Brookdale Valley View

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on a death report submitted to the department on 12/16/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. Death report dated 12/15/2025 indicated Resident 1 (R1) was having difficulty breathing and 911 was called. EMS arrived and performed CPR for approximately 20 minutes before declaring the resident deceased. Garden Grove Police Department responded as well. Per physician report dated 09/27/2025, R1 was diagnosed with Hemiplegia and Hemiparesis following Cerebral Infarction, Dysphagia following Cerebral Infarction, Obesity, Pleural Effusion, Atrial Fibrillation, Neuralgia and Neuritis. Resident had been admitted to a skilled nursing in May 2025 for the above diagnosis' as well as Hypertension Urgency. Resident was prescribed multiple medications for blood pressure management. Licensee to forward a copy of the death certificate to LPA upon receipt. During today's visit it was revealed that there had been a change in Administrator as the former administrator left on 10/24/2025. The new administrator was hired 11/03/2025 and there was no notification to the department. Based on the observations made during today's visit, the following violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Dec 17, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(g) · Plan of correction due date: Dec 24, 2025

The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator...This requirement is not met as evidenced by: Based on interviews conducted and observation, Licensee failed to ensure the department was notified of a change in Administrator which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 17, 2025

Plan of correction: Licensee to provide required notification/ documentation for new administrator to LPA by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on an SOC 341 received by the department on 08/29/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. SOC 341 indicated that Resident 1 (R1) had reported that a caregiver had caused a skin tear on the resident's arm attempting to prevent the resident from falling and while removing the resident's arm from the grab bar in the restroom. Resident initially stated being unaware of which caregiver had been involved and subsequently reported different names to LPA and facility management. Resident stated that the caregivers were not intentional in the injury and were attempting to assist when it happened. Per physician report dated 02/24/2025, Resident is diagnosed with Parkinson's Disease. Facility states resident has been declining and has a care plan meeting scheduled to address the decline. Health and Wellness Director conducted an in-service on transfers on 07/07/2025 in response to resident's decline. LPA observed no health or safety concerns during the visit. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 9, 2025

Allegation investigated: Facility is mismanaging resident's medication

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegation listed above. LPA was greeted and granted entry by facility front desk staff after introducing himself and stating the purpose of the visit. Facility Executive Director Christine Perez was present and assisted with the visit. An initial investigation visit has taken place on June 11, 2025. During the visit, LPA requested the facility current census as well as the identification of residents on medication management and residents self-administering. A random selection of records for three residents on self-administration and three residents on medication management was requested, obtained and reviewed during the visit. Medication administration records and centrally stored medication also reviewed for the residents in question. Additionally, LPA conducted or attempted four staff interviews and four resident interviews. Additional witness interviews were conducted via telephone during the investigation. CONTINUED ON FORM LIC9099-C Substantiated CONTINUED FROM LIC9099 During the present visit, LPA requested to review additional files as well as the medication central storage. Regarding the allegation that Facility is mismanaging resident's medication, the following has been concluded: Based on interviews conducted, records reviewed and observations made at the facility, it was determined that following R1's admission on May 23, 2025, initial difficulties filling prescriptions written at the skilled nursing facility where R1 was admitted previously resulted in multiple self-administered doses for several medications to be missed. At the time of the initial visit however, the issues had been resolved with the assistance of R1's responsible party and prescribed medications were observed to be adequately present in the facility's central storage. A random review of prescribed medications for other facility residents evidenced that one prescription for resident R2 had not been administered for four days (from June 9 until June 13, 2025) due to apparent errors made by the pharmacy during the refill. Despite measures described by staff to anticipate on upcoming refills, R2 could not be administered one of their medications for multiple days before the refill was finally issued and delivered on June 13, 2025. During the present visit, all medications reviewed are adequately present in central storage. However, based on the evidence gathered during the investigation, the allegation is found to be Substantiated, meaning that the preponderance of evidence standard has been met. A Type A deficiency is being cited on the attached form LIC9099-D. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.the state’s words, verbatim · CDSS document, Jul 11, 2025 · control 22-AS-20250605124628

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jul 12, 2025

Per California Code of Regulations Section 87465(a)(4) on Incidental Medical and Dental Care: "The licensee shall assist residents with self-administered medications as needed". This requirement was not met as evidenced by: Based on records reviewed, observation and interviews conducted, at least two residents did not receive multiple doses of prescription medication due to supply issues. This constitutes an immediate risk to the health, safety or personal rights of individuals in care.the state’s words, verbatim · CDSS document, Jul 11, 2025

Plan of correction: Licensee will conduct an in-service training with personnel helping with self-administration of medication. Proof of training and attendance to be provided to LPA.

