Cottages at Riverside

Allegation investigated: Facility did not provide records to resident in care.

On 8/21/2026, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to commence the complaint investigation and deliver the findings of the above allegation. LPA explained the purpose of the visit to Memory Care Director Bianet Fonseca. The investigation consisted of interviews with staff, relevent party and record review as well as observation. Allegation:Facility did not provide records to resident in care. Based on interviews and review of documents, LPA confirmed that facility staff provided the requested records to Resident #1 (R1) Power of Attorney (POA) representative. LPA verified this through a phone call with the attorney’s office as well as email documentation from the attorney’s representative confirming receipt of the records.No evidence was found to suggest the facility refused or failed to provide records to the resident or the resident’s authorized representative. Based on interviews and record review, the allegation mentioned above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation 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 at this time. An exit interview was conducted where this report, LIC9099 was discussed and provided to Memory Care Director Bianet Fonseca. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 21, 2026 · control 56-AS-20260814080857

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Javier Prieto made an unannounced visit to the facility to conduct a required annual inspection. LPAs met with Executive Director Dion and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). Licensed capacity is 110 with a current census of 86. LPAs conducted an overall inspection of the facility, which included, but was not limited to, the following: LPAs inspected all six (6) resident cottages inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient indoor and outdoor activity space for residents in care. Activities are posted in a common area of each cottage. All cottages are enclosed with self-latching gates with combination locks. Facility has no bodies of water. LPAs inspected the kitchen. Facility has sufficient non-perishable and perishable food for the number of residents in care. Menus are posted in various areas of the facility. Facility food is stored in a safe and healthful manner. Sharps are stored and kept locked and inaccessible to residents. LPAs inspected resident bedrooms. Bedrooms are equipped with beds, bed linen, chairs, night stands, storage space and sufficient lighting. LPAs inspected resident bathrooms. Bathrooms were equipped with grab rails and operating bathroom equipment. The hot water in the bathrooms tested between 110-112 degrees Fahrenheit. LPAs observed the facility is equipped with operating carbon monoxide alarms and telephone service. Facility has a complete first aid kit. Posters such as personal rights, Ombudsman Poster, the disaster plan and emergency numbers were posted in a common area. LPAs reviewed nine (09) resident medications and centrally stored medication logs. All medications are labeled and administered as prescribed. LPAs reviewed five (5) staff files for criminal record clearances, training, and health screenings. All staff records were up-to-date. LPAs reviewed nine (09) resident records for admissions agreements, physician's report, pre-admission appraisals and emergency contacts. All records had the required documentation. No deficiencies were cited during today's visit and copy of the reports LIC809 and LIC809-C were provided to the Executive Director Dion at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 17, 2026

Allegation investigated: Staff are not adequately supervising residents in care. Staff are not preventing altercations between residents in care. Staff do not ensure that resident(s) are administered their medications according to Physician's instructions.

On 06/16/2026,Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Julie Dion, Executive Director, Bianet Fonseca-Health Services Director and discussed the purpose of the visit. First Allegation: -Staff are not adequately supervising residents in care. LPA Singh reviewed records and interviewed Staff and residents, based on records review, interviews and LPA's observation, Seven(7) out of Seven(7) residents and Four(4) out of Four(4) Staff stated that Staff ensures that residents are adequately supervised all the time. Resident #1 is consistently supervised by facility staff, who are trained to provide immediate first aid in the event of an incident. In accordance with facility policy, staff members promptly document and report any injuries or bruises resulting from a fall or occurring during the resident's stay directly to the Physician,designated Power of Attorney (POA) and call emergency services if needed. Unsubstantiated Second Allegation: -Staff are not preventing altercations between residents in care. LPA Singh reviewed records and interviewed Staff and residents, based on records review, interviews and LPA's observation, Seven(7) out of Seven(7) residents and Four(4) out of Four(4)stated that Staff do prevents altercations between residents in care. According to facility staff, potential altercations between residents are pro-actively prevented through continuous supervision and the timely use of redirection techniques for those in their care. This supportive environment is reflected in the residents' own accounts, as they reported never having experienced any conflicts or altercations with one another. Instead, the residents characterized their relationships as harmonious, noting that they view each other as friends. According to facility documentation and staff interviews, residents regularly exhibit symptoms of sun downing—a state of increased confusion, anxiety, and agitation that typically occurs during the late afternoon or early evening hours. To address these behaviors effectively, the facility ensures that all personnel undergo specialized training designed to manage and mitigate instances of heightened resident distress. When a resident begins to display signs of sundown syndrome, trained staff members actively intervene using specialized behavioral techniques to de-escalate the agitation, offer redirection, and provide targeted comfort. This structured approach helps stabilize the residents' emotional states and maintains a safe, supportive environment and preventing altercations between residents in care. Third Allegation: -Staff do not ensure that resident(s) are administered their medications according to Physician's instructions. LPA Singh reviewed records and interviewed Staff and residents, based on records review, interviews and LPA's observation, Seven(7) out of Seven(7) residents and Four(4)) out of Four(5) stated Staff always administers the medications according to physician's instructions. According to facility personnel, staff members consistently ensure that all residents are administered their medications in strict accordance with prescribing physicians' instructions. The team diligently follows the specific protocols and medical directives provided by each resident's primary care physician to maintain health, safety, and compliance By systematically verifying these medical orders prior to administration, staff members minimize the risk of errors and ensure that the exact dosages, timing, and administration methods are precisely executed as intended by the residents' healthcare providers. During the investigation, LPA did not find evidence to corroborate the allegations. Based on the evidence found during the investigation, the allegations listed above Staff are not adequately supervising residents in care, Staff are not preventing altercations between residents in care and Staff do not ensure that resident(s) are administered their medications according to Physician's instructions are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted with Facility Representative, Bianet Fonseca-Health Services Director and a copy of this report LIC9099, 9099C were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 17, 2026 · control 56-AS-20250407161649

