Ciela

Type of visit: Required - 1 Year

At 9:35 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct a required annual inspection. Upon arrival LPA introduced herself to Valerie Trujillo and she was informed of the purpose of the visit. Valerie informed LPA that Rony Shram-Administrator would be arriving soon. At 10:15 AM, the Administrator Rony Shram arrived, and he was informed of the purpose of the visit. The facility is licensed to serve 100 non-ambulatory residents aged 60 and above, of which 20 may be bedridden. The facility is approved for 20 hospice residents and approved for delayed egress. All facility units are approved for bedridden clients. The facility is a four story building with two underground floors located in a residential area. There are currently no hospice residents or bedridden. The Annual Licensing Fees are current. The first floor consists of: The main entrance with lobby/front desk, office areas, kitchen, dining room, residential mail area, public restrooms,bistro, and lounge area. The first floor also has dementia care unit, kitchen area, café, dining room area, and medication room. The second floor consists of: Salon, office rooms, lounge/library area, courtyard, public bathrooms, and residential units. The third floor consists of: outside patio area, public bathrooms, and residential units. The fourth floor consists of: residential units Continued There are two underground lower levels that consists of: parking garage, theater room, gym, spa room, pool room, food storage, staff break room, resident storage. The facility has a total of 82 residential units, and several indoor and outdoor common areas with shaded seating. At 10:30 PM, LPA reviewed six (6) residents files for admission agreements, updated physician reports, needs and services plans all of which appeared to be current. LPA reviewed seven (7) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings which all appeared to be current. At 12:45 PM, LPA conducted a tour of the kitchen and there was 5-day supply of perishable and a 7day supply of non-perishable food items available, which were adequately maintained/stored. LPA also observed that there was a menu available for review there were no health and safety concerns. LPA inspected a total of six (6) bedrooms and six (6) bathrooms. The beds and bedding were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were in good condition and operational with required handrails and nonskid flooring. The water temperature ranged from 105°F to 118. °F. LPA observed that the facility appeared to be clean, sanitary, and appropriately furnished throughout the facility. LPA also observed the temperature to range between 72°- 85° degrees. Based on LPA observation no deficiencies were cited per Title 22 Regulations. An exit interview was conducted, and this report was discussed and provided to Rony Shran- Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 20, 2025

Allegation investigated: Staff are not distributing a resident's medication as prescribed

This report supersedes the reports created on 4/16/25, the findings remain the same. On 06/05/2025 Licensing Program Analyst-LPA Alfonso Iniguez conducted a subsequent complaint visit at the facility. LPA Iniguez met with Rony Shram/Executive Director and explained the purpose of today’s visit. Investigation consisted of the following: The Department conducted interviews with Residents (R2-R4) and Staff (S1-S3). LPA obtained R1 Medication Administration Records (Dated: 02/2025), Physicians Order for Medication (Dated: 05/17/2024), Physicians Report (Dated 06/20/2024), Face Sheet, Resident Appraisal, Identification and Emergency Information. The Department obtained R1 - R4 Physicians Report, Medication Administration Records (Dated 02/2025), and Physicians Order for Medications. LPA obtained copies of Med Tech training. LPA obtained copies of Register of Facility Residents, and Personnel Report. Evaluation Report continues LIC 9099-C Substantiated This report supersedes the reports created on 4/16/25, the findings remain the same. Investigation Revealed the Following: Allegation: Staff are not distributing a resident's medication as prescribed. The Department conducted an interview with Administrator Rony Shram, who stated he conducted an internal investigation, in January 2025, after learning that R1 experienced a Medication Administration error while residing in the facility from July 2024 to February 2025. Administrator Shram reported R1 received (1) tablet of Namenda 10 mg per day after an E-MAR system change occurred in July 2024. R1's physicians order reflected (1) tablet of Namenda 10 mg (2) times per day and the second tablet was not administered after the system change as the new E-MAR did not reflect the order for the second tablet. Administrator Shram self-reported the error and submitted an Unusual Incident Report (UIR) to CCL on January 29, 2025. The Department conducted interviews with LVN Wendy Cuadle (S1), who confirmed R1 received (1) tablet of Namenda 10 mg one time per day after the E-MAR system change occurred in July 2024. The Department interviewed Residents R2-R4 and found 3 of 3 Residents expressed no issues with staff assistance with Medication Administration. The Department interviewed Staff/Med Techs (S2-S3). S2-S3 stated Medication Administration training is provided prior to Med Techs administering medication independently. The Med Techs interviewed stated they administer and record passing medication on the E-MAR. The Med Techs interviewed stated they follow protocols per their training. The Department obtained and reviewed R1 physician's order (Dated:5/17/24) and R1's Medication Administration Records (Dated August 2024-Febuary 2025). The Department confirmed R1 received only (1) tablets of Namenda (Generic name: Memantine) 10 mg per day starting in August 2024 - February 2025. Evaluation Report continues LIC 9099-C This report supersedes the reports created on 4/16/25, the findings remain the same. During this investigation, LPA found sufficient evidence to support the above-mentioned allegation. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D). An exit interview was conducted, and a copy of the Complaint Report was given to Name/Executive Director.the state’s words, verbatim · CDSS document, Jun 5, 2025 · control 11-AS-20250205121215

