Brookdale Ocean House

Type of visit: Required - 1 Year

On September 13, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Executive Director Helen Lee and Resident Engagement Manager Sandra Solarano. LPA explained the purpose of today’s visit. The facility is licensed to serve 150 non-ambulatory elderly residents and an approved hospice waiver for (5) residents. Currently the facility has (3) residents on hospice care. The facility is a 10-story high-rise apartment building located in a residential beach neighborhood. It comprises 116 apartment units, which include 16 one-bedroom apartments, 92 studios, and 7 deluxe studios. The building features several amenities, including: a concierge, a patio area, two living rooms, a restaurant-style dining room, a private dining room, a commercial kitchen, an exercise/game room, a wellness/medication room, a beauty salon, a library/computer lounge, an activity/exercise room, and a TV/movie theater room. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected rooms: #210; #212; #314; #317; #407; #414; #505; #512; #605, and #611. The water temperature range from 105.0 - 111.9 degrees F. and room temperature range from 74 - 76 degrees F., call buttons, and smoke and carbon monoxide are all in operating condition. Evaluation Report continues LIC 809C LPA observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged. A review of Disaster, Elopement and Fire Drills was completed on 05/31/25, 07/31/25 and 08/31/25. Several working landline phones are available on-site. A review of Medication Administration Records found to be in order and accurate. During the visit LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters, including the Activities Calendar and Food Menu, were posted. The facility included stairway evacuation chairs in all the stairwells. An audit of resident's service records for residents #1-#6 (R1-R6) and staff personnel records for staff #1-#6 (S1-S6) were accurate and complete. The facility is current on Community Care Licensing annual dues. The facility has a current administrator certificate on file for Helen Lee #702209740 03/20/24 through 03/19/26 RCFE. The facility has a Liability Insurance Certificate valid with policy # SSIL-02-2025 effective 12/31/24 through 12/31/25. No Deficiencies were identified during this inspection visit. An exit interview was conducted, and a copy of this report was provided to Helen Lee.the state’s words, verbatim · CDSS document, Sep 13, 2025

Allegation investigated: Licensee does not ensure enough staff to meet residents needs Staff leave residents soiled for an extended period of time Staff are not properly supervising residents who may be a fall risk Staff are not answering call buttons in a timely manner

***This report supersedes the original report delivered on 5/21/2025. On 7/3/2025 at 8:50AM, the LPA arrived at the facility to deliver the corrected 9099, providing clarification on the original report issued on 05/21/2025. *** On 5/21/2025, at 9:19 AM Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct and deliver findings for the alleged allegations. LPA identified herself and met Helen Lee-Administrator who was informed of the purpose of the visit. The investigation consisted of the following: On 5/21/2025 at 9:25 PM, LPA Allen requested and obtained the personnel and resident roster, unusual incident reports (UIRs), and observations of the internal incident log/notes. Additionally, LPA conducted interviews with twelve (12) residents and nine (9) staff members, as well as observations of residents and staff interactions during the visit. Unsubstantiated Investigation revealed the following: #1- Allegation: Licensee does not ensure enough staff to meet residents needs LPA conducted interviews with twelve (12) residents (R1-R12), and 9 out of 12 residents stated the licensee ensures there is adequate staffing to meet their needs. LPA attempted to interview three (3) residents who chose not to participate in the process during the visit. The interviews with nine (9) staff members (S1-S9), 9 staff members revealed that there is adequate staffing to meet the residents’ needs, although there may be instances where individuals call out. But alternate measures are taken to maintain adequate staffing daily by calling backup staff for coverage. LPA also observed the staff schedule for the month of May 2025 which appeared that there is sufficient staff to care for the needs of the residents. #2- Allegation: Staff leave residents soiled for an extended period of time LPA conducted interviews with twelve (12) residents (R1-R12), and 9 out of 12 residents reported that they are not left soiled for an extended periods, with staff checking on them every 2-3 hours or as needed. LPA attempted to interview three (3) residents who declined to participate in the interviewing process during the visit. Additionally, LPA observed staff performing routine checks and assisting residents who required care or support. Interviews with nine (9) staff members (S1-S9) further indicated that they have not encountered any instances of a staff member or resident reporting that a resident was left soiled for an extended period. Staff stated residents are routinely checked on every 2-3 hours across all shifts to help the residents in care and or as needed. #3- Allegation: Staff are not properly supervising residents who may be a fall risk LPA conducted interviews with twelve (12) residents (R1-R12), and 9 out of 12 residents stated that they receive assistance with their needs, and the staff members are always encouraging them to use their ambulation devices to avoid falls. LPA attempted to interview three (3) residents who chose not to participate in the interview process during the visit. Additionally, LPA observed staff carrying out routine checks, encouraging residents to use their walkers, and assisting residents requiring care or support, contributing to fall prevention. LPA also noticed staff members assisting residents in the common area during the visit. Interviews with nine (9) staff members (S1-S9) further stated staff members encourage and implement appropriate measures to ensure residents, including those at risk of falling, are properly supervised to prevent falls. Furthermore, staff stated residents are regularly checked on every 2-3 hours across all shifts to provide necessary care and support. #4- Allegation: Staff are not answering call buttons in a timely manner LPA conducted interviews with twelve (12) residents (R1-R12), and 9 out of 12 residents reported receiving assistance with their needs, with staff checking on them every 2-3 hours or as needed. Residents also stated when they use their call buttons, assistance is provided immediately. If staff members are occupied assisting others, alternate measures are taken by other staff to ensure residents receive timely support. LPA attempted to interview three (3) residents who declined to participate in the process during the visit. Additionally, LPA observed staff performing routine checks and assisting residents requiring care or support. Interviews with nine (9) staff members (S1- S9) stated staff members implement appropriate measures to ensure residents receive timely assistance when using their call buttons, including those at risk of falling. Staff also stated that residents are routinely checked on every 2-3 hours across all shifts to provide necessary care and If staff members are occupied assisting others, alternate measures are taken by other staff to ensure residents receive timely support. Based on observations, record reviews, and interviews with staff members and residents, the evidence gathered during the investigation indicates that the above allegation is unsubstantiated. This means that while the allegation may have occurred or holds validity, there is insufficient evidence to determine whether the alleged violations did or did not take place. An exit interview was conducted where this report was discussed and provided to Helen Lee-Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 3, 2025 · control 11-AS-20250512120417

