Brookdale Sylvan Ranch

Type of visit: Case Management - Incident

On 08/26/2026 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a case management visit. LPA met with Executive Director (ED), Jerilyn Purol and Health and Wellness Director (HWD) Kristina Wardlow, and explained the purpose of the visit. The purpose of the visit is to gather additional information regarding an unusual incident/injury report that was sent to Community Care Licensing (CCL) on 08/08/2026 regarding Resident #1 (R1). During today's visit LPA conducted interviews regarding the incident and obtained relevant documents. No deficiencies cited at this time. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Aug 26, 2026

Allegation investigated: Staff did not administer resident's medication as prescribed.

On 7/13/2026, Licensing Program Analyst (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Kristie Wardlow LVN. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Based on resident interviews, staff interviews, and a review of facility records, there was insufficient evidence to support the allegation. Documentation reviewed, including medication administration records, indicated that staff followed the physician’s orders and the facility’s medication administration procedures. Interviews with staff and the resident were consistent with the documentation reviewed. Therefore, the allegation that staff did not administer the resident’s medication as prescribed is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted. Report left with facility. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 13, 2026 · control 59-AS-20260429134327

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cassandra Mikkelson and Seng Vang arrived unannounced and met with Executive Director to conduct an annual inspection utilizing the inspection tool. LPA conducted an inspection of the care facility to ensure compliance with Title 22 regulations. LPA observed resident rooms, common area bathrooms, kitchen, activities areas, and perimeter of care facility. LPA observed rooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. LPA checked the kitchen area for the ability to prepare and store food. Care facility has required (2) two day perishable and (7) seven day non-perishable food supply on hand. Smoke detectors and carbon monoxide detectors are operational in the care facility. Fire extinguishers and first aid kit are maintained and ready for emergency use. LPA checked medication storage and medication carts and found medications to be locked away and inaccessible to the residents. LPA reviewed eight (8) resident files, three (3) staff files and resident medications. Facility has a current copy of certificate of liability insurance and LPA obtained a copy. As a result of this visit, no deficiencies were cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted with Administrator.the state’s words, verbatim · CDSS document, May 26, 2026

Allegation investigated: Staff do not provide adequate food service Staff do not keep the facility clean and sanitary Staff are not adequately trained to meet the needs of residents in care

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Jerilyn Purol to deliver findings for the above complaint allegation. During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: *** Report continued on 9099-C*** Unfounded Staff do not provide adequate food service Interviews conducted indicated that facility is providing adequate food service and meal options to residents in care. Records reviewed indicated that facility provides a menu to residents during meal times where there are different food options. Residents are also able to pick from a secondary menu if they prefer a different option than what is being offered for the current meal. Therefore, the allegation staff do not provide adequate food service is unfounded. Staff do not keep the facility clean and sanitary Observations indicated that staff are trained on how to keep the facility clean and sanitary. Staff clean dining areas at the facility before and after meals, taking away any dirty dishes back to the kitchen for cleaning. Observations in the kitchen indicated that all dishes are cleaned and sanitized after use to ensure proper cleanliness. Records reviewed indicated that the facility has a third party vendor who comes in to inspect the kitchen and kitchen staff. Records show that the kitchen/kitchen staff are meeting the required cleanliness markers that are needed. Therefore, the allegation staff do not keep the facility clean and sanitary is unfounded. Staff are not adequately trained to meet the needs of residents in care Records reviewed indicated that staff are trained to meet the needs of residents in care. Staff have initial training, hands on training and continued education training throughout the year. In service trainings are also done as reminders on how to conduct care, emergency drills and food safety. Kitchen staff have additional training that is conducted to ensure the proper use of kitchen equipment, food safety and preparation and sanitation techniques. Therefore, the allegation staff are not adequately trained to meet the needs of residents in care is unfounded. Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.the state’s words, verbatim · CDSS document, Apr 1, 2026 · control 59-AS-20260318112934

Allegation investigated: Staff are not seeking medical attention for residents Staff are not preventing the spread of scabies