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87208(a) · Plan of correction due date: Jun 6, 2025

87208 Plan of Operation (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. This requirement was not met as evidence by: Based on a review of records and interviews conducted, the department found R#1 received only 1 of 2 tablets of prescribed medication (Generic name: Memantine) per day from August 2024 through February 2025. This poses an immediate health and safety risk to all residents in care.the state’s words, verbatim · CDSS document, Jun 5, 2025

Plan of correction: Licensee will adhere to Title 22 at all times. As part of the plan of correction, the licensee will conduct regular audits of medications, changes to the pharmacy, and retraining of facility staff, and will also bring in an outside consultant to oversee and regularly audit. A plan of correction will be submitted to LPA Inguez via email before the POC due date.

Allegation investigated: Staff are not distributing a resident's medication as prescribed

On 02/20/2025 LPA Yolanda Rosser and LPM, Eva Alvarez conducted a 10 day-visit at this facility. LPA met with LVN, Wendy Caudle(S1) and explained the purpose of todays visit. LPA was later introduced to Administrator Rony Shram. Investigation consisted of the following:LPA conducted interviews with Residents (R2-R4) and Staff (S1-S3). LPA obtained R1 Medication Administration Records (Dated: 02/2025 ), Physicians Order for Medication (Dated: 05/17/2024 ), Physicians Report (Dated 06/20/2024), Face Sheet, Resident Appraisal, Identification and Emergency Information. LPA obtained R1 - R4 Physicians Report, Medication Administration Records (Dated 02/2025), and Physicians Order for Medications. LPA obtained copies of Med Tech training. LPA obtained copies of Register of Facility Residents, and Personnel Report. Substantiated Investigation Revealed : Allegation- Staff are not distributing a resident's medication as prescribed LPA Rosser and LPM Alvarez conducted an interview with Administrator Rony Shram, who stated he conducted an internal investigation, in January 2025, after learning that R1 experienced a Medication Administration error while residing in the facility from July 2024 to February 2025. Administrator Shram reported R1 received (1) tablet of Namenda 10 mg per day after an E-MAR system change occurred in July 2024. R1's physicians order reflected (1) tablet of Namenda 10 mg (2) times per day and the second tablet was not administered after the system change as the new E-MAR did not reflect the order for the second tablet. Administrator Shram self reported the error and submitted an Unusual Incident Report (UIR) to CCL on January 29, 2025. LPA Rosser and LPM Alvarez conducted interviews with LVN Wendy Cuadle (S1), who confirmed R1 received (1) tablet of Namenda 10 mg one time per day after the E-MAR system change occurred in July 2024. LPA Rosser and LPM Alvarez interviewed Residents R2-R4 and found 3 of 3 Residents expressed no issues with staff assistance with Medication Administration. LPA Rosser and LPM Alvarez interviewed Staff/Med Techs ( S2-S3). S2-S3 stated Medication Administration training is provided prior to Med Techs administering medication independently. The Med Techs interviewed stated they administer and record passing medication on the E-MAR. The Med Techs interviewed stated they follow protocols per their training. LPA Rosser and LPM Alvarez obtained and reviewed R1 physician's order (Dated:5/17/24) and R1's Medication Administration Records (Dated August 2024-Febuary 2025). LPA Rosser and LPM Alvarez confirmed R1 received only (1) tablets of Namenda (Generic name: Memantine) 10 mg per day starting in August 2024 - February 2025.. Based on LPA’s observations, interviews, and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation above is found to be substantiated. An exit interview was conducted and a copy of this report was provided to Administrator Shram.the state’s words, verbatim · CDSS document, Apr 16, 2025 · control 11-AS-20250205121215

