Clearwater at North Tustin

Allegation investigated: Staff are not ensuring residents personal information is kept confidential

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit. The Department received the complaint on August 3, 2026. During today's visit LPA Mendivil toured both Assisted Living and Memory Care as well as interviewed staff. Regarding the allegation Staff are not ensuring residents personal information is kept confidential, the investigation revealed the following: It was alleged that the staff are not ensuring resident's personal information is kept confidential as there was a ring camera placed in both medication rooms. LPA observed a camera placed at the far left of the celling in the assisted living medciation room, LPA also observed a sign advising that a camera is present in the room. Unfounded LPA observed a camera placed in a similar spot in the memory care medication room. LPA toured the facility and observed no additional cameras in common areas. LPA Mendivil along with Maintenance Director Alex Mora viewed the live camera stream. LPA confirmed the video stream does not contain audio recordings. LPA confirmed with Executive Director Jennifer Kornmann that only management has access to view the cameras. While viewing the cameras LPA was not able to observe any identifiable resident information. Therefore based on the preponderance of evidence through observations and interviews the allegation Staff are not ensuring residents personal information is kept confidential is determined to be UNFOUNDED, meaning that the allegations were 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, Aug 11, 2026 · control 22-AS-20260803134123

Allegation investigated: Staff neglect led to resident sustaining pressure injuries

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on May 28, 2024. LPA was greeted and granted entry into the facility and met with Administrator (AD) Jennifer Kornmann. LPA explained the reason for the visit. This Department has investigated the complaint alleging that staff neglect led to resident sustaining pressure injuries. Regarding the allegation the following was revealed: During a follow up visit on May 16, 2024, the Primary Care Physician (PCP) for R1 noticed skin breakdown to right hip. On May 16, 2024, PCP ordered Wound Care. During the course of the interviews with the PCP, the PCP stated that in May he noticed a shallow hip and requested Home Health care for a Pressure Injury 2. Per PCP, the pressure injury was not due to neglect. During the investigation LPA reviewed the Physical and Occupational therapy visits dated April and May 2024 for R1. Per email dated May 17, 2024, the PCP ordered an egg cushion for bed and sheepskin for chair to help alleviate pressure on hip. CONTINUED ON LIC9099-C... Unsubstantiated During the course of the interviews with staff, Staff 3 (S3) reported that R1 is repositioned every two hours and stated that R1 favored positioning back to his right side. Per S4, R1 did not develop a pressure injury due to staff neglect. S5 stated that R1 did not develop pressure injuries due to lack of care or staff neglect. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations. LPA conducted an exit interview with AD Kornmann, and a copy of this report was provided to the facility. Per W1, he always sees staff working hard. Regarding the allegation that staff did not allowed resident access to telephone, the following was revealed: During the investigation LPA reviewed documents including the Clearwater at North Tustin Admission Agreement dated October 28, 2022, for R1. Per Admission Agreement, under Statement of Residents' Personal Rights it states residents to have reasonable access to telephones, to both make and receive confidential calls. During the course of the interviews with residents, R1 reported that he can use the telephone at anytime. During the course of the interviews with staff, S1 through S5 reported that staff always pass the telephone calls to the residents and/or stated that the residents always have access to the telephone. Regarding the statement that facility is understaffed, LPA reviewed documents including the Clearwater at North Tustin staff schedule dated May 2024. Per staff schedule, on average there are four Caregivers and one Medication Technician (MT) for the morning and evening shifts and two Caregivers and one MT for the night shift for 32 residents in care. Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or are without a reasonable basis. LPA Ramirez conducted an exit interview and a copy of this report was provided to the facility. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations. LPA conducted an exit interview with AD Kornmann, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 7, 2026 · control 22-AS-20240528112916