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Jerilyn Purol to open and deliver findings for the above complaint allegation. During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: *** Report continued on 9099-C*** Unfounded Staff are not seeking medical attention for residents Records reviewed indicated that staff are following up with resident’s physicians when there is any sort of skin rashes or flares. Staff check residents during showers, brief changes and when assisting with changing clothes. Staff notify resident’s responsible party and their physician when treatment needs to be assessed. Staff are following physician’s orders for the residents in care. Facility is assessing resident’s who have rashes and getting the proper treatments needed to ensure proper medical attention. Facility is in contact with all resident’s physicians and public health to ensure that all residents have access to medical attention as needed. Therefore, the allegation staff are not seeking medical attention for residents in unfounded. Staff are not preventing the spread of scabies Records reviewed indicated that there is no current outbreak of scabies or any other infectious disease at the facility. Staff are trained on a yearly basis, if not more often, on what to do in case of an infectious disease outbreak at the facility and how to prevent potential spread. Records of residents reviewed indicated that no residents currently have any diagnosis of scabies. Therefore, the allegation staff are not preventing the spread of scabies is unfounded. Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.the state’s words, verbatim · CDSS document, Apr 1, 2026 · control 59-AS-20260323100105

Allegation investigated: Licensee is not following infection control requirements Licensee is not preventing the spread of scabies

Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced and met with Executive Director Jerilyn Purol to deliver findings for the above complaint allegation. During the investigation, LPA conducted interviews, conducted a tour of the facility, and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: *** Report continued on 9099-C*** Unfounded Licensee is not following infection control requirements. Records reviewed indicated that facility’s infection control plan is up to date and would be followed in case of an infectious outbreak. Facility staff have yearly training on infection control and prevention. Interviews conducted indicated that no current infectious outbreak has been reported at the facility. Staff are all aware and knowledgeable on what to do if/when an outbreak occurs and how to prevent the infection from spreading to the best of their ability. Licensee is not preventing the spread of scabies. Records reviewed indicated that there is no current outbreak of scabies or any other infectious disease at the facility. Staff are trained on a yearly basis, if not more often, on what to do in case of an infectious disease outbreak at the facility and how to prevent potential spread. Records of residents reviewed indicated that no residents currently have any diagnosis of scabies. Based on records reviewed and interviews, LPA finds the above allegations to be UNFOUNDED- meaning that the allegations were false, could not have happened and/or is without reasonable basis. Exit interview conducted with the Administrator. Copy of report was given to facility.the state’s words, verbatim · CDSS document, Mar 17, 2026 · control 59-AS-20260224144459

Allegation investigated: Staff do not ensure that resident's incontinence care needs are met Staff handled resident in a rough manner, resulting in resident sustaining an injury Staff do not observe residents for change in condition Staff do not serve residents food of good quality Staff inappropriately spoke to resident

On 02/18/2026, Licensing Program Analyst (LPA) Cassandra Mikkelson arrived at the facility unannounced to deliver final findings to a complaint Community Care Licensing (CCL) received on 10/31/2025. LPA met with Executive Director and explained the purpose of the visit. During the course of the investigation, the Department conducted interviews and walked through the facility Please continue to LIC9099C… Unfounded Allegation: Staff do not ensure that resident's incontinence care needs are met-Unfounded LPA conducted interviews with staff and residents. Residents who are incontinent are checked frequently throughout the staff shifts. Staff indicated they check on residents about every two (2) to three (3) hours or more frequently if needed. Interviews revealed they have a resident who uses a colostomy bag. Interviews revealed the resident is able to empty it on their own but will sometimes need assistances as well as reminders. Allegation: Staff handled resident in a rough manner, resulting in resident sustaining an injury- Unfounded Interview with Health and Wellness Director (HWD) revealed that there was an incident with Resident #3 (R3) had a choking incident. HWD was called to the dining area R3 was blue and not making any noise. HWD attempted the Heimlich but was unsuccessful as the resident is bigger and in a wheelchair. With the assistances of other staff R3 was brought down to the carpet where HWD was successful with black blows. Due to being on the carpet R3 did get rug burn on their face. The food was dislodged. R3 is now on purees as they have been having difficulty with swallowing food. Interview with staff revealed that they do not believe HWD handled the resident roughly. The facility sent resident out to the hospital and returned with new puree diet orders. Allegation: Staff do not observe residents for change in condition- Unfounded Interviews with staff revealed they all follow/ know the same processes. Staff indicated when staff notice a change in a resident’s condition, they are to notify the med tech. The med tech will then notify HWD. If the resident is on hospice, hospice is notified. Additionally, staff indicate they contact the resident’s physician and responsible party. Allegation: Staff do not serve residents food of good quality-Unfounded Interviews with residents revealed that residents do like the food. Interviews with staff revealed that some residents have different food than others. It depends on the type of diet they are on. Some residents need a soft food diet and others need a puree diet. **continued on 9099-C2 Allegation: Staff inappropriately spoke to resident- Unfounded LPA conducted interviews with staff and residents. Resident #2 (R2) does have an animal that lives with them at the facility. It was part of R2s stipulation with family and facility if they were going to be residing at the facility. R2 was out with their animal, got tangled up with the leash and had a fall. R2 was then taken to see the HWD. HWD asked R2 if they were hurt anywhere and R2 responded no. HWD said they looked at R2 and then R2 just responded with "I am not getting rid of the dog." The response from R2 made HWD laugh when R2 said this. It was observed that R2 has a sense of humor. Interview with residents revealed they have good experience with staff. Based on information obtained through interviews, the Department finds the allegations to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 59-AS-20251031103518