Allegation investigated: Licensee does not ensure enough staff to meet residents needs Staff leave residents soiled for an extended period of time Staff are not properly supervising residents who may be a fall risk Staff are not answering call buttons in a timely manner

On 5/21/2025, at 9:19 AM Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conducted and deliver findings for the alleged allegations. LPA identified herself and met Helen Lee-Administrator who was informed of the purpose of the visit. The investigation consisted of the following: On 5/21/2025 at 9:25 PM, LPA Allen requested and obtained the personnel and resident roster, unusual incident reports (UIRs), and observations of the internal incident log/notes. Additionally, LPA conducted interviews with twelve (12) residents and nine (9) staff members, as well as observed resident and staff interactions during the visit. Investigation revealed the following: Unsubstantiated Allegation: Licensee does not ensure enough staff to meet residents needs LPA conducted interviews with twelve (12) residents (S1-S12), and 9 out of 12 residents stated the licensee ensures there is adequate staffing to meet their needs. LPA attempted to interview three (3) residents who chose not to participate in the process during the visit. The interviews with nine (9) staff members (S1-S9) all 9 staff revealed that there is adequate staffing to meet all resident needs, although there may be instances where individuals call out. However, measures are in place to maintain adequate staffing daily. LPA also observed the staff schedule for the month of May 2025 which appeared that there is sufficient staff to care for the needs of the residents. Allegation: Staff leave residents soiled for an extended period of time LPA conducted interviews with twelve (12) residents (S1-S12), and 9 out of 12 residents reported that they are not left soiled for an extended period, with staff checking on them every 2-3 hours. LPA attempted to interview three (3) residents who declined to participate in the interviewing process during the visit. Additionally, LPA observed staff performing routine checks and assisting residents who required care or support. Interviews with nine (9) staff members (S1-S9) further indicated that they have not encountered any instances of a staff member or resident reporting that a resident was left soiled for an extended period. Staff confirmed that residents are routinely checked on every 2-3 hours across all shifts to help the residents in care. Allegation: Staff are not properly supervising residents who may be a fall risk LPA conducted interviews with twelve (12) residents (S1-S12), and 9 out of 12 residents stated that they receive assistance with their needs, with staff checking on them every 2-3 hours. LPA attempted to interview three (3) residents who chose not to participate in the interview process during the visit. Additionally, LPA observed staff carrying out routine checks and assisting residents requiring care or support, contributing to fall prevention. LPA also noted staff members assisting residents in the common area during the visit. Interviews with nine (9) staff members (S1-S9) further confirmed that all staff members implement appropriate measures to ensure residents, including those at risk of falling, are properly supervised to prevent falls. Furthermore, staff stated that residents are regularly checked on every 2-3 hours across all shifts to provide necessary care and support. Allegation: Staff are not answering call buttons in a timely manner LPA conducted interviews with twelve (12) residents (S1-S12), and 9 out of 12 residents reported receiving assistance with their needs, with staff checking on them every 2-3 hours. Residents also stated that when they use their call buttons, assistance is provided immediately. If staff members are occupied assisting others, alternate measures are taken by other staff to ensure residents receive timely support. LPA attempted to interview three (3) residents who declined to participate in the process during the visit. Additionally, LPA observed staff performing routine checks and assisting residents requiring care or support. Interviews with nine (9) staff members (S1- S9) further confirmed that all staff members implement appropriate measures to ensure residents receive timely assistance when using their call buttons, including those at risk of falling. Staff also stated that residents are routinely checked on every 2-3 hours across all shifts to provide necessary care and support. Based on observations, record reviews, and interviews with staff members and residents, the evidence gathered during the investigation indicates that the above allegation is unsubstantiated. This means that while the allegation may have occurred or holds validity, there is insufficient evidence to determine whether the alleged violations did or did not take place. An exit interview was conducted where this report was discussed and provided to Helen Lee-Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 21, 2025 · control 11-AS-20250512120417

Allegation investigated: Facility staff do not prepare meals in a sanitary manner. Facility staff do not follow proper food and general sanitation practices. Facility staff do not store food properly. Facility staff do not provide adequate food service. Facility equipment is in disrepair.

