Channing House

Type of visit: Case Management - Other

On July 16, 2026, licensing Program Analyst (LPA) Murial Han conducted re-inspection to follow up on a change in capacity/prelicensing inspection that was conducted on 6/29/2026. LPA met with Administrator, Yadira Aldana. LPA explained the purpose of today's visit. During LPA's visit on June 29, 2026, LPA observed grab bar was installed in one of the apartments but not the rest of the apartments. Therefore, the increase in capacity/prelicensing was not approved. During today's visit, LPA randomly inspected rooms on the 1st, 2nd and the town home and observed grab bars were installed in the bath/shower rooms. Pre-Licensing/increase in capacity of 26 beds at the location of 430 Forest Avenue Palo Alto is now complete. Immediate Licensure is recommended pending final approval from the Central Applications Bureau. Comp III has been completed with the administrator. This report is reviewed and discussed with the administrator. A copy is provided.the state’s words, verbatim · CDSS document, Jul 16, 2026

Allegation investigated: Staff did not provide an adequate contract for resident

On 7/9/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to deliver conclusionary findings for this complaint. LPA Calandra was greeted by Yadira Aldana, Health and Wellness Administrator and explained the purpose of the visit. On December 18, 2025, the Department received a complaint alleging that the provider did not provide an adequate contract for a prospective resident. The complaint alleges that: (1) the Residency Agreement (80% repayment) “Death” provision is dishonest; (2) the provider retaliated by denying admission due to concerns raised about the contract; (3) the provider was unable to provide confirmation that there is no lead paint in the unit; (4) incorrect wire instructions were provided; (5) the provider refused to acknowledge statements made during a video call; and (6) a $500 fee was not refunded. Throughout the course of the investigation, the Department conducted interviews with the Reporting Party (RP) and provider staff and reviewed documentation relevant to the complaint. Unsubstantiated Based on interviews and the review of documents and information provided, the RP reported that they reviewed the Residence and Care Agreement (RCA) on behalf of a prospective resident and expressed concern regarding the contract provision stating that no entrance fee repayment would be issued in the event of death resulting from a natural disaster, catastrophic event, pandemic, or similar occurrence involving multiple residents. The Department reviewed the RCA, which discloses this provision in Section IX.D (Death). The provision further states that exceptions may be made at the provider’s discretion. The RP further alleged that the provider denied admission in retaliation for raising concerns about the contract. The Department reviewed the RCA which states in section IX A. “(Cancellation Period) “Cancellation Period. Under California law, there will be a cancellation period of ninety (90) days after the date that you first occupy your Residence during which either the Provider or you may cancel this Agreement, with or without cause (the “Cancellation Period”). For purposes of this Agreement, you shall be deemed to “occupy” your Residence as of the date that you receive a key entitling you to occupy it. If the Provider cancels this Agreement without cause, it will provide you with thirty (30) days’ written notice of such cancellation. If you cancel this Agreement, you will provide the Provider with the written Notice of Cancellation attached to this Agreement as Appendix G.” The RP also stated that the provider was unable to confirm whether the unit contained lead-based paint. The Department did not obtain sufficient evidence to support that the provider violated any applicable requirement related to such disclosure. Additionally, documentation reviewed indicates that wire instructions for Umpqua Bank were initially provided and later corrected to Columbia Bank. The statute does not outline that the wiring information be included in the agreement. The provider subsequently corrected the information and explained that different financial institutions may be used depending on the property. The RP alleged that the provider refused to acknowledge statements made during a video call, in which a provider staff indicated that the contract language did not reflect the provider’s intent and described the organization as ethical. The Department reviewed the information and confirmed that the contract is the version previously approved by the Department. Upon review, the contract was found to be in compliance and approved on June 7, 2022. Finally, the RP reported that a $500 fee was not refunded. The Department reviewed the RCA, which states that the processing fee is non-refundable. Documentation supports that the fee was disclosed as non-refundable in accordance with the contract terms. Due to this information, the Department finds the allegation to be UNSUBSTANTIATED – a finding of unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiencies citedthe state’s words, verbatim · CDSS document, Jul 9, 2026 · control 26-AS-20251208090952

