Brookdale Danville

Allegation investigated: Staff did not prevent a resident from hitting another resident in care. Staff did not maintain a comfortable temperature for a resident in care. Staff did not ensure that resident's call button was operable. Staff did not ensure that resident's room was cleaned. Staff did not bathe a resident in care. Staff are not providing night supervision Staff did not ensure that resident's medical device was operable. Facility did not report incidents to responsible party Staff did not respond to resident in a timely manner

On 7/13/2026 at 3:00 PM, Licensing Program Analyst (LPA), A. Gomez arrived unannounced to deliver complaint findings for the allegations above. LPA met with Business Office Coordinator, Kristy Andrews and explained the reason for the visit. During the course of the investigation interviews were conducted, resident records were collected, and observations were made. Report continues on LIC9099-C Unsubstantiated On the allegation “Staff did not prevent a resident from hitting another resident in care” During the coarse of the investigation the LPA attempted to identify the residents in question through interviews and reviews of available unusual incident reports however the LPA was unable to obtain additional information to identify the residents in question or the time frame of the alleged incident therefore the allegation is Unsubstantiated. On the allegation “ Staff did not maintain a comfortable temperature for a resident in care.” LPA toured the facility on multiple occasions including but not limited to residents’ rooms and common areas. LPA observed the facility to be of a comfortable temperature on all occasions. LPA did not receive any other additional information or documentation to support that the facility was not maintain a comfortable temperature therefore the allegation is Unsubstantiated. On the allegation “Staff did not ensure that resident's call button was operable.” LPA toured the facility on multiple occasions and observed that all available resident pendent systems were operable. LPA did not receive any other additional information or documentation to support that available resident call buttons were inoperable therefore the allegation is Unsubstantiated. On the allegation “Staff did not ensure that resident's room was cleaned” LPA toured the facility on multiple occasions. Previous citations were issued for resident rooms unclean however LPA was not able to identify a residents room unclean in relation to the allegation time frame. LPA did not receive any other additional information or documentation to support that "Staff did not ensure that resident's room was cleaned" therefore the allegation is Unsubstantiated. report continues on LIC9099-C On the allegation “Staff did not bathe a resident in care.” LPA reviewed bath logs, care notes, and care plans. LPA was unable to identify an instance where a resident in care did not receive adequate bathing assistance. LPA did not receive any other additional information or documentation to support that staff did not bathe a resident in care therefore the allegation is Unsubstantiated. On the allegation “Staff are not providing night supervision” LPA reviewed staff schedules and made observations. LPA was unable to identify inadequate staffing through record review and observations. LPA did not receive any other additional information or documentation to support that staff are not providing night supervision therefore the allegation is Unsubstantiated. On the allegation “Staff did not ensure that resident's medical device was operable” LPA reviewed list of R1’s items, care notes, and care plans. LPA was unable to identify an instance where Staff did not ensure that resident's medical device was operable. LPA did not receive any other additional information or documentation to support that Staff did not ensure that resident's medical device was operable therefore the allegation is Unsubstantiated. On the allegation “Facility did not report incidents to responsible party .” LPA reviewed unusual incident reports, care notes, and care plans. LPA was unable to identify an instance where a required incident was not reported. LPA did not receive any other additional information or documentation to support that Facility did not report incidents to responsible party therefore the allegation is Unsubstantiated. On the allegation “Staff did not respond to resident in a timely manner” LPA reviewed unusual incident reports, care notes, and care plans. Call button data was unavailable. LPA was unable to identify an instance where Staff did not respond to resident in a timely manner. LPA did not receive any other additional information or documentation to support that Staff did not respond to resident in a timely manner therefore the allegation is Unsubstantiated. report continues on LIC9099-C On the allegation “Staff is not adequately trained” LPA reviewed staff trainings and observed that they were up to date at the time of the alleged violations. LPA was unable to identify that Staff is not adequately trained. LPA did not receive any other additional information or documentation to support that Staff is not adequately trained therefore the allegation is Unsubstantiated. On the allegation “Staff did not properly store medications” LPA observed medication room, residents rooms, reviewed centrally stored log. LPA was unable to identify an instance where Staff did not properly store medications. LPA did not receive any other additional information or documentation to support that Staff did not properly store medications therefore the allegation is Unsubstantiated. On the allegation “Facility is not adequately staffed” LPA reviewed staff schedules and made observations of available staffing during all visits. LPA was unable to identify an instance where Facility is not adequately staffed. LPA did not receive any other additional information or documentation to support that Facility is not adequately staffed therefore the allegation is Unsubstantiated. On the allegation “Facility does not implement activities for residents” LPA reviewed multiple activities calendars and observed activities being done by residents on all visits. LPA was unable to identify an instance where Facility does not implement activities for residents. LPA did not receive any other additional information or documentation to support that Facility does not implement activities for residents therefore the allegation is Unsubstantiated. On the allegation “Facility is not providing adequate care” LPA reviewed unusual incident reports, care notes, and care plans for a random selection of residents. LPA was unable to identify an instance where Facility is not providing adequate care. LPA did not receive any other additional information or documentation to support that Facility is not providing adequate care therefore the allegation is Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 13, 2026 · control 15-AS-20250612143154