The investigation consisted of the following: On 03/14/2025, Licensing Program Analysts (LPAs) Regina Cloyd and Jose Anguiano conducted a complaint investigation at the above facility to address the following allegations. LPAs met with Business Office Manager Esmeralda Ornelas and Sales Manager Pro Jenn O'Brien Chavez and explained the purpose of the visit. Executive Director Helen Lee joined us later. LPAs conducted resident and staff interviews, toured the kitchen and dining area, and collected facility and staff records. On 03/27/2025, LPA Cloyd conducted a subsequent complaint to deliver findings. LPA met with Business Office Manager Esmeralda Ornelas and Executive Director Helen Lee. Allegation: Regarding the allegation "Facility staff do not prepare meals in a sanitary manner,” it is being alleged that kitchen staff often do not wash or sanitize their hands before cooking and frequently do not wear gloves while handling raw food and serving the residents. Continue to LIC9099-C. Unsubstantiated Record review revealed 15 out of 15 staff have their food handler certifications. On 03/21/25, a third-party vendor conducted an inspection, and the record revealed that employee training was not needed. Six out of six staff (S2 – S7) interviews indicated they use gloves while handling raw foods. Interview with S3 indicated that staff wash their hands at all times and whenever they switch jobs they immediately wash their hands to prevent contamination. During the kitchen tour, LPA Cloyd observed staff wearing gloves while preparing pizza and sandwiches. LPA observe a Sanitation & Food Safety sign that discusses food handling. During the dining room tour, LPA did not observe staff wearing gloves while serving residents. Regarding the allegation “Facility staff do not prepare meals in a sanitary manner," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Facility staff do not follow proper food and general sanitation practices,” it is being alleged food is improperly stored; for example, staff often place uncovered raw food next to uncovered cooked food in the refrigerator. It is also alleged that kitchen staff store unlabeled items, such as condiments, making it unclear whether these items are expired or not. It is alleged the kitchen is filthy, the vent over the stove is grimy and covered in layers of black soot and the mop used to clean the kitchen and dining area is dirty and has not been cleaned for months. Six out of six (S2-S7) staff interviews indicated food is properly stored and items are labeled with expiration dates. Interview with S2 indicated that uncooked food will always be on the bottom shelf and cooked food would be above it; never next to each other. During kitchen tour, LPA Cloyd did not observe uncovered raw food next to uncovered cook food in the refrigerators. LPA observed labeled condiments with prepared and expired dates. Though the expired dates were in the time slot. LPA observed refrigerator posters for proper food storage order: ready-to-eat foods, raw seafood, raw whole meats, raw ground meats, and raw poultry (should be stored from top to bottom). LPA observed quick reference guides for how long dry goods and frozen foods can be stored. Continue to LIC9099-C. LPA observed a clean kitchen, clean vents over the stove, and new mop heads. Interview with S3 indicated that the vents are cleaned everyday and it is the responsibility of the dinner cook. S3 indicated that mop heads are changed every week and are cleaned every night outside with hot water and bleach. On 03/21/25, a third-party vendor conducted an inspection, and the record revealed that the mop sink equipment is in good condition. Record review of the kitchen cleaning schedule (02/24/25 – 03/01/25) revealed the vent hood filters and hood ledge were cleaned everyday by staff. Regarding the allegation “Facility staff do not follow proper food and general sanitation practices," based on interviews, observations, and record review, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Facility staff do not store food properly,” it is being alleged that food is sometimes placed on the floor due to a lack of space in the kitchen. Recently, there was an instance where soup was left uncovered on the kitchen floor. Six out of six staff (S2 – S7) interviews indicated that there is adequate kitchen space to store food. During the kitchen tour, LPA Cloyd did not observe any food stored on the floor and the kitchen has adequate space. Regarding the allegation “Facility staff do not store food properly,” based on interviews and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Facility staff do not provide adequate food service,” it is being alleged residents are provided with chipped and broken plates and the filters for the ice machine and water stations have not been changed. Six out of six staff (S2 – S7) interviews indicated damaged plates are removed and placed into a bin for disposals. Interview with S3 indicated that damaged plates are placed in a specific bucket and dumped every week. Continue to LIC9099-C. Eight out of eight resident interviews indicated they have not received food on chipped plates and adequate food services is provided. During the kitchen tour, LPA Cloyd observed about 3 out of 100 plates with smooth chips about a ½” in size and posed no threat to residents. On 03/21/25, a third-party vendor conducted an inspection, and the record revealed that the kitchen filtration system is in good condition. Regarding the allegation “Facility staff do not provide adequate food service,” based on record review, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Facility equipment is in disrepair,” it is being alleged that there are broken floor tiles in the kitchen and other areas, the dishwasher is malfunctioning, and a refrigerator next to the soda machine leaks water onto the floor. Five out of six staff interviews indicated that there are no broken tiles, no leaky refrigerator, and no malfunctioning dishwasher. Interview with S2 indicated there was a condensation backup but it was cleared about two months ago. During the kitchen tour, LPA Cloyd observed one imperfect kitchen tile that was lower than the surrounding tiles. LPA observed about five imperfect tiles with thin cracks but there were no loose pieces. LPA observed a functioning dishwasher. LPA did not observe a leaky refrigerator near the soda machine. On 03/21/25, a third-party vendor conducted an inspection, and the record revealed that the floors and dishwasher machine are in good condition. Regarding the allegation “Facility equipment is in disrepair,” based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Executive Director Helen Lee.the state’s words, verbatim · CDSS document, Mar 27, 2025 · control 11-AS-20250307153652

Allegation investigated: Facility staff did not dispense medications as prescribed. Facility staff did not respond to resident's call button.

The investigation consisted of the following: On 10/31/2024, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced complaint investigation at the above facility to address the following allegations. LPA conducted resident and staff interviews and reviewed medication, training, and facility records. On 12/04/24, LPA conducted a subsequent complaint investigation and met with Executive Director Helen Lee and explained the purpose of the visit. During today’s investigation, LPA reviewed resident and facility records, reviewed medication, and interviewed staff. Regarding the allegation "Facility staff did not dispense medications as prescribed," it is being alleged staff gave Resident #1’s medication late or not at all. Specifically, medication #1, #2, and #3 was not given as instructed. Record review revealed medication #1 was administered daily except once in September 2024 and twice in October 2024 due to not being at the facility and hospitalization. Continue to LIC9099-C. Unsubstantiated Medication #2 was administered daily except for twice in September and eleven times in October due to medication refusal, not being at the facility, and hospitalization. Medication #3 is a pro re nata (PRN) and was administered once in September. Medication #1 and #2 are to be given daily and they were given as prescribed. LPA observed the labeling instructions for medication #1, #2, and #3 and it matches the instruction listed on electronic medication administration record. Plus, the label did not list a specific time but but morning for medication #2. Seven out of ten staff members indicated there hasn’t been any medication complaints in September nor October. One staff member was unable to recall. One staff indicated residents only complain if there are no refills or if the doctor discontinues the medication without them knowing. One staff indicated resident complained when medication did not arrive on time due to the hospital pharmacy. Three out of nine residents indicated staff has not made medication errors. One resident is unaware if errors are made and five residents do not need medication assistance. Regarding the allegation “Facility staff did not dispense medications as prescribed," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Facility staff did not respond to resident's call button," it is being alleged Resident #1 (R1) had three unwitnessed falls and even though R1 pressed R1’s emergency bracelet, R1 remained on the floor for one fall from 1:00 AM to 8:00 AM. Record review revealed R1 made five calls after 10:00 PM that exceeded 10 minutes (in October 2024). The response time ranged from 18 – 32 minutes. Interview with the Administrator (S1) indicated that the call logs do not clear right away because staff clear the calls while leaving. S1 indicated that staff will provide care to the resident first and then clear the call. LPA observed call bracelet with magnetic strip and call system on the monitor at the front desk. Interview with S1 indicated the facility has 24-hour concierge services. Eight out of ten staff interviews indicated staff responds to call buttons within ten minutes or they will radio for assistance. Six staff interviews, including S1, indicated they carry pagers on all shifts. Interview with S1 indicate staff conduct a couple of rounds per shift and will respond to calls within 7 – 15 minutes. Four out of nine resident interviews indicated staff respond within 10 – 30 minutes. Five out of nine resident interviews indicated they have not made calls at night. Continue to LIC9099-C. Regarding the allegation “Facility staff did not respond to resident's call button," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Administrator Helen Lee.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 11-AS-20241025161602