Type of visit: Case Management - Other

On June 29, 2026, Licensing Program Analyst (LPA) Murial Han conducted a change in capacity inspection. LPA met with Chief Executive Officer, Rhoda Bekkedabhl and Administrator, Yadira Aldana. LPA explained the purpose of today's visit. The additional capacity of 26 residents is located at 430 Forest Avenue Palo Alto that is about 2 blocks away from the main facility. During today's inspection, LPA observed this is a 2-story facility consisting of 5 apartments on the 1st floor and 5 apartments on the 2nd floor, 1 penthouse and 2 town homes. There are no residents during the time of the inspection. LPA observed good lighting in the apartment with comfortable temperature maintained. The facility is observed and be cleaned, tidy and spacious. LPA observed the hot water temperature was measured at 114- 118 degrees F. LPA observed call bells were installed in each bathroom/showroom. During the inspection, LPA observed grab bars were not installed in the bath/shower tubs except for one of the apartments on the 1st floor resulting in increased capacity is not recommended at this time. The administrator and the CEO stated that they will inform LPA to return for a reinspection when this matter is resolved. This report is reviewed and discussed with the administrator and the CEO. A copy of the report is provided.the state’s words, verbatim · CDSS document, Jun 29, 2026

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds of this Continuing Care Retirement Community, which consists of two buildings--the main tower is 11 stories tall and accommodates independent residents on floors 2 - 10 and assisted living residents in 11 units on the THIRD floor; on the ground floor of the adjacent 2-story building--called the Lee Center--there are 24 assisted living units, including a dining room. Apartments are equipped with emergency call alarms; in the Lee Center, pull alarms are installed in bedroom and bathroom, and a visual and auditory signal is activated; for the 3rd floor rooms of the main building, pull alarms are installed in bathrooms and pendants are worn by residents to summon staff. In addition, the land line phones can be activated to summon staff. Common areas--dining room, fitness rooms, recreation room, auditorium, library, music room, living room with pianos--are on the ground floor of main building, in addition to kitchen, offices, gift shop and 3 guest bedrooms for visiting overnight guests of residents. A large open area is available on the top floor for common use, as well as a large wrap around balcony. There is an indoor swimming pool and jacuzzi tub in the basement level, which is monitored by surveillance camera. There are no fire safety hazards observed. Hot water temperature is tested at 108 degrees in 3rd floor assisted living bathroom. Food supply, signal system, and first-aid kit are inspected. Reports of monthly consultations by registered dietician are maintained. Copy of report dated 2/24/26 is provided to LPA. Fire and emergency drills are documented and occur at least bi-monthly. Evacuation chairs are maintained for two stairwells in main building and both stairwells in Lee Center building. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as required staff records. Rhonda Bekkedahl and Yadira Aldana are certified RCFE administrators (x 2/27 and x11/26) that oversee facility operations. Staff records will be reviewed at a later date due to time constraints. Centrally Stored Medications Records are reviewed randomly. There are no residents receiving hospice services at this time. An updated Disaster and Mass Casualty Plan is readily available. Continued on following page. The following forms are requested to be completed and returned to CCL by 4/2/26: • LIC 309 Administrative Organization . • LIC 308 Designation of Facility Responsibility - LIC 400 Affidavit REgarding Client Cash Resources Update Personnel Report is given to LPA today, as well as recent Registered Dietician Report. Deficiencies of the California Code of Regulations, Title 22 are observed and cited on following pages.the state’s words, verbatim · CDSS document, Mar 26, 2026

Type of visit: Case Management - Other

On 10/20/2025, Licensing Program Analyst (LPA) Murial Han conducted a change in capacity inspection. LPA met with Chief Executive Officer, Rhoda Bekkedabhl and Chief Operating Officer, Elvyra Abare. LPA explained the purpose of today's visit. The additional capacity of 26 residents is located on 430 Forest Avenue Palo Alto that is about 2 blocks away from the main facility. During today's inspection, LPA observed the facility has a total of 3 floors and 2 townhouses that is next the facility. There are 5 apartments one the 1st and 2nd floor and the penthouse is on the 3rd floor. LPA toured 2 apartments on the 1st floor as the other apartments are occupied with tenants and according to the CEO and the COO, the tenants were provided with the notice to vacant last Thursday by 12/31/2025. During the tour of the apartments and the townhouse, LPA observed, kitchen, dining room, living room, laundry area, common areas, patio and bathroom. LPA did not observed any furniture and furnishings in any the apartments and the townhouse. LPA observed the water temperature in the bathroom and kitchen was measured at 128- 133 degrees F, no grab bars and no non-skid mats in the showers, broken patio furniture, dust in varies areas, unpleasant smell in one of the apartments, and dead flies in of the townhouse. The CEO and the COO were aware of the above observations and stated that the complete renovation will start after 12/31/2025. Increase in capacity for this location is not approved at this time. This report is reviewed and discussed with the COO. A copy is provided.the state’s words, verbatim · CDSS document, Oct 20, 2025