Type of visit: Required - 1 Year

On 4/15/2026 at 9:00 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Business Office Director, Kristy Andrews and explained the purpose of the visit. The facility’s fire clearance was approved for all may be non-ambulatory and 15 bedridden. LPA toured the facility with Maintenance including but not limited to residents apartments, bathrooms, activity room, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 73 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom measured between 105-120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Fire extinguisher was last serviced on 2/2/2026. First aid kit was observed to be complete. Emergency disaster drill completed 2/24/2026. Emergency Disaster plan reviewed 3/9/2026 LPA reviewed 5 residents records. LPA reviewed 5 staff records LPA advised facility to complete first aid training/ CPR for all required staff through such agencies as the American Red Cross and all staff were associated to the facility. Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 4/20/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 15, 2026

The state marks this report as 7 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 3/19/2026 Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct a case management visit. LPA met with Resident Care Coordinator, Christine Montemayor and explained the purpose of the visit. Executive Director, Cecily Palma was notified and arrived at approximately 11:20am On 10/3/2025 LPA A Gomez conducted a case management vist as a result of a self reported incident.During the visit on 10/3/2025 LPA observed residents room floors dirty and bathrooms unclean with dry fecal matter on the toilet in room 11. Operations Specialist stated that they are actively looking for a new maintenance and house keeping. LPA also observed that were not enough caregivers on shift. On 10/3/2025 there were 3 caregivers available, five out of twenty-three residents require a two person assist, facility states they were also hiring more care staff. LPA also observed facility common area/ activities area furniture (ie chairs and couches) in disrepair and damaged. LPA stated that they would return at a later date to cite for deficiencies observed and will now cite on todays date. LPA also observed on todays date dried blood on wall in room 18 and that common area chairs/sofas are in disrepair by being peeled/split on the cushions as well as the arm rests being soiled. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 19, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a)(2)(A) · Plan of correction due date: Mar 26, 2026

(a) A licensee shall ensure that infection control...as follows:(2) Environmental cleaning...at a minimum, as follows:(A)Surfaces ... visibly soiled with...potentially infectious material. This requirement was not met as evidence by: Based on LPAs observations the facility did not disinfect the visibly soiled surface in room 11. LPA observed that the surface had dried feces, dried blood on wall next to bed, and floors were unsanitary which posed a potential health and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 19, 2026

Plan of correction: By POC Facility agrees to provide an in service to all staff and notify CCLD

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(a) · Plan of correction due date: Mar 26, 2026

(a) Facility personnel shall at all times be sufficient in numbers...The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met as evidence by: Based on LPAs observations and record review facility care staff numbers is not suffient to meet the residents needs because on 10/3/2025 5 out of 23 residents require a two person assist and three caregivers and one medtech were on shift which posed a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 19, 2026

Plan of correction: By POC facility agrees to submit staff schedules and proof of trainings of other staff available to provide care if neccessary. LPA will asses if staff available is sufficient and follow up with facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(2) · Plan of correction due date: Mar 26, 2026

(d) The following...shall apply to all facilities:(2) The premises shall be maintained in a state of good repair... This requirment is not met as evidence by: Based on observation the facility did not maintain the furniture in a state of good repair by activities area sofas ripping at seams and exposing nails that pointed up which posed a potential safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 19, 2026

Plan of correction: By POC Facility will make a plan for repairs to furniture or relace and notify CCLD.