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Helen Lee, Executive Director and the purpose of the visit was discussed. Facility is licensed to serve 150 non- ambulatory elderly residents and an approved hospice waiver for 5 resident. None of the residents are diagnosed with dementia or receiving home health or hospice care services. The facility does not handle any of the residents’ money. LPA reviewed 8 resident and 8 staff records along with medication records during this visit. The facility is a 10-story high-rise apartment building located in a residential beach neighborhood. The facility consisted of the following: 116 apartment units/with bathrooms, (16) 1- bedroom, (92) studio, and (7) deluxe studio. The facility also includes the following:1st-floor concierge desk, open patio area, in front of the facility, with patio chairs, (2) living rooms with piano and audio speaker sound system, restaurant style dining room, private dining room for special occasions, and a kitchen. The 2nd-floor includes an exercise/game room and wellness/medication room. The 3rd-floor includes a beauty salon including a manicure/pedicure station. The 10th-floor includes a library/computer/lounge room, activity/ exercise room, outside patio/ garden area and TV/movie theater room. All areas were observed to be properly furnished, free of hazards, and appropriate for group activities. LPA and Executve Directorr toured the Resident bedrooms on the 10th floor, room 1003, the 8th floor room 815, the 7th floor room 710, the 6th floor rooms 607 and 611, the 5th floor rooms 506 and 516, 2nd floor room 204. All had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 120 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents on the 2nd floor Medication room. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. Exit interview conducted with Helen Lee, Executive Director and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2024

Allegation investigated: Staff mishandled a resident's medication while in care Staff did not provide adequate supervision to a resident Staff did not seek timely medical attention for a resident

This is an amendment of the complaint investigation report dated 07/19/2024. The purpose of this amendment is to provide additional evidence obtained from records reviewed during the investigation. This amendment does not change the findings and the findings remain unsubstantiated. On 07/19/2024 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, complaint visit to the above-mentioned facility at 9:00AM. LPA arrived at facility and was met by, Helen Lee, Executive Director (S1), and the purpose of the visit was explained. The investigation consisted of the following: On 10/03/24 LPA arrived at the facility at 09:30 to deliver this amended document. On 08/23/23 LPA obtained and reviewed facility documents, which included staff facility roster and facility resident roster and copies of resident’s medication admission record (MAR) (R1) and LPA interviewed four (4) residents and four (4) staff. On 07/19/24 LPA conducted a subsequent, unannounced, complaint visit to the above-mentioned facility at 9:00AM. LPA arrived at facility and was met by, Helen Lee, Executive Director (S1). LPA was given the Personnel Report (LIC500) and Register of Facility Clients/Residents and LPA interviewed eight (8) residents and two (2) staff. Report continues, see LIC9099C. Unsubstantiated The investigation revealed the following: Regarding the allegation: "Staff mishandled a resident's (R1) medication while in care". Interviews revealed that two (2) out of two (2) staff and eight (8) out of eight (8) residents have denied the allegation had taken place. Record reviews indicate that one of R1’s medications has two sets of administration records on file for August 2023. The first set of the medication was self administered on 08/01/23 and was discontinued on 08/02/23 and the second set of medication administration record indicates that the same medication was resumed, and administered on, 08/03/23 – 08/22/23. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Therefore, the above allegation is found to be Unsubstantiated. Regarding the allegation: "Staff did not provide adequate supervision to a resident". Interviews revealed that two (2) out of two (2) staff and eight (8) out of eight (8) residents have denied the allegation had taken place, R1 indicated that they do not have any issues with the supervision being provided by staff. Record reviews indicate that one of R1’s medications has two sets of administration records on file. The first set of the medication was self administered on 08/01/23 and was discontinued on 08/02/23 and the second set of medication administration record indicates that the same medication was resumed, and administered by staff, on the dates of 08/03/23 – 08/04/23 and was self administered from 08/05/23 – 08/22/23. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Therefore, the above allegation is found to be Unsubstantiated. Regarding the allegation "Staff did not seek timely medical attention for a resident". It has been alleged that it took staff 1 hour to respond to residents' medical emergency(ies)”. Interviews revealed that two (2) out of two (2) staff and seven (7) out of eight (8) residents have denied the allegation had taken place. Record reviews indicated the following: the facilities staff roster showed adequate number of staff present and staff records indicated that staff have been properly trained for the job duties at hand. Specificially, under the segments of first aid and fall-risk management. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Therefore, the above allegation is found to be Unsubstantiated. No deficiencies were cited. An exit interview was held with Helen Lee, Executive Director (S1), and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jul 19, 2024 · control 11-AS-20230815103818