Type of visit: Case Management - Incident

On 09/23/2025, Licensing Program Analysts (LPA) Cheyenne Ratajczak arrived unannounced to conduct a case management visit. LPA met with Executive Director (ED) Jerilyn Purol and explained the purpose of the visit. Facility sent multiple incident report into Community Care Licensing (CCL) concerning incidents with Resident #1 (R1). LPA conduct interviews regarding the incidents and obtained relevant documents. No deficiencies cited at this time. Exit interview conducted and a copy of the report was left at the facilitythe state’s words, verbatim · CDSS document, Sep 23, 2025

Type of visit: Required - 1 Year

On 04/03/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with Executive Director (ED), Jerilyn Purol, and explained the purpose of the visit. LPA and ED conducted a tour of the interior of the facility. Areas toured included but not limited to: ten(10) resident rooms, shower room, kitchen, medication room and common areas. The facility has four wings or "houses", with each house having a separate dining area. LPA observed residents in common areas getting ready for lunch. The residence was found to be clean, safe, sanitary and in good condition. LPA observed the facility to have the mandated posters posted. Fire extinguishers are maintained and ready for emergency use. Facility has required food supplies. There are appropriate staff present to meet the needs of residents. In areas toured, LPA did not observed any violation of health, safety and personal rights. LPA conducted a file review of ten (10) resident files. Resident files contain signed admission agreements, physician's reports, appraisals, identification sheets, releases, and resident's rights. LPA reviewed ten (10) staff files. A review of staff files indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current training completed. As a result of todays inspection no deficiencies observed. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 3, 2025

Allegation investigated: Staff does not administer residents medication as prescribed Lack of care and supervision resulting in residents sustaining multiple falls Facility is not following food preparation safety procedures Staff serve expired and spoiled food to residents in care

