 was never given an opportunity to properly pick up their belongings and when R1 went to collect their belongings everything was in the front of the street, with items missing. LPA interviewed 5 staff and 5 out of 5 staff denied the above allegation stating that residents items are typically packed and stored in the storage room for at least 30 days to allow residents to collect their items. LPA interviewed S4, who assisted R1 with gathering their belongings and it was stated that R1s items were stored in the storage room near administrative office and R1 collected their items with no issues that day, R1’s items were never placed on the street. LPA interviewed 7 residents and 6 out of 7 residents denied the above allegation and stated that they have never witnessed any residents belongings on the street and feel staff handle their personal items with care. Based on statements and interviews conducted with staff/residents, review of R1's file and observations made during facility tour, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report will be emailed to Silvia Vidal at brightstarassistedliving@gmail.com.the state’s words, verbatim · CDSS document, Jan 23, 2025 · control 28-AS-20250115120125

Allegation investigated: Staff did not obtain permits to do construction on the facility.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to determine the validity of the above-mentioned allegation. LPA met with Jennifer Serrano and Silvia Vidal, and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of the staff and resident rosters, copy of the Cirrection Notice (stop work order) issued from City of Bellfower, and photo copies of work being done to dining. LPA interviewed 2 Staff (S1&S2) and 6 Residents (R1-R6). (continued on LIC9099-C) Substantiated The Investigation Revealed the Following: Allegation: Staff did not obtain permits to do construction on the facility. It is alleged that there is construction being done at facility and staff did not obtain proper permits for construction. LPA interviewed S1 & S2 and both confirmed that there was work done to repair a leak in the dining, as work was being done the city of bellflower code enforcement arrived and issued a stop work order, and advised staff to obtain the needed permits prior to continuing remodel. LPA obtained a copy of the Correction Notice dated 11/18/24 that indicated the Stop Work Order. LPA interviewed 6 residents and 6 out of 6 residents stated that the work being done in the dining did not affect them and that they are able to have meals in dining even with the remodel. LPA was never given prior notice for the work being done and the failure to report/ failure to submit an incident report of remodel will be cited in a Case Management visit today. Based on LPAs observations and interviews which were, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview held, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 12, 2024 · control 28-AS-20241209121049

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: Jan 3, 2025

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This standard was not met as evidence by: During interviews with S1 and S2 both confirmed that construction had begun to dining area and was stopped as City of Bellflower Code Enforcement arrived on 11/18/24 at 10:45am with a Stop Work Order and informed facility staff that all necessary approvals/permits must be obtained prior to continuing remodel in dining.the state’s words, verbatim · CDSS document, Dec 12, 2024

Plan of correction: Licensee/Administrator to email LPA a copy of permits/apporoval by POC due date along with any updates/paperwork from City of Bellflower regarding the remodel to dining area. tena.herrera@dss.ca.gov

Allegation investigated: Staff did not give resident a proper rate increase.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to determine the validity of the above-mentioned allegation. LPA met with Jennifer Serrano and Silvia Vidal, and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of the staff and resident rosters, Notice of Payment Standard for Individuals from Social Security, LPA reviewed 3 resident admission agreements and rates. LPA interviewed 2 Staff (S1&S2) and 6 Residents (R1-R6). (Continued on LIC9099-C) Unsubstantiated The Investigation Revealed the Following: Allegation: Staff did not give resident a proper rate increase. It is alleged that on 12/6/24 R1 was informed that they will have a rent increase of $400 and if they refused to pay the increase they would be evicted. LPA interviewed S1 and S2 and it was explained that the rent notification that was provided to residents was the new Social Security Payment Standard Increase that takes effect January 2025. This increase letter explains the new rate increase/adjustments to Social Security Income (SSI) benefits, the amount provided by SSI for room and board, and care and supervision has increased therefore the facility will now be receiving that new among. This came as a shock to residents as some residents were not used to paying their full amount that is on their agreement because the previous Administrator of the facility was not following protocol. Both S1 and S2 confirmed that the residents will not be charged back pay for the previous months but moving forward beginning in January 2025 residents will be responsible to pay the agreed amount. LPA reviewed R1’s admission agreement and the admission agreement indicated that the previous amount was for the previous year (2024) SSI amount for board and care. LPA also reviewed letter of increase that was given to R1 and it was the same as the Social Security Payment Standard Increase that was mentioned to LPA by Staff, LPA explained to R1 how this rate is done yearly and the facility themselves are adjusting the rent to match what Social Security is now providing for board and care costs. LPA interviewed 6 residents and 6 out of 6 residents indicated that they were provided with the rent increase letter in a timely manner, had no complaints and are used to the yearly minor adjustments to the rent. Based on statements and interviews conducted, review of client files and increase letters, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 12, 2024 · control 28-AS-20241209121049