Allegation investigated: Licensee does not keep facility elevators maintained in operating condition Staff do not respond to residents' call buttons in timely manner Staff does not provide resident with timely meals

**This report’s purpose is to provide an amendment to the complaint report created 01/10/2024. This addendum is written to clarify the 9099 and does not change the complaint investigation report findings recorded on 01/10/2024. ** On 01/10/2024 at 9:29 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation visit for the allegation listed above. Upon arriving at the facility, LPA met with S#1 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is not clear of Covid-19 infection (four (4) residents and one (1) staff member have COVID). LPA was granted access and allowed to enter the facility to conduct inspections.The investigation consisted of the following: On 01/10/2024 at 9:29 am LPA España conducted a tour of facility plant; reviewed records for staff and residents and observations. LPA España conducted interviews with Eight (8) out of seventy-five (75) residents. LPA España interviewed Seven (7) out of forty-seven (47) staff members. Continued 9099-C Unsubstantiated LPA confirmed with the Administrator that there are a total of residents with oxygen one (1); Total residents with dementia one (1); Total residents with wheelchairs nine (9); and Total residents with diapers two (2). LPA requested and reviewed the following: Nurse Call/E-Call Systems: In-house Testing of Nurse Call Systems Last 12 Months; Dining Services Ocean House; Ocean House Schedule; Daily recipes; Nutrition Tracker as of January 9th; Benefits of Modernization include: Increased durability and reliability; Improved fire and life safety features; Decreased waiting times; Reduced energy consumption; Reduced operational cost; and Reduced troubleshooting time records etc. Allegation: Licensee does not keep facility elevators maintained in operating condition. This investigation revealed that interviews conducted with Eight (8) out of seventy-five (75) residents understood the facility was addressing the elevator per town hall once (3rd Thursday of every month) a monthly resident council meeting (every other week). Interviews conducted with Seven (7) out of forty-seven (47) staff members corroborated that they are addressing the elevators based on corporate investment. Additionally, per town hall once (3rd Thursday of every month) a month and resident council meeting(every other week) confirms that the Administrator has taken action. LPA reviewed the following records: Brookdale purchase order elevator po number 3692068. Based on interview with S#3 as of March 16, 2023, Modernization Proposal TK Elevator Corporation (hereinafter "TK Elevator") is dedicated to delivering (hereinafter "Purchaser") the safest, highest quality vertical transportation solutions Proposal (the "Proposal") in the amount of $592,580 inclusive of all applicable sales and use taxes to modernize the elevator equipment described in the pages provided at todays visit. Additionally, per S#1 the facility is developing the Benefits of Modernization which includes: • Increased durability and reliability • Improved fire and life safety features • Decreased waiting times • Reduced energy consumption • Reduced operational cost • Reduced troubleshooting time. LPA also noted the weekly status report for week ending - 12/15/2023 location - ocean house project commencement 1st elevator inspection 10/9/2023 actual dates 11/27/2023- elevator scope-passed 12/7/2023- fire service scope-passed accomplished. The facility addressed the final adjustments, the facility released elevator no. 1 to service on Monday 12/11 the facility transferred the operation of the hall buttons between elevator no. 1 & 2. the facility began the modernization scope on elevator no. 2. requisition #3768975 (partially received) ocean house elevator modification upgrade work orders for 00967 Brookdale Ocean house logbook report 00967 Brookdale ocean house - Santa Monica, ca 90405-2299.Continued 9099-C Based on the evidence gathered and interviews conducted, and records reviewed, 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 of “Licensee does not keep facility elevators maintained in operating condition” is unsubstantiated. Allegation: Staff do not respond to residents' call buttons in timely manner This investigation revealed following that interviews conducted with Eight (8) out of seventy-five (75) residents do not have issues with call buttons. Interviews conducted with Seven (7) out of forty-seven (47) staff members corroborated that they respond to all residents call buttons. Based on LPA interviews Seven (7) out of forty-seven (47) staff members, specifically, S#4. There is a logbook report 00967 Brookdale ocean house - Santa Monica, ca 90405-2299 task name: nurse call/e-call systems: in-house testing of nurse call systems last 12 months report was generated and provide at today's visit: 2024-01-10 due date 12/31/2023; 11/30/2023; 10/31/2023; 9/30/2023; 8/31/2023; 7/31/2023; 6/30/2023; 5/31/2023; 4/30/2023; 2/28/2023; 1/31/2023 history as of 01/10/24 11:13 am showing alerts. displaying the last 30 days. LPA confirmed the above dates and processes of the facility being taken when call buttons are issued to the facility's main front desk. LPA confirmed four (4) pagers in use by care staff. Based on the evidence gathered and interviews conducted, and records reviewed, 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 of "Staff do not respond to residents' call buttons in timely manner” is unsubstantiated. Allegation: Staff does not provide resident with timely meals This investigation revealed following that interviews conducted with Eight (8) out of seventy-five (75) residents do receive their meals on time. Interviews conducted with Seven (7) out of forty-seven (47) staff members corroborated that all residents are provided meals in a timely fashion. Based on interview with conducted with S# 2 revealed that there is a resident nutrition tracker. This item has all the information pertaining to the facility residents. Name, Location, and diet. LPA received documents showing recent menus 2024. Also reviewed were the recipes for residents, which contain how the facility prepares, hold the facility food, how the recipe applies to each diet restriction, how much to serve, and nutritional values. All menus and recipes reviewed come from the Crandall Corporation of Registered Dieticians. Continued 9099-C Based on interview with S#2 Room Service is available all day, but residents are asked to submit their orders in a timely fashion, (the day before, or, the meal prior) so they may receive it when expected. If resident places an order last minute, or during meal service, which the facility has residents that consistently practice their right, the residents are then placed on a waiting list of those residents who submitted their tickets first. LPA reviewed the most current schedule for meals. Broken down into three categories. Servers, cooks, and dishwashers. According to S#2 production works as follows: There are three (3) servers for breakfast, lunch and dinner. One acts primarily as room service, and once all trays have been delivered, join the other two servers on the dining room floor. There are three (3) cooks for the course of the daily operation, plus the Dining Services Director (Four in all). First cook comes at 5:30am-1:30pm, second cook comes from 8am-4:30pm, and last cook comes from 11am-7:00pm. Dining Director comes from 10am-7:00pm but is here until 8pm. Dishwashers: The first dishwashers come from 7am-2:30pm, and the last one come from 3pm-8pm. Dining room hours- All day dining from 7:30am-6:30pm. During these hours the facility serves a side menu consisting of omelets, burgers, assorted sandwiches, fish and chips, and pasta. LPA also confirmed the special menus for Breakfast, lunch and dinner are as follows; 7:30am-9:30am, 11:30am-1:30pm, and 4:30pm-6:30pm. Snacks are available after hours consisting of sandwiches, fruits, and yogurt. Juice and Soda Fountain, which also contains filtered water is available to residents 24/7. Based on the evidence gathered and interviews conducted, and records reviewed, 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 of “Staff does not provide resident with timely meals” is unsubstantiated.the state’s words, verbatim · CDSS document, Jan 10, 2024 · control 11-AS-20240103084316