Type of visit: Case Management - Other

On 10/21/2025 at 12:00PM, Licensing Program Analyst (LPA) A Gomez conducted a case management while at the facility for complaint 15-AS-20250612143154. LPA met with Operations Specialist, Dimple Kamdar and explained the reason for the visit. During visit, LPA returned to follow up on documents that were requested. During the visit LPA was informed by Operations Specialist, Dimple Kamdar that they were advised by their legal team that corrective actions (write ups) will not be released to CCLD. LPA advised Operations Specialist, Dimple Kamdar of the regulation and requested the denial with reasoning in writing via certified mail. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: Facility not providing requested documents as allowed; Inspection Authority of the Licensing Agency The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 21, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87755(c) · Plan of correction due date: Oct 24, 2025

(c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours.... subject to the requirements in Sections 87412(f), 87506(d), and 87508(b) This requirement was not met as evidence by: Based on interview with Operations Specialist, Dimple Kamdar the facility is refusing to provide corrective actions/ writeups issued to staff which poses a potential personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Oct 21, 2025

Plan of correction: By POC Facility agrees to submit the requested documents via certified mail to CCLD. Documents requested are all corrective actions/writeups for S1-S3 durring their employment with brookdale and any and all corrective actions/writeups related to care for any and all staff in 2024- current 2025

Type of visit: Case Management - Incident

On 10/3/2025 at 9:00AM, Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct a case management visit in regards to a self report incident received on 9/24/2025. LPA met with Operations Specialist, Dimple Kamdar and explained the reason for the visit. Based on the report received on 9/24/2025, it is alleged that S1 and S2 are abusing residents. It is also alleged that S2 and S3 are not providing adequate care to residents. Executive Director (ED) Theresa Truong was also suspended for failure to escalate the alleged incidents of abuse. ED has since been terminated. During visit, LPA requested copies of S1-S3 personnel record including but not limited to any and all disciplinary actions/ write ups, most recent training records, job positions held, schedules for all of 2024 and 2025; Records of all staff for 2024-2025, staff schedules, all write ups related to care; Transcripts of the allegations of abuse made by an anonymous caller, ED full termination record. During the visit LPA observed residents room floors dirty and bathrooms unclean with dry fecal matter on the toilet in room 11. Operations Specialist states that they are actively looking for a new maintenance and house keeping. LPA also observed that there are not enough caregivers on shift. On 10/3/2025 there were 3 caregivers available, five out of twenty-three residents require a two person assist, facility states they are also hiring more care staff. LPA also observed facility common area/ activities area furniture (ie chairs and couches) in disrepair and damaged. LPA will cite for the deficiencies observed today on return visit. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Case Management - Incident

On 4/4/2025 at 12:30 PM LPA A Gomez arrived to conduct a case management as a result of an unusual incident report received on 3/27/2025. LPA met with Executive Director (ED), Teresa Truong and explained the purpose of the visit. On Saturday, 3/22/2025, R1 was found on the floor of their room by S1 and S2. S2 went for help and when they returned they reported seeing S1 stepping on R1 and R1 yelling out. There were no other witnesses. LPA reviewed the Physicians report and Needs and services for R1. R1 is diagnosed with dementia. R1 was also observed randomly yelling out in the presence of LPA seemingly without cause. R1 is unable to recall the event and has no visible injuries. ED states that they spoke with S2 who reported the incident and S2 states that they may have just seen the incident at a wrong angle but reported just to be safe. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 4, 2025

Type of visit: Required - 1 Year

On 4/10/2024 at 8:45 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Teresa Truong and explained the purpose of the visit. The facility’s fire clearance was approved for all may be non-ambulatory and 15 bedridden. LPA toured the facility with Executive Director including but not limited to residents apartments, bathrooms, activity room, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 72 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 108.9, 111.9, 112.4 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Fire extinguisher was last serviced on 1/09/2025. First aid kit was observed to be complete. Emergency disaster drill completed 3/25/2025. Emergency Disaster plan reviewed 4/10/2024 At 9:30AM, LPA reviewed 6 residents records. At 10:30AM, LPA reviewed 5 staff records and required staff have current first aid training and all staff are associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 4, 2025