From the deficiency page — Deficiency type: Type A · Section cited: HSC 874654(a)(4) · Plan of correction due date: Apr 16, 2025

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: The licensee shall assist residents with self-administered medications as needed. The prepoderance was met as evidenced by: Based on Interviews and Record Reviews staff did not ensure medications were being administered as prescribed per the Physicians Orders.This violation poses a immediate health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Apr 16, 2025

Plan of correction: Deficiency was corrected prior to this visit.

Allegation investigated: Staff are not distributing a resident's medication as prescribed

On 02/20/2025 LPA Yolanda Rosser and LPM, Eva Alvarez conducted a 10 day-visit at this facility. LPA met with LVN, Wendy Caudle(S1) and explained the purpose of todays visit. LPA was later introduced to Administrator Rony Shram. Investigation consisted of the following:LPA conducted interviews with Residents (R2-R4) and Staff (S1-S3). LPA obtained R1 Medication Administration Records (Dated: 02/2025 ), Physicians Order for Medication (Dated: 05/17/2024 ), Physicians Report (Dated 06/20/2024), Face Sheet, Resident Appraisal, Identification and Emergency Information. LPA obtained R1 - R4 Physicians Report, Medication Administration Records (Dated 02/2025), and Physicians Order for Medications. LPA obtained copies of Med Tech training. LPA obtained copies of Register of Facility Residents, and Personnel Report. Substantiated Investigation Revealed : Allegation- Staff are not distributing a resident's medication as prescribed LPA Rosser and LPM Alvarez conducted an interview with Administrator Rony Shram, who stated he conducted an internal investigation, in January 2025, after learning that R1 experienced a Medication Administration error while residing in the facility from July 2024 to February 2025. Administrator Shram reported R1 received (1) tablet of Namenda 10 mg per day after an E-MAR system change occurred in July 2024. R1's physicians order reflected (1) tablet of Namenda 10 mg (2) times per day and the second tablet was not administered after the system change as the new E-MAR did not reflect the order for the second tablet. Administrator Shram self reported the error and submitted an Unusual Incident Report (UIR) to CCL on January 29, 2025. LPA Rosser and LPM Alvarez conducted interviews with LVN Wendy Cuadle (S1), who confirmed R1 received (1) tablet of Namenda 10 mg one time per day after the E-MAR system change occurred in July 2024. LPA Rosser and LPM Alvarez interviewed Residents R2-R4 and found 3 of 3 Residents expressed no issues with staff assistance with Medication Administration. LPA Rosser and LPM Alvarez interviewed Staff/Med Techs ( S2-S3). S2-S3 stated Medication Administration training is provided prior to Med Techs administering medication independently. The Med Techs interviewed stated they administer and record passing medication on the E-MAR. The Med Techs interviewed stated they follow protocols per their training. LPA Rosser and LPM Alvarez obtained and reviewed R1 physician's order (Dated:5/17/24) and R1's Medication Administration Records (Dated August 2024-Febuary 2025). LPA Rosser and LPM Alvarez confirmed R1 received only (1) tablets of Namenda (Generic name: Memantine) 10 mg per day starting in August 2024 - February 2025.. Based on LPA’s observations, interviews, and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation above is found to be substantiated. An exit interview was conducted and a copy of this report was provided to Administrator Shram.the state’s words, verbatim · CDSS document, Apr 16, 2025 · control 11-AS-20250205121215