Type of visit: Case Management - Incident

On 07/21/2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management – Incident visit regarding an incident that occurred on 07/03/2025 when the resident (R1) eloped from the facility. Upon arrival, LPA met with the Chief Operating Officer (COO), Elvyra Abare and Assistant Administrator (AAD), Beth Shirley. The LPA disclosed the purpose of the visit. LPA interviewed COO, who stated that R1’s wife (R2), was a resident of the Independent Living (IL) unit and took R1 out around 9:15 AM for AM exercise in the IL. Later around 11:45 AM, R1 called to let the Assisted Living (AL) staff know that R1 will be eating lunch with R2 at R2’s apartment at IL. R2 checked on R1 after lunch and observed R1 taking a nap. R2 took a nap as well and when R2 woke up, R1 was not in the room. A few minutes later, a private caregiver of a resident at Skilled Nursing unit saw R1 walking alone and verbally notified the staff. The Assistant Director of Nursing and one of the CNA went and brought R1 back inside the Assisted Living. A head-to-toe assessment was done and R1 was put on 72 hours monitoring. Law enforcement was not involved. COO stated that the facility held R1’s plan of care meeting with R2 and rest of R1's family members. The facility was offered an option of a private caregiver or family assisting R1 with the walks. The COO further stated that R1 likes to walk, and it would be good if R1 had a scheduled walk every day. The family decided to have R1 walk with their daughter who lives nearby. According to COO, the family stated that they are willing to sign whatever it takes for R1 to go out on walk on their own and offered to write a letter to the facility to indicate that family was liable for R1. LPA reviewed past Incident Reports and observed that R1 had dementia and have eloped from the facility twice on the same day in February 2025. Continued on LIC809-C The COO stated that the after R1's latest elopment incident, the facility has enforced the check-out and check-in procedure for R1 if anyone is taking R1 out of Assisted Living. R1 already have a wander guard bracelet on them. Additionally, R1’s family was going to provide and place an AirTag in R1’s shoes. The facility will continue to reassess R1’s well-being and safety by continuing R1’s safety discussions with R1’s family members. No deficiencies were cited during today's visit. An exit interview was conducted with the COO. A copy of this report was provided to the COO, Elvyra Abare, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Jul 21, 2025

Type of visit: Case Management - Incident

On July 02, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management – Incident visit regarding an incident that occurred on 06/26/2025 when the resident (R1) was administered the incorrect medication by a staff member. Upon arrival, LPA met with the Chief Operating Officer (COO), Elvyra Abare and Assistant Administrator (AAD), Beth Shirley. The LPA disclosed the purpose of the visit. LPA interviewed three (3) staff members: S1, S2, and AAD. The AAD stated that at around 5 pm on 6/26/2025, S1 was carrying two medication cups: one to administer to R1 and the other for another resident. While S1 administered R1’s medication, S1 sat down with the cup holding the other resident's medication on R1's bedside table. S1 then left R1’s room. S2 then went into the R1 to give R1 some juice because R1’s blood sugar was low. Once in the room, S2 saw the cup with the other resident's medication in it and administered it to R1 in error, thinking it was R1’s medication. AAD stated that on 07/01/2025, both S1 and S2 had completed re-training on Relias for medication administration. LPA interviewed S1 over the phone. S1 stated that they administered the wrong medication to R1. S1 stated that R1’s blood sugar was low, and they went to fetch the orange juice to raise the blood sugar. S1 informed S2 that they need assistance in giving juice and medication to R1. S1 left the room and by the time they realized the mistake, S2 had already administered the wrong medication to R1. S1 stated they contacted R1’s family member and PCP at Kaiser. The Kaiser nurse followed their protocols and advised S1 to monitor R1 for any adverse effects and change in condition, and PCP would contact if they had any questions. S1 stated R1 didn’t have any side effects or adverse reaction due to the wrong medication. Continued on LIC809-C LPA interviewed S2 over the phone. S2 stated that S1 mentioned that R1’s blood sugar was low and asked S2 to fetch orange juice for R1. S1 further asked S2 to give R1 their medications that were left on R1’s bedside. S2 gave the juice and the medication to R1 assuming the medication was for R1. S2 stated that S1 reached out to R1’s PCP and family about the medication error. LPA reviewed R1’s progress notes for 06/26/2025, which documented the medication error. The notes indicated R1's vital readings and the exchange with the Kaiser nurse and R1’s family member. LPA visited R'1 room to interview R1, but R1 was observed to be sleeping at that time. The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Assistant Administrator. A copy of this report and appeal rights were discussed and provided to the Assistant Administrator, Beth Shirley, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 2, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(5) · Plan of correction due date: Jul 3, 2025