Allegation investigated: Facility staff are not keeping resident rooms at a comfortable temperature

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA toured the facility and interviewed staff and resident as well as reviewed and obtained pertinent documentation such as work orders. Regarding the allegation that facility staff are not keeping resident rooms at a comfortable temperature, the investigation revealed the following: Resident 1 (R1) indicated facility temperatures are not comfortable. LPA observed temperature in resident's room is 76 degrees F and dining room/ hallway temperatures are 75 degrees F. Facility provided an oscillating fan to resident for additional cooling. Resident is observed to be wearing a shirt, long sleeve hoodie as well as a puffer jacket while stating the temperatures are cold in the dining room and the many layers are needed. LPA reviewed facility documentation indicating multiple visits to resident's room by Maintenance to observe and/or address the temperatures in the room. CONTINUED ON LIC 9099C DATED 07/10/2025. Unfounded Documentation from facility show temperatures were within regulatory guidelines. Therefore the allegation is deemed 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 this report was provided.the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 22-AS-20250707085837

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on incident reports received by the department on 06/23/2025 and 07/07/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. SOC 341 dated 06/23/2025 indicated that Resident 1 (R1) had reported that a caregiver had yelled and pushed the resident. Garden Grove Police Department was called and police report #25032623 was provided. Facility conducted an internal investigation and closed the investigation based on interviews conducted. Per physician report dated 02/27/2025, R1 is diagnosed with Mild Cognitive Impairment. Facility to forward copies of internal interviews to LPA by close of business 07/14/2025. Incident report dated 07/07/2025 indicated R2 had an un-witnessed fall leading to a fractured right hip. Resident stated getting up from the recliner and falling while attempting to get the resident's walker. Resident is currently admitted at Los Alamitos Hospital post surgery. Per facility notes, resident has had multiple prior falls resulting in no injuries to resident. Per service plan dated 03/10/2025, R2 is independent of escorting and uses a walker and/ or wheelchair. Physician report dated 09/03/2024 indicates resident is diagnosed with Generalized Weakness and Mild Cognitive Impairment. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:00 AM, LPA Tea was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 160 non-ambulatory residents, of which 21 maybe bedridden, with a hospice waiver for 12 residents. Currently there are 67 residents and 6 are on hospice during today's visit. The Executive Directors (ED) John Goodwin and Christine Perez arrived shortly to assist with the visit. LPA Tea reviewed eight resident files and five staff files. Resident files and staff files contained all required documentation. At 11:20 AM LPA Tea along with ED Perez and Maintenance Director (MD) Jose Contreras-Silva toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a two-story building. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. The fire alarm system of the facility is monitored and maintained by a third-party company. Fire extinguishers are fully charged throughout the facility. Last disaster drill was conducted May 7, 2025. LPA observed evac chairs by the stairways in the facility for emergencies. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured between 105.9 Fahrenheit degrees and 107.0 Fahrenheit degrees. LPA pulled emergency pendants in resident’s bathrooms; staff came immediately within in a minute or two. Common areas were clean and clear of hazards, doorways were free of obstructions. Facility kitchen and dining area was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed Annual inspection continued on LIC809-C emergency food in a storage closet in the dining room area and the emergency water stored in a maintenance closet. LPA Tea observed residents eating in the dining room and doing activities like exercises in the morning and playing games of bingo in the afternoon in the activities room. The facility provides different activities for residents daily, which are posted throughout the facility. LPA reviewed medication storage and administration. Medications are stored in locked carts in the medication room. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations An exit interview was conducted with ED Christine Perez and a copy of this report was given to the facility along with a copy of the LIC858, 858C; 859.the state’s words, verbatim · CDSS document, Jun 18, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on an SOC 341 submitted to the department. LPA was greeted and granted entry into the facility and explained the reason for the visit. SOC 341 dated 05/20/2025 indicated Resident 1 (R1) had reported that Staff 1 (S1) had propositioned the resident. Facility immediately suspended S1 pending investigation. Interview with resident indicated that no relations had occurred and resident denied any injuries. S1 will be returning to work today, May 29, 2025. Physician report dated 05/23/2024 indicates resident is diagnosed with Mild Cognitive Impairment and is currently receiving hospice care. Resident had just returned from a hospitalization for a bowel obstruction and urinary tract infection when the incident occurred. LPA spoke with R1 who appeared clean and well taken care. R1 verbalized feeling safe at the facility. LPA toured the facility and spoke with residents during the visit. LPA observed residents relaxing or participating in activities. The incident requires further investigation. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 29, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on an incident report received by the department on 02/19/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. Incident report dated 02/12/2025 indicated Resident 1 (R1) was sent out for elevated heart rate, lethargy and increased respirations. Incident report notated at the bottom that resident had sustained a displaced fracture of medial condyle to the right tibia. Interview with facility indicated the report inadvertently referred to a fracture that occurred previously in December 2024. In December 2024, R1 had an un-witnessed fall near the front door of the resident room. Resident stated at the time attempting to get to the restroom and got dizzy. At the time of the incident R1 was able to leave the facility unassisted and independent of activities of daily living. However, primary diagnosis per physician report is difficulty walking. Care plan dated 10/08/2024 indicated fall precautions encouraged such as low bed and scoop mattress which LPA observed during the visit. Resident had no prior falls. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 24, 2025