From the deficiency page — Deficiency type: Type A · Section cited: HSC 874654(a)(4) · Plan of correction due date: Apr 16, 2025

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: The licensee shall assist residents with self-administered medications as needed. The prepoderance was met as evidenced by: Based on Interviews and Record Reviews staff did not ensure medications were being administered as prescribed per the Physicians Orders.This violation poses a immediate health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Apr 16, 2025

Plan of correction: Deficiency was corrected prior to this visit.

Allegation investigated: Staff mismanage residents' medications.

On todays date LPA Sparkle Day conducted a Subsequent visit to the facility regarding the above allegations and met with Rony Shram, Executive Director. The initial 10-day visit was conducted by LPA España who also met with the Rony Shram, Executive Director (A1). LPA requested, received, and reviewed copies of the following documents: Staff and Resident Rosters, resident files which contained, Resident Appraisal RCFE (LIC 603A); Appraisal Need and Services Plan (LIC 625); Physician's Report for RCFE (LIC 602A), including specifics from Resident Medical Assessment Section 87569 and General Requirements for All (Section 87702.1); Identification and Emergency Information (LIC 601); Current admission agreement with authorized signatures, Admission (LIC 604A); Any Unusual Incident/Injury/Report (LIC 624); Centrally Stored Medication and Destruction Record (LIC 622); (Evaluation Report continues LIC 9099-C) and Register of Facility Clients/Residents (LIC 9020). An interview with the administrator( A1) ,Staff #2 - Staff #5 and residents was performed. During this investigation R#1 - R#6 were interviewed. 6 0f 6 residents insisted that they have not had any mismanagement of their medication. CONT on 9099-C Unsubstantiated 6 of 6 Staff were interviewed and insisted that they have not had any mismanagement of residents' medication. LPA España conducted a comprehensive review of the medication management practices at the facility. This included an inspection of the Assisted Living (AL) cart on the second floor and the Memory Care cart on the first floor. The review focused on ensuring compliance with medication protocols and identifying any discrepancies in medication administration. Not limited to comparing the medication MAR to the actual medication for each residents. Specific findings related to each resident's medication management were documented during the tour. LPA found that for 6 of 6 residents medication distribution was in compliance and found no errors. A review of the facility's medication training and Med -tech schedule was reviewed. LPA found that all Med- Techs have continuous monthly training on medication protocols. And Med tech staffing is adequate to provide adequate services for the residents in care. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, “Staff mismanage residents' medications. ” did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Rony Shram, Executive Director.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 11-AS-20240808195102

Type of visit: Required - 1 Year

On 11/15/2024, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator – Rony Shram. CCLD staff explained the purpose of the visit and was accompanied by a staff member inside and outside the facility during this inspection. This facility is licensed to serve 100 non-ambulatory adults ages 60 and above, of which 20 may be bedridden. The facility is approved for 20 hospice residents. The facility is approved for delayed egress. All facility units are approved for bedridden clients. The Annual Licensing Fees are current. The facility is a four-story building with two underground floors located in a residential street. The first floor consists of: main entrance with lobby and front desk, office rooms, industrial kitchen, dining room, residential mail space, public restrooms, salon, activity room, bistro, and lounge area. The first floor also has the Dementia Care Unit with residential units, the botanical garden, kitchen, café, dining room area, and medication room. The second floor consist of: a beauty bar, office rooms, lounge/library area, courtyard, public bathrooms, and residential units. The third floor consist of: outside patio area, public bathrooms, and residential units. The fourth floor consist of: residential units. The first underground floor consists of: parking garage, theater room, gym, spa room, pool room, food storage, freezer room, fridge room, staff break room, and lactation room. The second underground floor consist of: parking garage, resident storage, and storage rooms. The facility has a total of 82 residential units, 99 bathrooms, and several indoor and outdoor common spaces with shaded seating. The kitchen area has supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last Earthquake drill was conducted on 09/10/2024. There are several fire extinguishers around the premises, and they were last serviced on 09/27/2024. There are landline telephones on the premises. There is a videoconferencing device dedicated for client use in the computer room. 8 out of 82 residential units were checked. There is adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. This facility provides residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. 5 staff records were reviewed, 5 out of 5 staff records had required documentation. 5 resident records were reviewed and, 5 out of 5 resident records had required documentation. No deficiencies are being cited based on LPA observation and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and a copy of this report was left with the Administrator.the state’s words, verbatim · CDSS document, Nov 15, 2024