Allegation investigated: Staff did not treat resident with dignity and respect Staff did not provide adequate food service Staff did not provide a comfortable environment for residents Staff did not issue a refund Staff did not meet resident's needs

On 11/15/2023 at 10:20 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation visit for the allegation listed above. Upon arriving at the facility, LPA met with S#1 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections. The investigation consisted of the following: On 11/15/2023 at 10:20 am LPA España conducted a tour of facility plant; reviewed records for staff and residents and observations. LPA España conducted interviews with Five (5) out of seventy-five (75) residents. LPA España interviewed Five (5) out of forty-seven (47) staff members. LPA España interviewed with one (1) out of one (1) Witness. Continued 9099-C Unsubstantiated Allegation: Staff did not treat resident with dignity and respect This investigation revealed that interviews conducted with Five (5) out of seventy-five (75) residents got along with facility staff and did feel that they were accorded with dignity and respect in their relationships with them. Interviews conducted with Five (5) out of forty-seven (47) staff members corroborated that they had not received a complaint from residents that they felt as though they were not being accorded with dignity from a specific staff member. A review of the facility staff records on the topic of “Personal Rights” training was conducted. Based on the evidence gathered and interviews conducted, and records reviewed, 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 of “Staff did not treat resident with dignity and respect” is unsubstantiated. Allegation: Staff did not provide adequate food service. Investigation consisted of the following: Interview of Five (5) out of seventy-five (75) residents. Interview of Five (5) out of forty-seven (47) staff members. LPA observed the facility and the food supply. Five (5) out of seventy-five (75) residents were able to respond to questions for interview purposes. Five (5) out of seventy-five (75) residents stated they felt staff did provide adequate food services. The facility was clean and sanitary during visit. LPA observed the food supply to also be adequate at time of visit. LPA determine that the food service was adequate. Residents interviewed said they were full after each meal and had enough food. Based on the evidence gathered and interviews conducted, and records reviewed, 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 of “Staff did not provide adequate food service” is unsubstantiated. Continued 9099-C Allegation: Staff did not provide a comfortable environment for residents During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. There is no evidence that resident’s are not provided a comfortable environment. LPA interviewed Five (5) out of seventy-five (75) residents who stated no issues with ADLs being met at the facility. Five (5) out of seventy-five (75) residents stated they are given a comfortable living environment at the facility. Five (5) out of seventy-five (75) residents who get help with showers have no issues with the shower schedule and staff assisting. Five (5) out of forty-seven (47) staff members stated residents ADLs are being met on a daily basis. Five (5) out of forty-seven (47) staff members stated they assist residents with everything they need according to the scheduled services. LPA obtained a copy of a Personal Service Plan (PSP) which includes personalized assisted living based on an individual preference. This PSP is itemized and includes but is not limited to assistance with medications, showering or bathing, bathroom, escort and mobility and dressing and grooming. Based on LPA’s interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated. Allegation: Staff did not issue a refund LPA conducted an interview with S1, S1 denied the allegation. S1 informed LPA that R1 is requesting a refund for full payment because of toast and room services. S1 stated that R1 was told the facility would provide new toast to R1’s room. S1 stated that R1 instead took it upon R1’s self to ask for R1’s full payment from the facility. S1 stated a prorated amount would be provided to R1. S1 stated that there was an ongoing back and forth between S1 and R1, finally in order to move forward S1 spoke to R1 on 11/11/2023 and 11/14/2023 to ask for more details. S1 called R1 to hear her side of the story. R1 stated that if the facility refunded the full amount R1 would drop R1's claims. S1 stated that the facility would call corporate about how to move forward. R1 was interviewed by LPA regarding the incident R1 stated that although she did live at the facility, R1 wanted a full amount payment of everything R1 paid to the facility. R1 stated that the matter could be resolved if the facility paid back full amount provided 10/31/2023 (admission date). Based on information gathered, LPA did not find enough evidence to support allegation “Staff are not providing resident with a refund.” Continued 9099-C Allegation: Staff did not meet resident's needs During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. There is no evidence that resident’s needs are not being meet. LPA interviewed Five (5) out of seventy-five (75) residents who stated no issues with their needs being met at the facility. Five (5) out of seventy-five (75) residents stated they are given a comfortable living environment at the facility and all needs are being met. Five (5) out of seventy-five (75) residents who get help with showers have no issues with the shower schedule and staff assisting and there needs are being met. Five (5) out of forty-seven (47) staff members stated residents needs are being met on a daily basis. Five (5) out of forty-seven (47) staff members stated they assist residents with everything they need according to the scheduled services. Based on the evidence gathered and interviews conducted, and records reviewed, 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 of “Staff did not meet resident's needs” is unsubstantiated.the state’s words, verbatim · CDSS document, Nov 15, 2023 · control 11-AS-20231107132513

Allegation investigated: Staff do not provide resident with fluids when requested. Staff do not ensure resident is provided privacy. Staff do not treat resident with dignity and respect.