Allegation investigated: Staff did not respond to resident's call in a timely manner Staff utilizes an inappropriate lock on resident's door.

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as facility notes. Regarding the allegations that staff did not respond to resident's call in a timely manner and staff utilizes an inappropriate lock on resident's door, the investigation revealed the following: On 02/13/2024, Resident 1 (R1) requested staff to call 911 for knee pain. Administrator called 911 and Emergency Medical Services (EMS), Lynch Ambulance, arrived to the facility. EMS put the resident on a gurney and took the resident downstairs for transport. In the meantime, staff locked the resident's door with an exterior lock per resident request. Once downstairs, the resident declined transport as the resident requested transport to a hospital that was too far away. Resident did not want to go to Los Alamitos Medical Center as advised by EMS. EMS transported the resident back to the resident's room which had been locked per resident request. Staff in charge at the time had gone on break and had to be called. CONTINUED ON LIC 9099C DATED 01/15/2025 Unfounded Once the staff was back, the door was unlocked. Two out of two staff state the elapsed time was approximately 10-15 minutes as the staff was on a break. Facility protocol is to have the staff in charge hold onto the key so no other staff/ residents can access the room when the resident is out. LPA observed the lock during the investigation. The lock is an exterior lock put on the doorhandle. Residents are able to open the door from the inside and exit while the lock is on the outside and LPA observed this firsthand. Administrator indicates that they have the locks on-site for those who want extra security for their rooms while out of the facility. R1 was one of the residents that would always request the lock when leaving the facility. Based on interviews conducted and observation, the allegations are deemed unfounded, meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to facility representative.the state’s words, verbatim · CDSS document, Jan 15, 2025 · control 22-AS-20240214140414

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced plan of correction visit to follow up on citations issued on 01/08/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87464(f)(4) pertaining to Basic Services has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87628(a) pertaining to Diabetes has been cleared. Licensee provided proof of correction. Licensee has complied with the terms of the POC. Exit interview conducted and a copy of this report was left at the facility along with clearance letter for cited items.the state’s words, verbatim · CDSS document, Jan 15, 2025

Allegation investigated: lack of care and supervision

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff and residents as well as reviewed and obtained pertinent documentation such as staff schedule. Regarding the allegation of lack of care and supervision, the investigation revealed the following: Facility schedule indicates three caregivers, one med tech and one coordinator for 1st and 2nd shift and one caregiver/ med tech for the overnight shift. Six out of six staff and four out of four residents state care and supervision is being provided to residents. One out of four residents state staff are slow to respond when the emergency pendant is pushed. Staff indicate Resident 1 (R1) came back to the facility under the influence of marijuana after a visit with family and was observed face down in the resident's meal. Resident was immediately assessed once it was brought to staff's attention. Resident was determined to be without injury and coherent once awakened. During the visit, LPA observed three caregivers working along with two med techs. Based on interviews conducted, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, CONTINUED ON LIC 9099C DATED 01/08/2024 Unsubstantiated meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility. Therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided as well as appeal rights.the state’s words, verbatim · CDSS document, Jan 8, 2025 · control 22-AS-20240205143436

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Jan 9, 2025

Basic services shall at a minimum include: Personal assistance and care as needed by the resident.., with those activities of daily living such as assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This req is not met as evidenced by: Based on record review, Licensee failed to ensure medication assistance was provided to resident. Resident missed multiple medications as well injections. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Licensee to provide an in-service on medication administration and forward proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20240205143436. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed staff. Two out of two staff stated performing glucose checks on Resident 1 without being an appropriately skilled professional. Regulations require any finger stick to be performed by a licensed professional. Based on the observations made during today's visit, the following violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Jan 8, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Jan 9, 2025