On 02/19/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Licesnsing Program Manager (LPA) Laura Munoz arrived at the facility unannounced to deliver final findings for a complaint Community Care Licensing (CCL) received on 05/16/2024. LPA and LPM met with Executive Director (ED) Jerilyn Purol and explained the purpose of the visit. During the course of the investigation, the Department conducted interviews and obtained pertinent documents relevant to the complaint investigation. Please continue to LIC09099... Unsubstantiated Allegation: Staff does not administer residents medication as prescribed On 02/19/2025 LPA and LPM conducted a medication audit for three (3) residents. Resident #1 (R1) did have a discontinued medication with their currents meds but it has not been given to the resident since it was discontinued. Additionally, R1 was out of a medication but the facility is waiting for the refill.Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Lack of care and supervision resulting in residents sustaining multiple falls During the course of the investigation LPAs interviewed facility staff. Interviews with staff revealed that the facility does have a handful of residents who are a fall risk. All staff are aware of which residents are a fall risk as well as their care needs. LPA reviewed all Unusual Incidents Reports (UIRs) regarding falls from May 2024 to September 2024. LPA found no discrepancies with falls and that the facility documented the falls as required with follow ups as necessary. Additionally, LPA reviewed the Post Fall Evaluation for six (6) residents. Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Facility is not following food preparation safety procedures On 05/22/2024 LPA Ratajczak and LPA Hiratsuka conducted staff interviews which indicated staff are trained on proper food preparation procedures. On 02/19/2025 LPA and LPM conducted a tour of the facility kitchen. Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff serve expired and spoiled food to residents in care On 05/22/2024 LPA Ratajczak and LPA Hiratsuka conducted staff interviews. Staff interviews indicated they have not observed any expired or spoiled food. Additionally, 02/19/2025 LPA and LPM conducted a tour of the facility kitchen, which included looking at facilities perishable and non- perishable foods. LPA and LPM did not observed any spoiled or expired food. Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of the report and appeal rights was left at the facility. Allegation: Staff handled resident in a rough manner.- Unfounded On 05/02/24 LPA Ratajczak conducted a case management visit to gather additional information regarding an unusual incident/injury report that was sent to Community Care Licensing (CCL) on 04/25/2024. That report indicated that Staff #1 (S1) allegedly used force to redirect a resident from another resident’s room. LPA interviewed the Executive Director (ED), Jerilyn Purol and S1. This resident was no longer walking and would crawl to get around the facility. On this particular day, S1 was redirecting R1 out of another resident’s bedroom. S1 and R1 were holding hands as R1 was crawling out of the bedroom. Interviews indicated it could have been perceived as if R1 was being dragged however because R1 ambulated by crawling, R1 would request that staff hold their hand for assistance. Based on information obtained through interviews and file review the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Allegation: Lack of care and supervision resulting in resident's sustaining pressure injuries. - Unfounded LPA conducted a record review for R2 who had documented pressure injuries. R2’s resident file indicated that although R2 had pressure injuries, R2 was receiving Hospice services. Wounds were being monitored and cared for my Hospice staff. Based on information obtained through file review the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Allegation: Facility is not providing incontinence care products. - Unfounded Interview with ED, Jerilyn Purol, revealed that the facility does not provide incontinence care products for residents. The facility does have a program called Personal Solutions. Residents can sign up for an auto-ship program where their personal products, including incontinence supplies, are shipped directly to the facility. Many families provide the residents with their incontinence care products and have them shipped to the facility from Amazon. Residents who are on hospice are provided with incontinence care products from the hospice agency. Based on information obtained through interviews, the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Allegation: Facility is not addressing the pests issue. - Unfounded Interviews with staff revealed that they have seen cockroaches in the facility on occasion. During LPAs visit no pests were observed. Interview with ED, erilyn Purol revealed that the facility has Ecolab come out monthly. Facility keeps a binder with documentation of each of their visits. Some of the things that Ecolab has sprayed for are cockroaches, ants, files, silkworms and more. Based on information obtained through interviews and file review the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of the report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, Feb 19, 2025 · control 59-AS-20240516125100

Allegation investigated: Resident sustained unexplained bruising while in care

On 09/12/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to deliver findings regarding a complaint the Department received on 06/18/24. LPA met with Executive Director (ED),Jerilyn Purol and explained the purpose of the visit. During the course of the investigation, the Department conducted interviews and obtained pertinent documents relevant to the complaint investigation. Please continue to LIC9099C… Unsubstantiated Allegation: Resident sustained unexplained bruising while in care On 06/18/24, around 12:05 AM, a marking was seen on Resident #1 (R1) upper thigh. When R1 was asked about the mark, they could not give any information. Staff #1 (S1), who observed the mark notified Medication Technician and Resident Care Coordinator (RCC). S1 did not know how the mark occurred. Staff #2 (S2) was interviewed, and they stated that they never observed a mark on R1’s upper thigh. On 06/18/24, around 11:03 AM, Local Law Enforcement arrived at the facility in response to a report of suspected abuse. RCC stated to Local Law Enforcement that the mark was no longer there by 9:00 AM. It was noted that the mark on R1 appeared to be a “pressure mark” due to the time in which it faded. Based on interviews it was noted that R1 has a history of slapping their own thigh at night. Interviews with staff indicated they did not have concerns regarding staff physically abusing residents. Residents interviewed did not express concerns about their safety in the facility. Based on this information, these allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated. Exit interview conducted. A copy of the report and appeal rights left at the facility.the state’s words, verbatim · CDSS document, Sep 12, 2024 · control 59-AS-20240618084515

Allegation investigated: Staff did not dispense resident’s medication(s) as prescribed.