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Tena Herrera conducted a Case Management Visit-Deficiencies on, stemming from initial complaint investigation conducted on 12/12/24, complaint control # 28-AS-20241209121049. LPA Herrera met with Jennifer Serrano and Silvia Vidal and explained the reason for visit. Case Management-Deficiencies findings: During complaint investigation it was revealed that facility Administrator/Licensee failed to report to the department of renovations that were being done to the facility dining area. Renovations began on approximately 11/13/24 and was stopped due to failure to obtain necessary approvals/permits by the City of Bellflower (failure for permit, cited on complaint visit). LPA was never informed of the remodel nor were there any incident reports provided to the department indicating there were plans for renovations. LPA will issue a deficiency on Reporting Requirements that can be found on the LIC809-D. Exit interview held, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 12, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80086(a) · Plan of correction due date: Dec 26, 2024

80086 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all licensees shall notify the licensing agency of the proposed change. This standard was not met as evidence by: Administrator/Licensee failed to report to the department of renovations that were being done to the facility dining area. Renovations began on approximately 11/13/24 and licensing became aware of remodel to dining due to a complaint that was generated on 12/9/24.the state’s words, verbatim · CDSS document, Dec 12, 2024

Plan of correction: Administrator/Licensee to submit an Incident Report to LPA by POC due date that discloses all renovations that have been done when it started, why it stopped and when it is schedule to end. Incident report can be emailed to LPA tena.herrera@dss.ca.gov