Type of visit: Case Management - Incident

On 6/14/2024 at 2:00 PM LPA A Gomez arrived to conduct a case management as a result of an unusual incident report received on 5/24/2024. LPA met with Executive Director, Teresa Truong and explained the purpose of the visit. On Thursday, 5/23/2024, at 9:50 pm, staff heard screaming coming from room #9; staff ran to the room. and saw the R1 had a cane in hand attempting to hit R2 and R3 as they were on the floor.Staff were able to escort R1 out of the room, 911 was called for the R2 and R3, and they were sent to the hospital. Police were notified as well as all responsible parties. LPA reviewed the Physicians report and Needs and services for R1. Prior to the incident R1 did not require a 1:1 and did not have a record of violent tendencies. ED states that after the incident R1 was provided a 1:1 and assessed to see if there was a higher level of care. R1 did have additional outburst with staff after incident and family agreed that the facility was not appropriate for R1's care needs. R1 no longer resides at the facility. R2 and R3 have returned from the hospital and are back to baseline. The facility continues to monitor them for any changes. Staff were additionally trained on care for residents with dementia and aggressive behavior. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 14, 2024

Allegation investigated: Staff does not ensure facility is kept in clean, safe sanitary conditions for residents in care. Staff do not ensure resident care plans are followed. Staff do not ensure adequate care and supervision is provided to residents in care. Staff do not ensure reporting requirements are followed.

On 5/14/2024 at 09:10AM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Executive Director Teresa Truong. On the allegation facility staff does not ensure facility is kept in clean, safe sanitary conditions for residents in care. Based on observations and interviews the facility did not clean up vomit from R1’s floor. LPA observed the mess on the floor and spoke with W1 who said that it has been there for at least a week, and the floors have not been moped to clean it. On the allegation facility did not ensure resident care plans are followed. Based on record review and interviews the facility has not been putting the compression socks on R1 as instructed by his doctor and written in his care plan. Continued on 9099C... Substantiated ...Continued from 9099 On the allegation facility do not ensure adequate care and supervision is provided to residents in care. Based on record review and interviews the facility did not have enough staff. S1 stated that at the time of the complaint there was a shortage in staffing. On the allegation facility staff do not ensure reporting requirements are followed. Based on record review and interviews the facility was not reporting incidents that were happening. S2 stated that S3 was responsible for reporting but she left the facility and other staff were unaware of the reporting process and reporting requirements. Based on LPAs interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. Exit interview conducted. Appeal Rights and a copy of this report provided. ...Continued from 9099A On the allegation facility do not ensure residents are getting meals. Based on interviews the facilities meals are served at regular times each day and if a resident oversleeps or is busy at a mealtime, they will save a plate for them. When asked about special meals or assistance S1 state that the care staff know who needs help with meals and that they have a list of who has dietary restrictions. On the allegation Staff do not ensure medications are dispensed as prescribed for residents in care. Based on interviews the facility staff do dispense medication as prescribed for the residents and logs each dosage given in the medication log. Staff mark if a medication was refused or missed by a resident. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 14, 2024 · control 15-AS-20231222120155

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 28, 2024

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 was not met as evidence by: Based on observation, LPA observed vomit left uncleaned on the floor.the state’s words, verbatim · CDSS document, May 14, 2024

Plan of correction: Facility has since hired a full time housekeeper. POC cleared

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(4) · Plan of correction due date: May 28, 2024

There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement was not met as evidence by: Based on records review and observation LPA reviewed staff roster and staff schedules and observed that the facility did not have adequate staffingthe state’s words, verbatim · CDSS document, May 14, 2024

Plan of correction: Facility has since hired additional staff and are fully staffed. POC cleared

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: May 28, 2024

A written report shall be submitted to the licensing agency and to the person responsible for the resident ... This report shall include...date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidence by: Based on observation and interviews the staff working were unaware of how and where to report incidents to licensing.the state’s words, verbatim · CDSS document, May 14, 2024

Plan of correction: The facility agrees to train additional staff on the reporting process. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5)(A) · Plan of correction due date: May 28, 2024

When any medical assessment, appraisal, or observation indicates that the resident’s dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. Based on records review and interveiws the facility was not following directions made by reisdents doctor.the state’s words, verbatim · CDSS document, May 14, 2024

Plan of correction: The facility agrees to review the regulation regarding care plans.Proof of correction will be sent to CCLD by POC date.