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications… (5) Each resident's medication shall be stored… No medications shall be transferred between containers. This requirement was not met as evidenced by: Based on interviews and records review, the facility staff did not ensure R1 was given the correct medication as staff was transferring multiple residents' medications at the same time from the originally received container/bubble packs to small cups.the state’s words, verbatim · CDSS document, Jul 2, 2025

Plan of correction: The AAD will submit the POC to CCLD by 07/03/2025.

Allegation investigated: Resident was left on the floor for an extended period of time due to lack of supervision Staff did not ensure that resident was adequately hydrated

On May 09, 2025, at 08:50 AM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Complaint Investigation visit. Upon arrival, LPA met with the Assistant Administrator (AAD), Beth Shirley. The LPA disclosed the purpose of the visit. The AAD informed the LPA that the total census of the facility was 231, including 28 residents in Assisted Living. LPA requested and collected the Resident Roster and the Staff schedule records for the period of April 28, 2025 to April 30, 2025. LPA reviewed the Resident Roster record and noticed that the resident (R1) mentioned in the complaint narrative was a direct resident of skilled nursing section of the facility, which is not licensed by CCLD. LPA interviewed AAD, who stated that some of the residents in the skilled nursing unit are admitted as direct (permanent) and some as temporarily from Assisted Living or the Independent Living sections. Continued on LIC9099-C Unfounded Based on observations, interview conducted with the Assistant Administrator, and records reviewed, the department has determined that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, the allegation is UNFOUNDED. No deficiencies were cited under the California Code of Regulations, Title 22. An exit interview was conducted with the Assistant Administrator. A copy of this report was provided to the Assistant Administrator, Beth Shirley, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, May 9, 2025 · control 26-AS-20250502100433