Allegation investigated: Staff did not seek medical attention in a timely manner. Facility is requiring staff to administer medication that should be given by an appropriately skilled professional. Staff are not administering medication to residents in care. Staff did not comply with Infection control requirements. Facility is storing expired medication. Facility did not ensure that staff are properly trained.

** LPA Sparkle Day conducted a subsequent visit to the facility today to amend this report . However the findings remain the same. The Amendmenment is to soley remove duplicate information. It does not supersede the complaint investigation findings reflected on report created 06/21/24.** On 06/21/24, Licensing Program Analyst (LPA) David España made an unannounced visit to this facility and was greeted by Administrator #1 (A1) Rony Shram, Administrator. LPA explained the purpose of today’s Subsequent visit is to gather information for the allegations mentioned above. The investigation consisted of the following: On 06/21/24 (LPA) David España was met by Rony Shram, Administrator #1 (A1). LPA requested, received, and reviewed copies of the following documents: Staff and Resident Rosters, resident files which contained, Resident Appraisal RCFE; Appraisal Need and Services Plan; Physician's Report for RCFE, including specifics from Resident Medical Assessment; Identification and Emergency Information; Current admission agreement with authorized signatures, Admission; Any Unusual Incident/Injury/Report; Death Report, Centrally Stored Medication and Destruction Record; and Register of Facility Clients/Residents. (Evaluation Report continues LIC 9099-C) Unsubstantiated LPA interviews were conducted with 5 out of 5 residents, identified as R1, R2, R3, R4, and R5. LPA España reviewed records of resident 1-Resident5 (R1-R5). LPA España interviewed staff1-staff5 (S1-S5). LPA España reviewed records of 5 out of 5 Staff. Investigation revealed the following: Allegation: Staff did not seek medical attention in a timely manner. On June 20, 2024, LPA España conducted interviews between 8:00 AM and 5:00 PM with staff members S1-S5, observation of an in-service training session, and review of facility records. LPA España interviewed staff (S1-S5) who denied the allegation. S1-S5 stated that medical attention is managed promptly. S1-S5 described detailed procedures for medical emergencies and medication administration. LPA España interviewed Administrator Rony Shram (A1) who provided documentation of strict adherence to protocols. A1 stated a temporary pharmacy account issue on June 18, 2024, but confirmed no critical medication was missed. LPA interviews were conducted with 5 out of 5 residents, identified as R1, R2, R3, R4, and R5, who stated satisfaction with staff attentiveness. 5 out of 5 residents confirmed timely medical responses. LPA España reviewed medical logs, eMAR, training files, infection control protocols, and medication inventories. LPA España found no evidence supporting the allegation of delayed medical attention. (Evaluation Report continues LIC 9099-C) Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, “Staff did not seek medical attention in a timely manner.” did or did not occur, therefore the allegation is Unsubstantiated. Allegation: Facility is requiring staff to administer medication that should be given by an appropriately skilled professional. During the visit on June 20, 2024, LPA España observed an in-service training session focused on medication management, which provided insights into staff competency. LPA España interviewed 5 staff members (S1-S5), all of whom denied the allegation. S1-S5 stated that only trained and certified personnel administer medications, emphasizing adherence to regulations and the involvement of healthcare professionals for specialized medications. On June 21, 2024, LPA España interviewed Administrator Rony Shram (A1), who refuted the claim and reiterated the facility's commitment to regulatory compliance. A1 confirmed that policies ensure only qualified personnel handle medications requiring specialized skills. LPA interviews were conducted with 5 out of 5 residents, identified as R1, R2, R3, R4, and R5, who stated confidence in the facility's practices, noting that only trained nurses administered their medications. (Evaluation Report continues LIC 9099-C) LPA España conducted a thorough review of medical logs, electronic medication administration records (eMAR), training files, and protocols revealed no evidence supporting the allegation. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, “Facility is requiring staff to administer medication that should be given by an appropriately skilled professional” did or did not occur, therefore the allegation is Unsubstantiated. Allegation: Staff are not administering medication to residents in care. On June 20, 2024, LPA España interviewed 5 staff members (S1-S5). S1-S5 unanimously denied the allegation, emphasizing that medication administration records confirm that all prescribed medications are administered as directed. S1-S5 highlighted a robust system of audits and checks that supports this claim. On June 21, 2024, LPA España interviewed Rony Shram, the facility's administrator (A1). A1 refuted the allegation and underscored the meticulous nature of Medication Administration Records (eMARs), which undergo regular audits by both internal and external bodies to ensure high compliance. (Evaluation Report continues LIC 9099-C) LPA interviews were conducted with 5 out of 5 residents, identified as R1, R2, R3, R4, and R5, who stated receiving their medications regularly and on time. 5 out of 5 residents praised the diligence of the staff in managing their medication needs. On June 20, 2024, LPA España reviewed records of relevant documentation, including medical logs and training files. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, “Staff are not administering medication to residents in care” did or did not occur, therefore the allegation is Unsubstantiated. Allegation: Staff did not comply with Infection control requirements. On June 20, 2024, LPA España observed an in-service training session on infection control, which demonstrated staff competency in this area. LPA España conducted interviews with staff 1- staff 5 members (S1-S5). on June 20, 2024. S1-S5 unanimously denied the allegation, emphasizing the facility's strict infection control system, including regular checks and adherence to proper protocols. On June 21, 2024, LPA España interviewed Administrator Rony Shram (A1), who refuted the claim. A1 highlighted robust infection control protocols aligned with CDC guidelines and noted frequent training sessions and audits. A1 also reported that the facility's infection rates were below the national average. (Evaluation Report continues LIC 9099-C) LPA interviews were conducted with 5 out of 5 residents, identified as R1, R2, R3, R4, and R5, who supported the facility's practices. 5 out of 5 residents praised staff for maintaining cleanliness and infection prevention through consistent hand hygiene and use of protective gear. LPA España interviews were attempted with 6 residents; however, 1 out of 6 residents refused to participate. On June 20, 2024, LPA España conducted a thorough review of relevant documentation, including medical logs and infection control protocols. A Gastrointestinal Outbreak Notification Letter from February 12, 2024, indicated effective early intervention during an outbreak. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, “Staff did not comply with Infection control requirements” did or did not occur, therefore the allegation is Unsubstantiated. Allegation: Facility is storing expired medication. On June 20, 2024, LPA España observed an in-service training session on medication management, underscoring staff competency in handling medications. LPA España interviewed staff 1-staff 5 (S1-S5) revealed unanimous denial of the allegation. S1-S5 emphasized a strict system for regularly checking expiration dates and disposing of expired medications promptly. (Evaluation Report continues LIC 9099-C) Administrator Rony Shram (A1) refuted the claim, highlighting weekly audits by a dedicated pharmacy team to ensure no expired medications are stored. On 6/20/2024, LPA interviews were conducted with 5 out of 5 residents, identified as R1, R2, R3, R4, and R5, who stated confidence in the facility's medication management, noting regular checks on expiration dates. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, “Facility is storing expired medication” did or did not occur, therefore the allegation is Unsubstantiated. Allegation: Facility did not ensure that staff are properly trained. On June 20, 2024, LPA España observed an in-service training session on June 20, 2024, demonstrating the facility's commitment to staff education and competency. On June 20, 2024, LPA España interviewed staff 1- staff 5 (S1-S5) who revealed unanimous disagreement with the allegation. S1-S5 described a comprehensive training program that includes initial orientation, ongoing education, and regular skill assessments. (Evaluation Report continues LIC 9099-C) LPA España interviewed Administrator Rony Shram (A1) refuted the allegation, stating that the training program exceeds state and federal requirements and is consistently praised by residents, families, and inspectors. LPA interviews were conducted with 5 out of 5 residents, identified as R1, R2, R3, R4, and R5, stated confidence in staff training, noting their preparedness and professionalism. LPA España conducted record review of medical logs and training files, confirmed adherence to proper procedures. The review included a department-wide in-service sign-in sheet from February 15, 2024. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, “Facility is storing expired medication” did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies cited at the time of visit. An exit interview was conducted with Rony Shram, Managing Principal and Allie David, VP of finance a copy of this report was provided. Intentionally left blank Intentionally left blank Intentionally left blank Intentionally left blank Intentionally left blankthe state’s words, verbatim · CDSS document, Jun 21, 2024 · control 11-AS-20240613131841