The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens.. or has it administered by an appropriately skilled professional. Based on interviews conducted, Licensee failed to ensure glucose testing was performed by an appropriately skilled professional. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Licensee to perform an in-service on glucose testing/ injections and forward proof to LPA by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit .LPA was greeted and granted entry into the facility by concierge and later met with Executive Director (ED) Jeri Miles. The purpose of the visit is to follow-up on an incident report that was sent by this facility to Community Care Licensing; the incident report stated a resident (R1) was hospitalized and later found out R1 had fracture to medial right tibia after sustaining a fall in own room at the facility. LPA reviewed resident’s file and LIC-602 (Physician’s Report) and observed that R1 is ambulatory and can transfer to and from bed and can manage their own medication. LPA also reviewed the pendent call history for R1 and observed that R1 had placed 10 service calls in the past 30 days with the 20th of December being the last day. LPA confirmed that R1 still at the hospital and had gone into surgery. Its unknown when R1 will be back to facility. LPA interviewed three staff member and three of three confirmed that R1 is ambulatory and did attend a happy hour inside the facility where R1 had two small cups of wine prior to going back to her room. No deficiencies are being cited on today's visit. An exit interview was conducted with ED and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 27, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Rose Ruppert conducted an unannounced case management visit at 1:30 PM. LPA was greeted and granted entry into the facility by concierge and met with Patricia Perez, Executive Director. The purpose of the visit is to follow-up on an eviction letter received in our office on May 6, 2024 for Resident #1 (R1). LPA requested resident records from Business Office Coordinator and was informed that R1 had passed away on May 30, 2024. LPA obtained a copy of the death report for R1. An exit interview was conducted with Patricia Perez, ED and a copy of the report and files reviewed (LIC 858) were given at the time of the visit.the state’s words, verbatim · CDSS document, Aug 16, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Executive Director Patricia Perez and explained the reason for the visit. The facility is a two story building with 81 resident rooms. LPA and the Executive Director toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry way of the facility. LPA observed the first floor of the facility is well lit and the hallways are free of obstacles and hazards. All fire extinguishers on the first floor are fully charged. LPA observed cleaning supplies are kept locked in a storage closet. Facility does not have a memory care unit and does not have any delayed egress exits. The dining room is clean and has enough room to accommodate the residents. LPA observed the kitchen is clean and organized. LPA observed a two day perishable and a seven day non-perishable food supply on hand in the kitchen. The refrigerators and the freezer were at the required temperature. The fire extinguisher in the kitchen is fully charged. LPA inspected 3 resident rooms on the first floor. LPA observed the resident rooms had the required furnishings and bed linens. LPA observed the bathrooms were clean and operational. Hot water measured 105.0 to 106.0 degrees Fahrenheit. LPA observed residents participating in a trivia game in the activity room during the visit. LPA tested the signal system in 2 rooms, one the second floor and one on the first floor, the response time was 3 minutes. There is an outdoor patio with shaded seating outside of the dining room. The patio has a yard with a small circular walkway that residents can use to walk. No bodies of water observed. The emergency exit gates in the outdoor area are operational. No obstacles or hazards observed in the patio. LPA and the Executive Director toured the second floor. LPA observed that each stairway has an emergency evacuation chair. LPA inspected 3 resident rooms on the second floor. LPA observed the resident rooms had the required furnishings and bed linens. LPA observed the bathrooms were clean and operational. Hot water measured 105.0 to 106.0 degrees Fahrenheit. LPA observed all fire extinguishers on the second floor are fully charged. There is a patio with shaded seating on the second floor. The facility has a library on the second floor with books for the residents to read. No obstacles or hazards observed on the second floor. LPA reviewed 5 resident files no discrepancies observed. All smoke detectors/carbon monoxide detectors in the resident rooms inspected tested operational. The last emergency drill was conducted on May 6, 2024. LPA reviewed 5 resident medications, no discrepancies observed. LPA reviewed 5 staff files, all 5 staff members had the required 20 hours of annual training. No discrepancies observed in the staff files. No deficiencies observed during the visit. An exit interview conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jun 17, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on incident reports submitted to the department. LPA was greeted and granted entry into the facility and explained the reason for the visit. Incident report dated 04/22/2024 indicated Resident 1 (R1) reported missing checks from the resident room. The theft was of two checks in the amount of $900 each. Two days later Resident 2 (R2) reported $140 in cash missing from room. On 04/28/2024, Resident 3 (R3) reported missing checks in the amount of $1000 and Resident 4 (R4) reported $1000 cash missing on 04/29/2024. Facility conducted an investigation on 04/22/2024 and Staff 1 admitted to the thefts and was terminated. Garden Grove Police responded to the incident and charges are pending. It was determined through investigation that S1 attempted to cash $6,260 through a check cashing business. LPA interviewed the theft victims during the visit and all confirmed the thefts. All residents with checks missing were reimbursed through individual banks. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 7, 2024