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and was greeted by MedTech/Caregiver Yakelin Carrillo, shortly after Luisa Mascardo (Administrator) arrived and assisted with the visit. The purpose for the visit was explained upon arrival. The facility is licensed to serve 70 Ambulatory (of which 50 may be Non-Ambulatory) residents ages 60 and over. With an approved hospice waiver for 20. (there are currently no residents on hospice at the facility). This is a two-story facility located in Bellflower, Ca. A tour of the facility includes: First Floor: Front Office, Conference Room with Storage Room and File Room, Activity Room, Storage Closets Under Parking Port, Laundry Room, Dining Hall, Kitchen, Medication Room, Linen Closet and Outdoor Patio Areas. There are 3 buildings on first floor (A,B,F&G) totaling 16 Resident Rooms, 6 Full Bathrooms, 4 Half Bathrooms. Second Floor: 3 buildings totaling 28 Resident Rooms, 8 Full Bathrooms, 4 Half Bathrooms, Patio Area and Storage Closets. There are call buttons in and smoke detectors in each unit and there is an emergency sprinkler system throughout facility. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility maintains a current Plan of Operation and an approved Fire Clearance. The facility maintains the required Liability Insurance. Physical Plant & Environment Safety: LPA toured facility, a total of 14 residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably available. The resident rooms each had a signal system with call buttons that were tested an operating properly. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. (Continued on 809C) Physical Plant & Environment Safety (continued): The fire extinguishers were observed and are fully charged. No bodies of water were observed at facility. Hot water temperature was tested throughout the facility and measured within the required range of 105-120 degrees. The passageways are free of debris/hazards and are free of obstruction All storage areas for cleaning solutions, toxins, knives, and hazardous items are properly stored are inaccessible to residents. Staffing: There appears to be sufficient staffing at all times with at least one nighttime staff that is able to operate the facility signal system, is familiar with emergency procedures and has a current CPR and First Aid training on file. Personnel Records-Training: Staff files are maintained in a locked storage room within the Conference Room. Staff files observed during today’s visit have criminal record clearance, health screening and current First Aid/CPR/AED certificates (with the exception of 1 staff that was missing First-Aid certificate, cited on 809-D), dementia training, and sufficient on-going training. Administrator Luisa Mascardo certificate expired on 5/28/24, but was able to provide proof of pending renewal and all current training were within the personnel file, CCL website showed pending renewal, expiration of 5/28/26.Resident Rights-Information: Personal Rights and Complaint signage are posted within the Dining Hall. Resident Records-Incident Reports: Resident files are maintained in the Administrators Office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan (1 of the resident files reviewed were missing their Physician Report, details cited on 809-D page). Planned Activities: LPA observed the Activity Schedule posted in the Dining Hall and toured the Activity Room, there were books, magazines, supplies for activities, board games and puzzles readily available for residents. The facility has a designated Activity Director. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medications are centrally stored in locked Medication Room and in their original containers. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Facility maintains documentation of the required emergency drills. Residents with Special Health Needs: The facility is in communication with the Home Health agency to ensure the needs of residents are being met. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on 809D. Exit interview was held and a copy of the report and appeal rights were provided Administrator Luisa Mascardothe state’s words, verbatim · CDSS document, Aug 15, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and was greeted by MedTech Venus Andres and later by Yakelin Carrillo (caregiver) and Luisa Mascardo (Administrator) who later assisted with the visit. The purpose for the visit was explained upon arrival. The facility is licensed to serve 70 Ambulatory (of which 50 may be Non-Ambulatory) residents ages 60 and over. With an approved hospice waiver for 20. (there are currently no residents on hospice at the facility). This is a two-story facility located in Bellflower, Ca. A tour of the facility includes: First Floor: Front Office, Conference Room with Storage Room and File Room, Activity Room, 16 Resident Rooms, 5 Full Bathrooms, 2 Half Bathroom, Dining Hall, Kitchen, Medication Room, Storage Rooms, Linen Closet and Outdoor Patio Area. Second Floor: 28 Resident Rooms, 6 Full Bathrooms, 4 Half Bathrooms, Patio Area and Storage Closets. Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan maintained at the facility. Operational Requirements: The facility maintains a current Plan of Operation and an approved Fire Clearance. The facility maintains the required Liability Insurance covering injury to residents and guests, however, the coverage for total annual aggregate is not within the required amount, details provided on the 809D page. Physical Plant & Environment Safety: LPA toured facility there are a total of 44 resident bedrooms (36 double rooms and 8 single rooms) a total of 15 resident rooms were checked and bedding/closet/drawer space to accommodate each resident comfortably was available. The passageways and patio areas were observed to be free of debris/hazards and are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available for residents. (Continued on 809C) The hot water temperature was tested throughout the facility and were above the required range of 105-120 degrees F, details will be documented on 809D page. All storage areas for cleaning solutions, toxins, knives, and hazardous items are properly stored are inaccessible to residents. Smoke detectors and carbon monoxide detectors are operable and in compliance. There fire extinguishers were observed and are fully charged. Facility operates a signal system LPA observed call buttons in rooms and restrooms that were toured. Staffing: There appears to be sufficient staffing at all times with at least one nighttime staff that is able to operate the facility signal system, is familiar with emergency procedures and has a current CPR and First Aid training on file. Personnel Records-Training: Staff files are maintained in a locked storage room within the Conference Room. Staff files observed during today’s visit have criminal record clearance, health screening with negative TB results and current First Aid/CPR/AED certificates and sufficient on-going training. Administrator Luisa Mascardo certificate expires on 5/28/24. Resident Rights-Information: Personal Rights and Complaint signage are posted within the Dining Hall. The facility does not have any clients that require postural supports. Facility provides a telephone land line for the residents. Resident Records-Incident Reports: Resident files are maintained in the Administrators Office and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. Planned Activities: Residents at the facility are encouraged to engage in planned activities. LPA observed the Activity Schedule posted in the Dining Hall and toured the Activity Room, there was books, magazines, supplies for activities, board games and puzzles readily available for residents. The facility has a designated Activity Director. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: The facility provides assistance in meeting necessary medical and dental needs to the residents. Medications are centrally stored within the locked Medication Room and in their original containers. During the visit today, LPA reviewed 7 residents’ medications, no issues were observed. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Facility maintains documentation of the required emergency drills. The facility does not have the required evacuation chairs at each stairwell, additional information documented on 809D. (continued on 809C) Residents with Special Health Needs: There is only one resident at the facility that utilizes services with Home Health and the facility is in communication with the agency to ensure the needs of resident are being met. The facility does not have any bedridden residents nor residents that have postural supports. LPA conducted 4 staff interviews and 5 resident interviews and reviewed 6 staff files and 6 resident files during today’s visit with no issues. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on 809D. Exit interview was held and a copy of the report was provided Administrator Luisa Mascardothe state’s words, verbatim · CDSS document, Oct 21, 2023