On 05/15/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to deliver final findings to a complaint Community Care Licensing (CCL) received on 02/26/24. LPA met with Executive Director (ED) Jerilyn Purol and explained the purpose of the visit. During the course of the investigation, the Department conducted interviews, mediation review and obtained pertinent documents relevant to the complaint investigation. Please continue to LIC9099-C Substantiated Allegation: Staff did not dispense resident’s medication(s) as prescribed- Substantiated On 03/28/24 LPA Ratajczak and LPA Mirlohi conducted a medication audit of five (5) residents’ medications. Medication orders were compared to medications being administered and documentation on the Centrally Stored Medication List (LIC622) and Medication Administration Record (MAR) was reviewed. The following discrepancies were noted for three (3) residents, as follows: Resident #1 (R1)- LPA compared the current medication orders from facility MAR to the medications stored at the facility. LPA observed medication Fluoxetine HCI Oral Capsule 40 mg available to resident however the MAR showed resident missed medications on March 1, 2024 through March 5, 2024. MAR states, “Pharmacy action required” and “other/see nurse notes”. Administrator stated there were no notes documented. LPA observed medication Locaine external patch 4% was available to resident however the MAR showed resident missed medication on March 1, 2024 through March 5, 2024. MAR states, “Pharmacy action required” and “other/see nurse notes”. Administrator stated there were no notes documented. LPA observed medication Lisinopril Oral Tablet 40 mg was available to resident however on the MAR it shows resident missed medication on March 1, 2024 through March 5, 2024. MAR states, “Pharmacy action required” and “other/see nurse notes”. Administrator stated there were no notes documented. LPA observed medication Seroquel tablet 25 mg was available to resident however LPA observed the MAR showed resident received 12 medications however there were only 11 pills popped from the bubble pack. LPA observed medication Montelukast Sodium 10 mg, and observed the bubble pack was started on March 13, 2024. LPA observed there were 4 missing pills from the bubble pack. LPA observed resident PRN medication Hydrocodone-Acetaminophen tablet 5-325 mg was not available to resident. Med Tech stated they will reorder medication today. Resident #2 (R2) - LPA compared the current medication orders from facility MAR to the medications stored at the facility. LPA observed resident prescription for Trazodone HCI Oral Tablet 50 mg, with orders stating give 1 tablet by mouth at nighttime for behaviors related to Alzheimer’s disease. LPA reviewed the bubble pack, and observed the bubble pack was started on March 13, 2024. LPA observed there were 18 pills left in the 30-bubble pack which indicated resident missed 1 day of medication. LPA observed resident medication Vitamin D3 tablet 50 MCG to be out and unavailable to resident. Med tech took note and stated they would call and reorder the medication that day. LPA observed medication Seroquel oral tablet 25 mg and observed March 2024 MAR which showed on March 4, 2024 resident did not receive medication and it states under why the medication wasn’t given as “Other/see nurse notes”. Administrator stated there were no notes documented. LPA observed Omeprazole medication available however on the March 2024 MAR it states resident did not received medication on March 1-2 and 4-5, 2024. Reasoning for resident not receiving medication was “pharmacy action required” and “other/see nurse notes”. Administrator stated no notes were documented. LPA observed medication Seroquel was available to resident however the MAR indicates resident did not receive medication on March 4, 2024. It was documented as “other/see nurse notes”, administrator stated notes were not documented. Resident #3 (R3)- LPA compared the current mediation list to the medications the resident has stored at the facility. R3 was missing the medication Magnesium Hydroxide Oral Suspension 400 MG/5ML. Staff stated that it needs to be reordered and has not been ordered yet. Based on LPAs medication audit, the facility did not ensure that residents were given their medication as prescribed. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 regulations, Division 6, are being cited on the attached LIC 9099D. Exit interview conducted a copy of the report and appeal rights was left at the facility. Staff do not ensure residents are bathed regularly. - Unsubstantiated During the investigation LPA interviewed staff. Staff interviews indicated that residents are scheduled for showers two (2) to three (3) times a week depending on each resident’s individual care plan. Staff stated that sometimes residents refuse showers, but staff will make several attempts to assist residents with showering if refused. If the resident does not shower at all because of a refusal, staff said that they complete a form indicating a resident has refused showering. During LPA visit, LPA observed the facility to be clean and order free. Staff did not prevent resident from being hit by another resident.-Unsubstantiated During the investigation LPA interviewed staff. Staff mentioned that some residents do have diagnosed behavior’s associated with Dementia. Interviews indicated sometimes resident’s will direct behaviors at staff but other times can be directed at other residents. Staff indicated, when staff witness a resident starting to become agitated, they will try to redirect the resident to another activity or different area of the facility. Depending on the type of the behavior a resident has, they will contact the resident’s physician and send the resident out of the community for a re-evaluation. Staff stated that when a resident hits another resident, staff will separate the residents and redirect them to different activities away from one another. Based on staff interviews, staff know which residents tend to have more behaviors and will intervene when they notice that resident is agitated. Based on this information, these allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated. Exit interview conducted a copy of the report and appeal rights was left at the facility.the state’s words, verbatim · CDSS document, May 15, 2024 · control 59-AS-20240226150013