Type of visit: Case Management - Incident

On April 23, 2025, at 9:00 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management – Incident visit regarding an incident that occurred on 04/17/2025 when the resident (R1) was administered the incorrect medicine by a staff member. Upon arrival, LPA met with the Chief Operating Officer (COO) Elvyra Abare and Assistant Administrator (AAD), Beth Shirley. The LPA disclosed the purpose of the visit. LPA interviewed three (3) staff members: S1, S2, and COO. LPA interviewed S1 over the phone. S1 stated that on 04/17/2025, they had received a call from staff (S2) reporting a medication error. S2 had administered one of the Assisted Living (AL) resident’s morning medications to Independent Living (IL) resident R1. According to S1, S2 was conducting a medication pass when the phone rang. S2 grabbed a medication cup from the top of the med cart and administered the medications to R1. IL residents who are on medication management typically go down to AL to receive their medications. After completing the phone call, S2 realized that R1’s actual medications were still on the cart, but R1 had already left. R1, R1’s family member, and R1’s primary care physician (PCP) were informed about the medication error. R1 was offered the option to return to AL for monitoring. The PCP recommended that staff monitor R1 and continue with their regular medications. The COO stated that the nurse responsible for the medication error would receive education and training. The plan was to assign the nurse a Relias training module, including a reminder on medication administration protocols and a quiz. Continue on LIC809-C The COO emphasized that, fortunately, R1 did not experience any adverse effects or changes in condition. Staff continued to monitor R1 every hour for the first 24 hours and extended the monitoring to 72 hours. S2 stated that around 8:20 AM on 04/17/2025, R1 came to AL to receive their medication. At the same time, another AL resident was approaching quickly on a scooter requesting their medication, and the telephone rang. S2 answered the phone and, while distracted, handed the wrong medication cup to R1, who took the medication and left. A few minutes later, S2 realized that R1’s medications were still on the cart and that the wrong medications had been given. S2 checked whether R1 had any known allergies to the administered medication and then went to R1’s room to inform them of the error and the need for monitoring. S2 then returned to the nursing station and notified S1 of the incident. S2 also contacted R1’s PCP office, and at approximately 1:50 PM, the medical assistant advised to continue regular medications and to withhold one specific medication only if R1’s blood pressure was below 130/80. S2 confirmed that R1 did not experience any adverse effects and was doing well. S2 endorsed the situation to the incoming evening shift and instructed them to continue monitoring R1 and to check blood pressure before administering medications. S2 stated they learned from the incident and acknowledged the importance of not answering phone calls during medication passes unless it is an emergency. Although S2 had not yet received new training following the incident, they mentioned having worked at the facility for 17 years and had always maintained focus on their responsibilities. S2 also shared that R1 had expressed understanding, stating, "Everyone makes mistakes. We are all human and not perfect." AAD called to check if the resident (R1) is willing to talk to the LPA about the medication incident that happened last week, but the resident stated that it’s not necessary for them to talk to the LPA LPA reviewed R1’s progress notes for 04/17/2025, which documented the medication error in detail. The notes indicated that R1 had been offered the option to stay in an AL room for monitoring, but R1 declined. Staff began taking R1’s blood pressure readings hourly starting at 9:30 AM. At 1:30 PM, R1 left the facility with a family member for a pre-scheduled appointment with their cardiologist. After 3:30 PM on 04/17/2025, R1 resumed their regular medications. Continue on LIC809-C LPA also reviewed R1’s Centrally Stored Medication and Destruction Records, the Medication Administration Record (MAR), and obtained a list of the incorrect medications that had been administered. LPA requested AAD to submit proof of S2’s training and continuing education. No deficiencies were cited during today's visit. An exit interview was conducted with the Assistant Administrator. A copy of this report was provided to the Assistant Administrator, Beth Shirley, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Apr 23, 2025