Type of visit: Required - 1 Year

On November 26, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Executive Director (ED) Jennifer Kornmann was present and assisted on today's visit. LPA observed that Jennifer Kornmann has a valid Administrator certificate which expires on June 13, 2026. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for one hundred and twenty four non-ambulatory residents, of which six may be bedridden, and has a hospice waiver for fifteen. The facility consists of two single-story buildings, the front building is used for assisted living residents and the back building is used for memory care residents. Each building consist of resident apartments, with bathrooms located in suite, a dining hall, multiple activity rooms, multiple storage rooms, a wellness center, a beauty salon, a medication room, and staff offices. LPA, accompanied by the ED, conducted a tour of the exterior portions of the facility. LPA observed the See Something, Say Something (PUB 475) poster mounted on the wall by the entryway of the facility. LPA inspected resident apartments in both assisted living and memory care. LPA observed resident apartments to be clear of any hazards. LPA observed resident apartments to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. Resident beds had clean linens and blankets. LPA observed additional linens to be stored in a hallway closets. LPA inspected the bathrooms in each of the residents apartments and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 115.5 and 119.8 degrees Fahrenheit. CONTINUED ON LIC809-C LPA inspected the commercial kitchen located in the assisted living building. LPA observed the kitchen has a two day perishable and seven day nonperishable food supply on hand. LPA observed knives and sharps to be inaccessible to residents. LPA observed the facility has a three day emergency food and water supply. LPA observed chemicals and toxins to be stored in a locked closet inaccessible to residents in care. LPA observed multiple fire extinguishers to be mounted on the walls in both buildings. Fire extinguishers were observed to be charged and serviced as of August 21, 2025. LPA observed the facility passed their most recent fire inspection visit conducted on October 21, 2025, which consisted of testing the smoke detectors, carbon monoxide detectors, and fire sprinklers. LPA observed the facility conducted their most recent emergency disaster drill on October 23, 2025. The facility has a medication room located in each building. The centrally stored medications are kept in locked medication carts in their respective buildings. LPA observed that First Aid kits are also stored in the medication rooms and they have all the required components. LPA inspected all other common areas such as the dining rooms, activity rooms, beauty salons, and wellness centers and observed them to be clear of any hazards. LPA, accompanied by the ED, conducted a tour of the exterior portion of the facility. LPA observed the facility has an outdoor area for each buildings. LPA observed the outdoor areas for each building to be free of any hazards or obstructions. LPA observed shaded outdoor seating areas with furniture for resident use. There are no bodies of water on the premises. LPA reviewed ten resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed residents’ medication and medication records. LPA reviewed ten staff files. LPA observed that Staff #3 (S3) did not complete the required twenty hours of annual training, and only had twelve hours of annual training documented for the year of 2024. All staff are background cleared and associated to the facility. Based on today's observations, a deficiency is being cited on the attached LIC809-D. An exit interview was conducted with Executive Director Jennifer Kornmann. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Nov 26, 2025

Allegation investigated: Staff placed restrictions on residents right to have visitors and did not have privacy with visitors

On September 19, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to initiate the investigation into the allegation listed above and to deliver findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Health Services Director Jasmine Barajas was notified via telephone and later arrived to assist with today's visit. Regarding the allegations that, staff placed restrictions on residents right to have visitors and did not have privacy with visitors, the following has been concluded: It was alleged that Resident #1 (R1) had restrictions on who was able to visit her and was not given privacy when she had visits on September 10, 2025, and September 11, 2025. LPA was unable to conduct an interview with R1 for this complaint due to R1 passing away on September 13, 2025. LPA interviewed four facility staff. Four out of four staff confirmed that R1's Power of Attorney (POA), provided instructions to the facility to restrict certain visitors to R1 on September 10, 2025, and September 11, 2025, due to those visitors causing distress to R1 during their visit on September 10, 2025. CONTINUED ON LIC9099-C Unfounded LPA conducted an interview with R1's POA who confirmed that he gave instructions to the facility to restrict certain visitors to R1 on September 10, 2025, and September 11, 2025, due to those visitors causing distress to R1 during their visit on September 10, 2025. LPA reviewed R1's Advance Health Care Directive dated July 15, 2021. R1's Advance Health Care Directive states that R1's POA has sole discretion to limit or prevent visitations or contacts with any individual that distresses R1 or interferes with R1's treatment, once R1 becomes incapable of making her own decisions. LPA reviewed a note from R1's Primary Care Physician (PCP) dated November 20, 2024, which states that due to R1's dementia diagnoses, R1 was incapable of making her own decisions. Therefore, R1's Advance Health Care Directive is valid, and R1's POA has authority to make decisions and place restrictions over R1's visitations, as of November 20, 2024. Based on the evidence gathered during this investigation, the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Health Services Director Jasmine Barajas and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 19, 2025 · control 22-AS-20250912152427

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Claudia Gutierrez and Eboni Bentley made an unannounced visit for the purpose of conducting a Required/Annual Inspection. Upon entry. LPAs were greeted by Concierge and explained the purpose of the inspection. LPAs met with Sales Manager Linda Robbins and further discussed the purpose of the inspection. Executive Director (ED) Jennifer Kornmann arrived at approximately 9:20 a.m. During the inspection, LPAs and SM conducted a tour of the inside and outside of the facility, common areas, resident rooms, and observed the following: The facility consists of two single-story buildings, the front building is used for assisted living residents and the back building is used for memory care. Each building has common areas which include, two dining areas, multiple activity rooms, a hair salon, and wellness center. Select resident rooms were inspected and all were observed to have the required furnishings. LPAs observed all resident beds had linens and blankets. Signal system was tested and observed to be operable. There are two courtyards with multiple shaded sitting areas. LPAs observed residents socializing in common areas and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 105.0-123.6 degrees Fahrenheit; a Technical Violation was issued on this date. LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguishers are located in every hallway and were observed to be fully charged with service tags dated August 15, 2024. Facility appliances were inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. (Cont. LIC809-C) Medication was observed to be centrally stored and locked in a medication cart located within the medication room. LPAs reviewed centrally stored medication for select residents and did not observe any discrepancies. LPAs reviewed ten resident files and nine staff files. LPA interviewed ten residents and five staff. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jan 9, 2025