On 11/2/2023 at 10:56 AM, Licensing Program Analyst (LPA) Lourdes Montoya conducted a subsequent complaint visit to deliver complaint findings of the allegations listed above. LPA Montoya met with Helen Lee, the new Executive Director/Administrator, and explained the purpose of this visit. The investigations consisted of the following: On 9/12/2023, LPA conducted a tour of the facility. LPA Montoya interviewed 8 out of 76 residents and 7 out of 66 staff. LPA requested and obtained copies of Staff roster, Resident roster, and R1’s service records (Admission Agreement, Physician's Reports, Appraisals/Needs and Services Plans, and other pertinent records associated with this complaint. REPORT CONTINUED IN LIC 9099C Unsubstantiated INVESTIGATIONS REVEALED THE FOLLOWING: Allegation: Staff do not provide resident with fluids when requested. According to SOC 341, it was reported that staff declines to give R1 fluids/drinks. Based on interviews conducted with seven out of eight residents (R2-R8), it was denied that staff do not provide residents with fluids/drinks when requested. Two residents (R7 & R8) revealed they get anything they request from staff. The department was not able to conduct an interview with R1 because R1 has passed away and was no longer available at the time of the visit. Based on interviews conducted with seven out of seven staff (S1-S7), it was denied that staff do not provide residents with fluids/drinks when requested. Four staff (S1-S4) stated R1 has a reserve of water jug in the bedroom that staff refills it when empty; Staff assists R1 with drinking because R1 has difficulty in drinking and R1 drinks from a cup with a straw. S5 stated when residents ask for water or any other drinks, S5 would get it for them. S6 stated when residents have any concerns, staff or residents would report to S6 and S6 denied that there was any complaint about staff not providing residents with fluids when requested. S7 stated residents would call the front desk for services like requesting fluids but sometimes S7 would bring residents water or juice when requested directly from S7. Based on LPA's observations during the visit on 9/12/2023, care providers, dining crew and front desk staff are attentive to resident's requests. Allegation: Staff do not ensure resident is provided privacy. According to SOC 341, staff have exposed R1’s private areas while taking R1 to the restroom with other people at the present location. Based on interviews conducted with seven out of eight residents (R2-R8), it was denied that staff do not ensure residents are provided privacy. The department was not able to conduct an interview with R1 because R1 has passed away and was no longer available at the time of the visit. Based on interviews conducted with seven out of seven staff (S1-S7), It was denied that staff do not ensure resident is provided privacy. Four staff (S1-S4) stated R1 has a private bathroom in the bedroom and R1 did not like using the common bathrooms. S6 stated when residents have any concerns, staff or residents would report to S6 and S6 denied that there was any complaint about staff not ensuring resident is provided privacy. Based on LPA's observations during the visit on 9/12/2023, LPA did not observe any incidents that violate residents' privacy. LPA observed each resident's bedroom including R1's bedroom has ensuite bathroom. This page was amended to change the word "privacy" to dignity/respect on line #16. Allegation: Staff do not treat resident with dignity and respect. According to SOC 341, R1 is enduring abuse from a perpetrator consistently. Based on interviews conducted with seven out of eight residents (R2-R8), it was denied that staff do not treat resident with dignity and respect. Three residents (R2, R7 & R8) revealed staff are respectful. The department was not able to conduct an interview with R1 because R1 has passed away and was no longer available at the time of the visit. Based on interviews conducted with seven out of seven staff (S1-S7), It was denied that staff do not treat residents with dignity and respect. Two staff (S1-S2) stated staff respect the residents and their families. S3 stated S3 did not have any issue with R1. S4 stated one staff (S8) reported to S4 that one staff (S8) heard S9 telling R1 to stop whining. S4 investigated the issue, R1 and S9 denied the allegation. S4 stated no further investigation was made because there was not enough evidence to prove the allegation. S4 admitted S4 did not report the incident to the facility administrator. LPA made an attempt to interview S8 but S8 was not working at the time of visit. LPA was not able to interview S9 because S9 was no longer working at the facility. S6 stated when residents have any concerns, staff or residents would report to S6 and S6 denied that there was any complaint about staff not ensuring resident is provided dignity/respect. Based on LPA's observations during the visit on 9/12/2023, staff treat residents with respect. Based on interviews, available evidence, observations, information received, and records reviewed there was not sufficient evidence to support the allegations, "Staff do not provide resident with fluids when requested, Staff do not ensure resident is provided privacy, Staff do not treat resident with dignity and respect". 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 deemed UNSUBSTANTIATED. There were no deficiencies cited. An exit interview was conducted and a hard copy of the report was provided to Helen Lee.the state’s words, verbatim · CDSS document, Nov 2, 2023 · control 11-AS-20230905082714

Allegation investigated: Staff financially abused resident.