Allegation investigated: Facility staff are not properly trained Facility is unsanitary

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the investigation, LPA toured the facility, interviewed staff and witness as well as reviewed and obtained pertinent documentation such as staff training. Regarding the allegations that facility staff are not properly trained and facility is unsanitary, the investigation revealed the following: On 02/12/2024, Staff 1 (S1) administered a vaginal suppository to Resident 1 (R1) per Health and Wellness Director's (HWD) instruction. LPA reviewed S1's training records during the visit and staff had required annual training. While the staff had medication training, S1 is not a skilled professional as required by title 22 regulations. Facility was alerted to the situation and the Health and Wellness Director was terminated on 02/26/2024. S1 was provided re-training. On the evening of 02/15/2024, Resident 1 (R1) vomited and requested assistance from S2 cleaning up the floor and the resident's wheelchair. Per interview with resident and facility documentation, S2 stated that the CONTINUED ON LIC 9099C DATED 3/4/2024 Substantiated morning shift will clean it up and left the floor and wheelchair soiled. The next morning the soiled areas were cleaned by morning staff. S2 was put into corrective action on 02/19/2024 for the incident. Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted with ED and a copy of this report was provided as well as appeal rights.the state’s words, verbatim · CDSS document, Mar 4, 2024 · control 22-AS-20240226161612

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87622(a)(2) · Plan of correction due date: Mar 6, 2024

The licensee shall be permitted to accept or retain a resident..,suppositories shall be permitted if administered according to physician's orders by either the resident or an appropriately skilled professional. This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure an appropriately skilled profession administered a suppository. S1 administered a suppository to R1 and is not a skilled professional. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 4, 2024

Plan of correction: Licensee to forward a statement of understanding of the regulation to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 18, 2024

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure facility is clean and sanitary. S2 failed to clean up resident's soiled floor and wheelchair. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 4, 2024

Plan of correction: Licensee to provide an in-service to staff and forward proof to LPA by POC due date.

Allegation investigated: Staff do not ensure special dietary restrictions are followed for resident in care Staff did not ensure resident received medical treatment in a timely manner

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to deliver the findings on the complaint allegations mentioned above. LPA Haley met with Executive Director (ED) Melissa Weibel and explained the reason for the visit. During the investigation, staff interviews were conducted, documents were reviewed, and observations were made during the unannounced visit. Regarding the allegation: Staff do not ensure special dietary restrictions are followed for resident in care Document review revealed Resident 1 (R1) was not on a special diet at the time the complaint was filed September 1, 2023. R1 was on a texture modified diet when the resident first moved into the facility in July 7, 2023. However, on August 1, 2023, R1 received a physician’s order for a regular diet with no texture modifications. During interviews, it was discovered R1 doesn’t like sweets and doesn’t eat sweet food. During the visit, observations were made that contradict the allegation above. Continued on LIC9099C Unfounded While observing R1’s room, there were no sweets present, flavored water was the only item in the refrigerator, and “Sweet’ N Low” packets were observed in a plastic container with some tea bags. During an inspection of the kitchen, a dietary restrictions board was observed. Resident photos are placed on color coded cards with details of their diet for kitchen personnel to follow. 5 of 8 witnesses interviewed during the investigation confirmed dietary restrictions are followed. Regarding the allegation: Staff did not ensure resident received medical treatment in a timely manner 5 of 8 witnesses denied the allegation. It was discovered the R1 complained of shoulder pain and a Med tec was sent to assess the resident. During the assessment, R1 complained of shoulder pain and dizziness. When the Wellness Director came to assess the resident, there were still complains of shoulder pain and the resident was offered Tylenol for the pain. Paramedics were eventually called, and transported R1 to the hospital at the request of a family member who was on the phone during the entire time a aware of what was going on. R1 was sent to Los Alamitos Medical Center for shoulder pain and returned to the facility the same day (8.31.23) with no new orders. Based on the information gathered during the investigation through interviews, document review, and observation. The allegations mentioned above are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 3, 2023 · control 22-AS-20230901162928