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 16, 2024

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on medication audit the facility did not ensure that residents were given their medications as prescribed. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 15, 2024

Plan of correction: Licensee will schedule and conduct a training with all med techs, topics to be covered importance of reordering in a timely manner, medication administration, and how to use the MAR. Submit proof of planned training to LPA by POC due date. Once training is complete Licensee will send LPA proof of completed training by all med techs.

Type of visit: Case Management - Incident

On 05/02/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Case Management Incident visit. LPA met with Executive Director (ED), Jerilyn Purol, and explained the purpose of the visit. The purpose of the visit is to gather additional information regarding an unusual incident/injury report that was sent to Community Care Licensing (CCL) on 04/25/2024. The report indicates that Staff #1 (S1) allegedly used force to redirect a resident from another resident’s room. During today’s visit LPA and ED discussed the incident that occurred. Facility conducted an internal investigation as well. Since the time the incident occurred R1 has moved out of the facility to receive a higher level of care. Additionally, LPA requested a copy of R1s file and staff training. At this time, deficiencies are not being cited. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, May 2, 2024

Type of visit: Required - 1 Year

On 03/20/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA met with Executive Director (ED), Jerilyn Purol, and explained the purpose of the visit. LPA and ED conducted a tour of the interior and exterior of the facility. Areas toured include but are not limited to: common areas, ten (10) resident rooms, three (3) common shower rooms, dining rooms, kitchen, outdoor area, lobby, and common restroom. The facility has four wings or "houses", with each house having a separate dining area. Food is cooked in a central kitchen and brought out to each house. LPA observed required furniture, and lighting throughout the residents' bedrooms and facility. LPA observed fire detectors and carbon monoxide present in all residents' bedrooms. Bathrooms are clean, sanitary, and in good repair. LPA observed food supplies of non-perishables for a minimum of one week and perishable foods for a minimum of two days. Toxins and cleaning supplies are locked and inaccessible to residents in care. The hot water temperature was measured in a residents bathroom at 110 degrees Fahrenheit. First aid kit was completed. LPA observed centrally stored medications area were locked and inaccessible to residents in care. During LPA visit the facility was conducting an elopement drill with staff. LPA reviewed eight (8) personnel files and eight (8) residents' files. Staff have annual training as well as first aid and CPR. Residents files contain signed admission agreements, updated physician reports, Identification sheets, releases, appraisals needs and service plan, and resident rights. No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Mar 20, 2024

Allegation investigated: Staff force resident to eat while in care.