Allegation investigated: Staff are yelling at residents and not according residents with dignity.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Beth Shirley, Assistant Administrator. On 11/01/2023, the department received a complaint with the above allegation. LPA Marrufo conducted an initial complaint investigation visit on 11/09/2023. LPA Marrufo obtained a copy of the Unusual Incident/Injury Report (IR) that the facility submitted to the department on 10/30/2023. The IR states that on 10/30/2023 resident R1 reported to the facility Administrator (ADM) that staff S1 was disrespectful to R1 on two different occasions. The first occasion involved an incident in which S1 was assisting another resident who is known to have aggressive behaviors in the common area. R1 stated that S1 used a raised voice to tell R1 to go back to his/her room. See LIC9099-C pages for more information. Page 1 of 3. Unsubstantiated The second occasion involved S1 raising his/her voice at R1 when S1 found R1 on another floor of the building. R1 stated S1 used a raise voice towards R1 to ask R1 what R1 was doing and to tell R1 that R1 is not supposed to be in that part of the building alone. LPA Marrufo obtained a copy of resident R2’s Appraisal/Needs and Services Plan (ANS). R2’s ANS states, “The resident has episodes of being verbally aggressive towards other residents,” and “Resident had an incident of physical aggression with another resident, the resident moved [his/her] walker and hit another resident on [his/her] right leg.” LPA Marrufo obtained a copy of written statements made by staff as part of an internal investigation by the facility. The internal investigation had interviews of six staff. One of the six interviewed staff, S2, stated to have observed the incident in which R2 was having aggressive behaviors and S1 was attempting to supervise and redirect R2. S2 stated that while R2 was having aggressive behaviors, R1 was sitting in the common area. R2 stated that S1 was attempting to tell R1 to go to his/her room and that the area was not safe. S2 stated that S1 did not raise his/her voice at R1 but used a firm, but not disrespectful tone. S2 stated that S1 was encouraging R1 to go to his/her room. S2 stated that R1 continued to walk towards R2 and walked around R2. On 11/09/2023, LPA Marrufo interviewed R1. R1 stated that R1 had an incident with a staff, but did not want to name the staff. R1 stated that a resident used his/her walker to block R1 and a staff. R1 stated the resident uses the walker “almost as a weapon.” R1 stated to have asked the resident to let him/her out and R1 was able to walk past the resident, but the resident continued to block the staff. R1 stated the staff did not say anything to R1, but R1 did not like that the staff told R1’s child that he/she was protecting R1 from the resident with the walker. On 11/09/2023, LPA visited R2, who had a private care giver at the facility. LPA Marrufo attempted to interview R2. However, R2 appeared confused, and LPA Marrufo did not continue with the interview. LPA Marrufo interviewed R2’s private care giver, who stated that R2 does block people with R2’s walker. Page 2 of 3. On 03/21/2025, LPA Marrufo conducted a telephone interview with S1. S1 stated to recall R1 and recall the incident involving R2 having aggressive behaviors while R1 was in the common area. S1 stated that R2 has been both verbally and physically aggressive towards others. S1 stated that R2 was being verbally aggressive and S1 feared that R2 may become physically aggressive. S1 stated that S1 told R1 that R2 was not in a good mood and the situation was not good. S1 stated that S1 may have suggested to R1 to go back to his/her room, but did not use an angry or disrespectful tone and did not yell at R1. S1 stated to have not acted in a way that did not give R1 dignity. S1 stated to have never yelled at R1 or spoken to R1 in a disrespectful or angry tone while R1 was in an elevator on another floor of the building. LPA Marrufo obtained copies of R1’s training logs, which include “Dementia Bill of Rights” completed on 03/29/2023, “Mandated Reporting,” completed on 04/24, 2023, “Interpersonal Communication” completed on 7/11/2023, and “Res. Behaviors, Narcotic Count, Breaks, Trays, Res. Appts, TEFs, Meal Waivers, Announcements” on 10/26/2023. Based on information from interviews conducted with staff and residents, and records reviewed, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with Beth Shirley, Assistant Administrator and a copy of this report was provided. Page 3 of 3. END REPORTthe state’s words, verbatim · CDSS document, Mar 21, 2025 · control 26-AS-20231101151155

Type of visit: Required - 1 Year

On March 20, 2025, at 8:50 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Chief Operating Officer (COO) Elvyra Abare, Assistant Administrator (AAD), Beth Shirley, and disclosed the purpose of the inspection. The facility was a single building, multi-floor facility with a combination of assisted living and independent living sections. The AAD informed the LPA that the facility had 229 residents in care at the time, including 27 in Assisted Living and 202 in Independent Living. LPA initiated a walk-through of the facility, accompanied by AAD. LPA inspected randomly selected resident rooms in Assisted Living and Independent Living. The rooms were found to be clean, well-lit, and equipped with the required furniture. Emergency pull cords were observed to be functioning in the resident rooms. LPA inspected the private bathrooms in these rooms. The bathrooms contained soap, grab bars, towels, a trash can, and non-slip flooring. The hot water temperature at the sink faucets measured between 116.4°F and 118.9°F. LPA inspected the fire extinguishers mounted on the hallway walls in Assisted Living and Independent Living and found them fully charged, with the last service tag dated 09/04/2024. All common areas were free from obstructions, and hallways were well-lit. The smoke and carbon monoxide detector are tested daily by facilities technicians and yearly by a third party vendor, PAFA, with the last testing completed on 10/18/2024. LPA inspected the main kitchen and found it clean. The refrigerator, freezer, and pantry cabinets were checked, and there was a sufficient supply of fresh perishable food for two (2) days and nonperishable staples for seven (7) days. No expired food items were found. Open food items were wrapped and dated. The dining room was inspected and found to be clean, with all furniture in good repair. LPA observed recreational rooms such as activity rooms, fitness centers, library, swimming pool, and auditorium for events, movies, and other activities. The residents were seen actively engaged in recreational programs and activities. Continued on LIC809-C LPA toured the garden terraces and patio area and found ramps and passageways in good condition, free of obstructions, and without any blocking or tripping hazards. These areas had patio tables, chairs, and shaded area for residents’ use. LPA reviewed six (6) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. LPA observed that 6 of 6 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 6 of 6 staff members were associated with the facility. LPA observed a locked centrally stored medication cart located near the nursing station in the Assisted Living floor. Medications were organized in separate bins for each resident. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records (CSMR) were reviewed and found to be complete. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted monthly, with the most recent drill completed on 03/12/2025. The following updated forms are requested to be submitted to CCLD by 03/27/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility LIC 400: Resident Cash Resources Affidavit LIC 402: Surety Bond Certificate of Liability Insurance Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Assistant Administrator. A copy of this report was provided to the Assistant Administrator, Beth Shirley, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Mar 20, 2025