Type of visit: Case Management - Incident

On 4/25/2024 at 1:30 PM Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct a Case Management visit in regards to an unusual incident report received 3/21/2024. LPA met with Executive Director, Teresa Truong and explained the purpose of the visit. CCLD received an unusual incident report dated 3/21/2024 That stated that on 3/17/2024, at approximately 3:00pm and 8:00 pm, R1 was given the wrong dose of medication. On 3/18/2024, Medtech noticed the medication error and notified the Area nurse Manager. R1 was given 8 mg of Ativan at 3:00 pm and 8:00 pm. R1 order is Ativan 2mg: take 2 tablets by mouth three times a day. Physician and responsible parties were notified. LPA spoke with Executive Director who stated that when the medication was renewed the milligrams per tablet went up and the Medtech(S1) did not notice. When giving R1 their medications they gave them the usual amount of tablets not noticing that because of the milligram increase they should have given less tablets. Executive Director acknowledged that it was an oversight and spoke with staff about the importance of paying attention to detail. A training was provided on Medication Procedures and Documentation on 3/20/2024. Medtech(S1) who gave the wrong dosage of medication was written up. Resident sustained no ill side effects. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 25, 2024

Allegation investigated: Staff did not inform resident's physician of resident's change of condition. Staff did not ensure resident's medication supply was available at the facility

On 4/10/2024 at 1:20PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct complaint investigation and to deliver complaint findings for the above allegations. LPA met with Executive Director, Teresa Truong and explained the purpose of the visit. During the investigation LPA interviewed the Executive Director and spoke with med-tech. While interviewing the Executive director, Teresa Truong confirmed that at the time of the complaint physicians were not being notified in a timely manner that is required by reporting requirements. ED also confirms the supply of medications was being mismanaged at the time. LPA interviewed med-tech who stated Health and Wellness director was in charge of medications and the availability of them and at the time Health and wellness director was not doing their job duty and medications were being overlooked. Health and Wellness director has been let go as a result Report Continues on LIC9099-C Substantiated LPA cited for CCR-87466 on complaint 15-AS-20240131134629 and will not be recited on this complaint. Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099Dthe state’s words, verbatim · CDSS document, Apr 10, 2024 · control 15-AS-20240227113854

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Apr 19, 2024

(a) A plan for incidental medical and dental care shall be developed by each facility. The ... assistance in obtaining such care...with the following: The licensee shall assist residents ...as needed. This requirement was not met as evidence by: Based on interviews LPA was informed that previous Health and Wellness Director was not insuring the availability of medications.the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: Executive Director dismissed Health and wellness director and trained Med-techs on the proper medication protocols

Allegation investigated: Staff do not ensure resident's hyigene is being met. Staff do not safe guard resident's personal items. Staff lock residents out of their bedrooms. Staff do not ensure reporting requirements are followed. Insufficient staffing to ensure adequate care and supervision is provided to residents in care.

On 4/10/2024 at 11:00AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct complaint investigation and to deliver complaint findings for the above allegations. LPA met with Executive Director, Teresa Truong and explained the purpose of the visit. During the invesgetation LPA interviewed the Executive Director, care staff, and activities coordiantor. LPA also toured the facility icluding the activies area, Laundry room, and random residents rooms. While interviewing the Exectuitive director, Teresa Truong confirmed that at the time of the complaint there was a shortage in staffing, and that residents hygine needs and care needs were not able to be met. Executive Director also confirmed that responsible parties were not being notified in a timely manner that is required by reporting requirements. Executive Director acknowledged that residents clothing was getting mixed up. Report continues on LIC 9099-C Substantiated LPA interviewed S1 in regards to residents personal items not being safeguarded. S1 stated that in the laundry room they personally know which clothes belongs to who but that newer caregivers do not. LPA also observed in the laundry room clothing not delegated to specific residents. LPA observed that there is now a system in place to manage clothing for residents but that it is not currently being utilized. LPA interviewed Activities Coordinator. Activities Coordinator confirmed that at the time of the complaint there was a shortage in staffing but that now it is starting to get better, and that residents care needs were not able to be met. Activities Coordinator also confirmed that they knew that responsible parties were not being notified in a timely manner that is required by reporting requirements. Activities Director also confirmed that sometimes residents clothing gets mixed up. While touring the facility LPA observed residents doors locked and that a majority of residents did not have their own key to get in. Executive director stated that when she arrived that was already the system in place and that they were looking to change it. Activities coordinator stated that doors are locked because some residents have wandered into other residents room and taken their belongings. Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099Dthe state’s words, verbatim · CDSS document, Apr 10, 2024 · control 15-AS-20240131134629