On 12/19/23 Licensing Program Analysts (LPAs) Cheyenn Ratajczak and Cassie Yang arrived at the facility unnanounced to open the complaint and deliver the findings. LPAs met with Executive Director (ED) Jerilyn Purol and explained the purpose of the visit. During this investigation LPAs interviewed ED, four (4) staff and seven (7) residents. The result of the investigation is as followed please see LIC9099C Unfounded Allegation:Staff force resident to eat while in care. Based on interview conducted with ED, it revealed that all residents are self fed. ED stated residents who need assistance with feedings are fed privately in their rooms with caregiver. Interview further revealed that all residents in care are English speakers. Interview conducted with S1 revealed that only R1 requires assistance with feeding. Interview further revealed that the resident is non verbal and may be aggressive at times. Interviews conducted with S2, S3, S4 revealed that R1 is non-verbal but is able to communicate when they want more food. Interviews further revealed R1 does not reject food and is a good eater. Based on interviews conduct with R2 and R3 revealed that staff does not force feed during meal times. R2 and R3 stated that they can feed themselves. Interviews conducted with R4 and R5 revealed that they have never witnessed residents in care being force fed. Interviews conducted with R7 revealed staff do not aggressively feed residents but ensure residents are provided the materials needed for feeding. Based on the extensive interviews conducted, LPAs find the allegation to be UNFOUNDED-means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. Copy of report and appeal rights was provided to Administrator.the state’s words, verbatim · CDSS document, Dec 19, 2023 · control 59-AS-20231215155333

Allegation investigated: - Facility does not have enough staff to meet the needs of residents in care. - Facility staff was not adequately trained. - Staff did not provide all of resident's records to resident's authorized representative.

On 11/02/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to deliver final finding Community Care Licensing received on 04/14/2023. LPA met with Executive Director, Jerilyn Purol, and explained the purpose of the visit. During the course of investigation, the Department interviewed facility staff and obtained pertinent documents relevant to the complaint investigation such as, resident’s (R1) physician’s report, unusual injury/incident report, in-service calendar, SOC 341, personnel report (LIC 500), email communication, and staff trainings. Continue on page LIC 9099-C. Unsubstantiated Allegation: Facility does not have enough staff to meet the needs of residents in care. - Unsubstantiated. Interview statement received from reporting party indicated, there has been some incidents of R1 being aggressive towards other residents in care. The Facility demanded R1's responsible party (RP) to provide R1 1:1 outside care source. Reporting party stated the facility will continue to provide care but wants outside care source to shadow R1. Outside source is not allowed to interact when R1 gets combative. Reporting party stated does not have any knowledge that the facility had accomplished assisting R1 with activities of daily living (ADLs). The Department reviewed R1's physician's report. According the R1's physician's report, R1's primary diagnosis is Dementia. R1 has aggressive behavior, wandering behavior, and sundowning behavior. R1 is not able to bathe self and care for own toileting needs. R1 is not able to administer own prescription medications, own PRN medications, and store own medications. According the R1's service plan, showering is provided twice weekly, Wednesday between 9am and 10am, Saturday between 9am and 10 am, along with laundry and housekeeping are subject to change to accommodate R1's schedule. Staff is to remind R1 to change protective undergarments as needed. Staff is to assist R1 approximately every 2 to 4 hours and as needed and to the bathroom brief changes and peri-care is provided at the time of bathroom assistance. The facility submitted a SOC 341 for review. SOC 341 indicated, R1 kicked R2 in the leg. R1 and R2 were separated and there was no further incident. All parties were notified. The Department received interview statements from a total of five (5) facility staff. Interview statement received indicated, staff conducted rounds every 2 hours to check on R1. Facility staff assisted R1 with toileting, showers, and medication. Interview statements received from staff indicated, R1 was very combative and aggressive towards staff and residents in care. Staff indicated there were 3 caregivers and 1 Med Tech scheduled for each shift. Staff stated R1's needs were being met. Allegation: Facility staff was not adequately trained. - Unsubstantiated. Interview statement received from reporting party indicated staff are not adequately trained to handle residents with Dementia. The Department reviewed the facility's in-service calendar. The facility provides staff training every month. Topics that are discussed during training are behavior intervention, behavior problem-solving, challenging behavior intervention/redirection, and more. Based on interviews with staff, staff indicated that training was conducted at the time of hire and on a continuous basis per Department regulations. The Department reviewed staff training records and observed that training requirements were met. Staff interviews indicated that staff have required mandated training upon hire and on a continuous basis per facility needs and requirement. Records reviewed indicated that the facility kept proper record of all staff training for all staff without any issues. Though training requirements are met, meaning classes were taken; the Department cannot determine if all staff understood the training and applied it appropriately. Allegation: Staff did not provide all of resident's records to resident's authorized representative. - Unsubstantiated. The Department interviewed and received statement from R1's RP. RP indicated RP is working with a Dementia specialist to try to figure out the best medication for R1's behavior. RP requested copies of all incident reports for the last 2 months. The Department interviewed and received statement from Health and Wellness Director (HWD), Ayana Allison. HWD provided the Department with email communicated between RP and HWD for review. HWD indicated incident reports are internal documents only. HWD stated the facility provided RP with 3 options, have the facility fill out a questionnaire, speak to someone regarding the past couple of months or facilitate on-site observation. Interview statement received from ED indicated, the facility's incident reports are not residents' records, this is an internal reporting system tool. ED stated, R1's incident reports also has other residents' in care information. Due to the information above, CCL finds the allegations to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted with Executive Director, copy of report was provided via email.the state’s words, verbatim · CDSS document, Nov 2, 2023 · control 59-AS-20230414105422