On 10/12/23, Licenising Program Analyst (LPA), Wendy Gibbs conducted an unnanounced visit to amend the report. LPA met with Executive Director Jayden Bennencourt and explained the purpose of today's visit. On 09/29/2023 at 10:00 a.m. Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced visit to deliver the findings of the complaint allegation: Staff stole resident's money while in care. LPA identified himself and discussed the purpose of the visit and the elements of the allegation(s). with Assoc. Executive Director Jayden Bettencourt. The Investigation Consisted Of The Following On 06/28/23 Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced 24-hour visit to Brookdale Ocean House. LPA was met by Matan Burstyn Executive Director. The Purpose of the visit was explained to investigate the allegation " Personal Rights” and conduct a health and safety check on residents in care. Substantiated Cont from Pg 1 All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained throughout the facility. LPA observed the facility to be operational and in good repair. Residents were currently sitting in the movie screening room, activity room, and gaming rooms. Residents did not show any signs of distress or abuse. LPA requested pertinent documents pertaining to the investigation. The following documents were gathered: Resident Roster, Staff Roster, Copy of entire resident file for (R1) including Admissions Agreement, Needs and Services, physicians report. LPA requested facility staff schedules and other pertinent documentation such as staff files. On 6/28/2023 LPA referred this assignment case to the Investigations Branch (IB) of the Department of Social Services to conduct the interviews of the above allegation. Investigator Heidy Bendana (IB) interviewed the following individuals. Witness (W1), Victim (V1), Administrator (A1), Staff (S1-S2) and Residents (R1-R4). The Investigation Revealed The Following. Allegation: Staff financially abused resident. On 7/25/2023, at approximately 0754 hours, Investigator Heidy Bendana, interviewed Witness #1 via telephone. Witness #1 indicates W1 assist V1 with accounting due to V1 medical diagnosis but V1 is responsible for V1’s checkbook. W1 indicated during a review of V1 taxes W1 noticed on V1 bank account online a $9,000 check cleared made out to cash. W1 reported this to V1 and V1 denied writing a check for cash. On 7/25/2023, at approximately 1058 hours, Investigator Heidy Bendana, interviewed Victim #1. V1 had been a resident at Brookdale Ocean House. V1 informed Investigator that $9,000 was withdrawn from V1 First Citizen’s bank account and $1,000 from Bank of America account. V1 reported V1 checkbooks were stolen from Brookdale Ocean House. V1 confirmed S1 gave V1 a $8000 cashier’s check and said it solved the problem. V1 stated V1 asked S1 where’s the rest because the total amount stolen was $10,000. Cont from Page 2 On 7/27/2023, at approximately 0946 hours, I, Investigator Heidy Bendana, interviewed Matan Burstyn at her place of employment. Matan stated Victim #1 lived at the facility before she started her employment with the facility. Matan stated she was informed S1 stole $10,000 dollars from V1. On 08/2/2023, at approximately 0924 hours, Investigator Heidy Bendana, interviewed S3 via FaceTime. S1 stated V1 gave S1 a check for $1,000 & $9,000. S1 confirmed S1 cashed both checks at S1 bank. S1 stated later S1 attempted to return the money and V1 told S1 to keep some money therefore S1 only gave V1 a Cashiers check for $8,000. IB investigator interviewed Staff #2 and S2 corroborated the allegation. IB investigator interviewed Residents #1-4 and 4 of the 4 residents did not have any knowledge of the allegation. Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the LIC 9099 and 9099D and Appeal Rights was provided to Assoc. Executive Director Jayden Bettencourt ,the state’s words, verbatim · CDSS document, Sep 29, 2023 · control 11-AS-20230627152651

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(e) · Plan of correction due date: Sep 29, 2023

87468.1 Personal Rights of Residents in All Facilities(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3)To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money....This requirement is not met as evidenced by: Based on interview and records review, the licensee failed to ensure resident's personal rights due to staff person #1 mis- appropriating residents money from Resident V1 personal bank account. This poses a personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Sep 29, 2023

Plan of correction: Administrator will provide LPA, per fax, staff meeting sign in sheet, regarding review of resident's personal rights - specifically abuse, or other actions of a punitive nature, such as withholding residents’ money, by 10/09/23. LPA fax number (323) 981-1781

Type of visit: Case Management - Deficiencies

On 09/29/23, Licensing Program Analyst (LPA) Jeremiah Randle conducted a case management visit in conjunction to a complaint visit conducted today at this facility. LPA met with Assoc. Executive Director Jayden Bettencourt and explained the purpose of the visit. During a complaint investigation visit on 06/28/23 control # 11-AS-20230627152651, LPA identified Staff Trevor Weiss in conjunction to a complaint visit conducted on 06/28/23. Staff Trevor Weiss does not have a Criminal Record Clearance associated to the facility named above in the Complaint. During a complaint investigation visit on 06/28/23 control # 11-AS-20230627152651, LPA identified Administrator Matan Burstyn, or designated staff did not timely report incident of Financial Abuse to CDSS CCLD. The licensee violated Title 22 Regulations 82711- Reporting Requirements and 87355 - Criminal Record Clearance California Code of Regulations (Title 22, Division 6, Chapter 8), deficiencies were observed, and citations were issued (ref. LIC 9099-D). Civil Penalties are Assessed. An exit interview was conducted and a copy of this report and appeal rights provided to Assoc.Executive Director Jayden Bettencourt.the state’s words, verbatim · CDSS document, Sep 29, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Sep 29, 2023

Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) This requirement was not met as evidenced by Based on LPA observation and interview conducted, the licensee failed to ensure that staff Trevor Weiss was cleared or associated to the facility on 6/28/2023 and prior during employment.the state’s words, verbatim · CDSS document, Sep 29, 2023

Plan of correction: Licensee will have cleared staff on schedule, staff has been adequately fingerprinted and background cleared and associated to facility. Per administrator staff Trevor Weiss has been terminated. Administrator to provide LPA updated LIC 500.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(d) · Plan of correction due date: Sep 29, 2023

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:Any incident which threatens the welfare, safety or health of any resident...This requirement was not met as evidenced by Based on LPA observation and records review conducted, the licensee failed to ensure that staff or administration reported incident in complaint referenced to CDSS CCLDthe state’s words, verbatim · CDSS document, Sep 29, 2023

Plan of correction: Administrator will provide LPA, per fax, staff meeting sign in sheet, regarding review of incident reporting requirement for Facilities per CDSS CCLD Regulations