Type of visit: Case Management - Incident

On February 12, 2025, at 11:30 AM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Case Management – Incident visit regarding (2) incidents that occurred on 02/03/2025. Upon arrival, the LPA was greeted by the Assistant Administrator (AAD), Beth Shirley. The LPA disclosed the purpose of the visit. For incident #1, which occurred on 02/03/2025, resident (R1) eloped from the facility around 10:56 AM and was later found by a staff member at 12:05 PM, about 0.5 miles away from the facility. AAD stated that R1’s spouse talked to the nurse in the AL to took R1 to an event in the Independent Living Auditorium. R1 was sitting in the back of the Auditorium while the spouse was sitting in the front. R1 eloped from the auditorium, and the front desk receptionist was notified via the Roam Alert system that Assisted Living resident R1 had exited the building on their own. The receptionist notified the nursing staff and the Administrator. At 11:01 AM, the Administrator notified all managers via radio. Multiple staff members were sent out on foot and by car to look for R1. Searchers were provided with a picture of what R1 was wearing that day. At 11:35 Am, 911 was notified of R1’s elopement and began assisting in the search. Two Palo Alto police officers arrived at the building around 11:38 AM to assist. At 12:05 PM, R1 was found by a staff member about 0.5 miles away from the building. A staff member offered R1 a ride back to the community and they arrived at 12:14 PM. R1 was tired but was in good spirits. For incident #2, which occurred on 02/03/2025, resident (R1) eloped from the facility through stairwell exit around 05:38 PM and was later found by a staff member at 05:58 PM, walking about a block from the facility. AAD stated that the nurse on duty responded to an alert from Roam Alert system for Assisted Living resident R1. The nurse immediately checked the area around the alarm but was unable to locate R1. At 5:45 PM, the front desk was notified of the elopement. Staff were sent out to search the area around the building. At 5:58 PM, R1 was found walking less than a block from the building. R1 stated they were just going out for a walk. R1 was tired but was in good spirits upon their return to the community. Continued on LIC809-C LPA reviewed R1’s Physician’s Order Summary Report dated 11/18/2024, R1 has a primary diagnosis of Dementia, is ambulatory, and is deemed unable to leave the facility unaccompanied. The facility staff did not ensure that R1 didn’t leave the facility unaccompanied. Based on the review of R1’s Service Plan Report, on 12/15/2024, R1 attempted to elope via stairs to the basement. A deficiency was cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Assistant Administrator. A copy of this report and appeal rights were discussed and left with the Assistant Administrator, Beth Shirley, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Feb 12, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Feb 13, 2025

87411 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: The facility staff was not able to prevent resident (R1) from eloping the facility on two separate occasions on 02/03/2025. R1 has dementia, deemed not able to leave the facility unaccompanied, and was able to leave the facility unaccompanied in the morning and evening of 02/03/2025, which posed an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 12, 2025

Plan of correction: The Assistant Administrator will develop a plan to ensure residents are being supervised at all times. Assistant Administrator will provide a copy of the plan to CCLD by 02/13/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Yadira Gonzalez-Mendoz. During visit, LPA Marrufo toured the food storage areas, including the emergency food supply areas. The facility had a perishable food supply of at least 2 days and a non-perishable food supply of at least seven days. LPA Marrufo observed storage areas for emergency PPE supplies and cleaning supplies. LPA Marrufo toured the outdoor exits and found them to be clear of obstructions. LPA Marrufo toured resident bedrooms in the Assisted Living Area. LPA Marrufo reviewed the Centrally Stored Medication Logs of 5 residents and found them to be complete. LPA Marrufo conducted a resident record review for 5 residents and found them to be complete. Due to time constraints, the annual inspection will need to be continued at a later time. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Yadira Gonzalez-Mendoz and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 7, 2024