Allegation investigated: Resident in care sustained unexplained injuries

On 09/28/2023, Licensing Program Analysts (LPAs) Sarena Keosavang arrived at the facility unannounced to deliver final finding Community Care Licensing received on 04/10/2023. LPA met with Executive Director, Jerilyn Purol, and explained the purpose of the visit. During the course of investigation, the Department interviewed facility staff and obtained pertinent documents relevant to the complaint investigation such as, resident’s (R1) physician’s report, service plan,admission agreement,identification and emergency information, appraisal, and fall management policy. Continue on page LIC 9099-C. Unsubstantiated According to interviews, R1 had multiple abrasions on both knees, toes, right elbow, and right hip. Care staff were not able to recollect falls or how R1 sustained multiple injuries. R1 has history of falls, but no documented falls noted at facility. The Department reviewed R1's physician's report. Physician's report indicated R1's primary diagnosis is dementia and is confused/disoriented. R1 has visual impairment and has wandering behavior. According to R1's service plan, R1 requires assistance with using the bathroom. R1 uses incontinence products and will remove their depends and urinate on the floor or on bedding. Frequent checks are required throughout the night to ensure that R1's beddings are dry and that R1 has not urinated on the floor. Facility staff is to provide assistance to and from dining room and or community activities as needed due to memory impairment and physical impairment. R1 uses a wheelchair. R1 has fallen in the last twelve months. The Department interviewed a total of eight (8) facility staff. Interview statements received from six (6) staff indicated, they have observed R1's injuries but have no knowledge of how R1 sustained injuries while in care. Interview statement received from the staff that reported the unwitnessed fall indicated, staff conducted rounds to check on R1 and observed R1 on the floor in the bedroom. Staff assisted R1 into bed and observed a scratch on R1's back. Staff reported the unwitnessed fall to the Med Tech. Med Tech reported the incident to management and R1's responsible party. Interview statement received from ED indicated, staff observed scratches and bruises on R1. The fall may have occurred during the NOC shift and injuries were observed in the morning. There were no signs of trauma. R1 was not sent to the hospital for an evaluation. R1's primary care physician was notified along with R1's RP. A nurse practitioner was at the facility to evaluate R1 and ordered an X-ray on 4/7/2023. Interview statement received from Health and Wellness Director, Ayana Allison, indicated the facility is unsure when the incident occurred. It may have occurred at night on 4/3/2023 or in the morning on 4/4/2023. Management was notified in the morning of 4/4/2023 of the fall incident. The fall is considered unwitnessed due to staff not knowing how R1 fell, the time of the fall, or the date. R1 did sustained injuries while in care; however, after a thorough investigation, there was no evidence to suggest that the facility was negligent in their care and treatment of R1. Due to the information above, CCL finds the allegations to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted with Executive Director, copy of report was provided via email.the state’s words, verbatim · CDSS document, Sep 28, 2023 · control 59-AS-20230410082316