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Apr 19, 2024

Personal Rights of Residents in All Facilities This requirement is not met as evidenced by: Based on observation and interviews residents rooms are locked and most residents do not have a key and must ask to get let in which poses a potential health and safety risk to the persons in care. .the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: By POC date Executive Director agrees to have all residents’ rooms unlocked and give them a key, and self-certified that Executive Director understand resident personal rights by the and notify CCLD.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Apr 19, 2024

Safeguards for Resident Cash, Personal Property, and Valuables. Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not safeguarding resident's belongings which poses a potential health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: By POC date Facility has agreed to develop and implement plan to better safeguard resident's belongings in the future and notify to CCLD

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(4) · Plan of correction due date: Apr 19, 2024

Licensees who accept and retain residents with dementia shall be responsible for... the following: There is an adequate number of direct care staff to support each resident’s ... needs as identified in his/her current appraisal. This requirement is not met as evidence by: Based on observation and interviews there was not adequate staffing to meet residents needs.the state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: Executive Director has hired additional staff to meet care and hygiene needs of residents

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Apr 19, 2024

The licensee shall ensure that residents are regularly observed for changes in physical ... such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidence by: Staff was not notifing residents responsible party ofchanges in residents conditionsthe state’s words, verbatim · CDSS document, Apr 10, 2024

Plan of correction: Executive Director dismissed staff not reporting properly and a traing was provided.

Type of visit: Required - 1 Year

On 4/10/2024 at 9:45 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Teresa Truong and explained the purpose of the visit. The facility’s fire clearance was approved for all may be non-ambulatory and 15 bedridden. LPA toured the facility with Executive Director including but not limited to residents apartments, bathrooms, activity room, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 69 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 114.4, 119.5, 121.6 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Fire extinguisher was last serviced on 2/06/2024. First aid kit was observed to be complete. Emergency disaster drill not on file. At 2:30pm, LPA reviewed 5 residents records. At 3:00pm, LPA reviewed 5 staff records and 5 of 5 have current first aid training and associated to the facility. At 10:25AM , LPA reviewed a sample of resident’s medications. Report Continues on LIC809-C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:40 AM While touring LPA observed Hot water in room 12 measured at 121.6 degrees F At 3:21 PM during File review there are no records of Disaster Drills. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 4/19/2024: LIC 610E Emergency Disaster Plan (9 Pages) The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 10, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) A. Gomez and Licensing Program Manager (LPM) Y Flores-Larios arrived unannounced to conduct 1-Year Annual Required visit on this date starting at 9:30am. LPA was greeted by Executive Director (ED), Jasmine Seiffert. Health and Wellness Director Cheyenne Flores arrived at approximately 11:00AM during the tour. LPA and LPM toured facility with Executive Director including but not limited to random residents rooms, kitchen, common area and dining area. There were no accessible bodies of water. Hallways and passages were free of obstruction. Comfortable room temperature was maintained at 71 degrees F. Hot water temperature was tested at 115.8 degrees F in one of the bathrooms. Refrigerator temperature measured at 36.3F and Freezer measured at -3F. One week supply of nonperishable and 2-day supply of perishable foods were available and in compliance with regulations. Employee's files and residents files and a sample of medications were reviewed. Employees were fingerprint cleared. Centrally stored medications were locked in medication room. LPA observed a sample of medication. The facility had a written emergency disaster plan dated 11/27/2023. Disaster drill was last conducted on 09/21/2023. Smoke detector and sprinklers were observed throughout facility. Fire extinguisher was last serviced 9/12/2023. ED holds current administrator certificate that expires 7/22/2024 The following deficiencies were observed: At approximately 9:55AM during resident file review R4's file was missing Safeguards for Property/Valuables, Consent Form, and Personal Rights. At approximately 11:50AM during employee file review all employee files were observed incomplete. At approximately 11:55AM during employee file review it was observed that required staff are missing first aid training. Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 12/04/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Updated facility sketch The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 27, 2023

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.