Type of visit: Prelicensing

On 11/20/23 Licensing Program Analysts (LPA) Elvira Gonzalez, (LPA) Socorro Leandro, (LPA) Regina Cloyd conducted a pre-licensing evaluation for an RCFE (Residential Care Facility for the Elderly) facility type. Today’s pre-licensing evaluation was conducted with licensee Rony Shram. The licensee has applied for a license to serve (100) age range 60 and over adults. The fire clearance is approved for (80) non-ambulatory and (20) bedridden residents. LPA’s toured facility Kitchen, Dining Room, Living Room areas, (82) Bedrooms, (99) Bathrooms, Garage, and botanical garden, patios with shaded areas. LPA’s toured the lobby, lounge, beauty bar, gym, theater room, indoor pool and several common spaces. LPA’s observed sufficient storage areas for kitchen supplies, linens, medications (secured) and chemicals (secured). LPA observed the following during this visit: MEDICATIONS There is a locked centralized storage area for Resident medications. PHYSICAL PLANT LPA’s observed the facility is clean, sanitary, and in good repair. Indoor and outdoor passageways, stairways, open areas, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68° degrees and 85° degrees. Open patios, and areas of potential hazard are well-lit. Carbon monoxide/Smoke detectors operate properly. BEDROOMS All rooms were inspected and are compliant with California code of regulations title 22. Continued on LIC 809-C BATHROOMS There are plenty toilets and washbasins for clients, family, and personnel. There are plenty showers for clients, family, and personnel. Hot water temperature is between 105°-120° degrees Fahrenheit. Bathrooms are located inside client bedrooms and common areas. Public restroom calling system is operational. SUPPLIES There is a sufficient supply of clean linens to permit weekly changing or more of client top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE Dining room is near kitchen. Refrigerator and freezer are clean and have the capacity to store at least two (2) days of perishable foods. There is storage for seven (7) day supply of non-perishable food. There are enough tableware, tables, dishes, and utensils. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. RECORDS There is confidential storage for personnel records at the facility. There is storage for Resident confidential information and records at the facility. Continued on LIC 809-C RECORDS There is confidential storage for personnel records at the facility. There is storage for Resident confidential information and records at the facility. ADMINISTRATION The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES There is an outdoor activity space with a shaded area and furnished for outdoor use. There are at least 3 common areas available to clients for visitors. There are activities scheduled during the current month. MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. Continued LIC 809-C MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. LPA’s observed a sign-in/sanitation station at the facility entry. There is hand sanitizer located at the entrance of the facility. Facility has screening process for all visitors, sanitizer/soap, paper towels, and additional PPE supplies are stored inside the facility. LPA Cloyd conducted the Component III Orientation with the Licensee and copy of this report was provided. A copy of the facility evaluation report will be available to the Central Applications Unit (CAU) for review.the state’s words, verbatim · CDSS document, Nov 20, 2023

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Capacity: 100 Census (if any clients in care): Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Sep 28, 2023