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility for a case management visit to retrieve resident records related to case number 56-AS-20251117110643. LPA Prieto met with Executive Director Dion and obtained required documentation. This report was signed by LPA Prieto and Executive Director Dion and a copy was left with the facility.the state’s words, verbatim · CDSS document, Mar 26, 2026

Allegation investigated: Resident was physically abused while in care.

Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to deliver findings regarding the above allegation. LPA met with Executive Director Dion and explained the purpose of the visit. The Department’s investigation included interviews and a review of facility records. Interviews revealed that Resident #1 (R1) was admitted to the facility on June 6, 2025, with a care plan identifying fall risk. R1 was placed on hospice care on July 11, 2025. The investigation found no witnesses or evidence indicating physical abuse. Interviews were conducted with outside parties, facility staff, and residents, all of whom denied that R1 was physically abused. The facility staff reported that R1 sustained bruising from falling on June 19, 2025. All parties interviewed denied any concerns of mistreatment and stated that R1 expressed to like living at the facility. Residents interviewed at the facility described the staff as respectful and caring, and confirmed that R1 never reported being abused. A family member responsible for R1’s medical oversight stated they visited the facility many times and observed attentive care with no concerns of abuse. ***continued on 9099C*** Unsubstantiated Based on interviews and records review, the investigation did not produce sufficient evidence to substantiate the allegation of physical abuse. Therefore, the allegation is Unsubstantiated. An exit interview was conducted, during which this report was reviewed and a copy was provided to the facility.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 56-AS-20250710093444

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Javier Prieto made an unannounced visit to the facility to conduct a required annual inspection. LPAs met with Eva Tawfik and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). Licensed capacity is 110 with a current census of 85. LPAs conducted an overall inspection of the facility, which included, but was not limited to, the following: LPAs inspected all six (6) resident cottages inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient indoor and outdoor activity space for residents in care. Activities are posted in a common area of each cottage. All cottages are enclosed with self-latching gates with combination locks. Facility has no bodies of water. LPAs inspected the kitchen. Facility has sufficient non-perishable and perishable food for the number of residents in care. Menus are posted in various areas of the facility. Facility food is stored in a safe and healthful manner. Sharps are stored and kept locked and inaccessible to residents. LPAs inspected resident bedrooms. Bedrooms are equipped with beds, bed linen, chairs, night stands, storage space and sufficient lighting. LPAs inspected resident bathrooms. Bathrooms were equipped with grab rails and operating bathroom equipment. The hot water in the bathrooms tested between 109-110 degrees Fahrenheit. LPAs observed the facility is equipped with operating carbon monoxide alarms and telephone service. Facility has a complete first aid kit. Posters such as personal rights, Ombudsman Poster, the disaster plan and emergency numbers were posted in a common area. LPAs reviewed eight (08) resident medications and centrally stored medication logs. All medications are labeled and administered as prescribed. LPAs reviewed five (5) staff files for criminal record clearances, training, and health screenings. All staff records were up-to-date. LPAs reviewed ten (08) resident records for admissions agreements, physician's report, pre-admission appraisals and emergency contacts. All records had the required documentation. No deficiencies were cited during today's visit and copy of the reports LIC809 and LIC809-C were provided to the Executive Director at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 27, 2025

Allegation investigated: Unqualified staff are administering medications to the residents Staff are not providing adequate care and supervision of the residents

On 6/09/2025 at 12:00 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to Executive Director Eva Tawfik. The investigation consisted of file review, interviews with staffs and residents as well as observation. Allegation #1 Unqualified staff are administering medications to the residents – Based on residents and staff interview, 7 out of 7 residents and 4 out of 4 staff stated that the staff are qualified to administer their medication. Residents stated they have no reason to believe that the staff are not qualified. LPA reviewed files and observed that all Medtech’s that work at the facility have their training and certificate to administer medication. Allegation #2 Staff are not providing adequate care and supervision of the residents - Based on resident’s interview, 7 out of 7 residents and 4 out of 4 staff stated that the facility has staff that provides adequate care and supervision. Every resident interviewed stated that they are taken care of. *** Continuation in LIC9099C *** Unsubstantiated During the investigation, LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation 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 at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Executive Director Eva Tawfik.the state’s words, verbatim · CDSS document, Jun 9, 2025 · control 56-AS-20250609020226

Allegation investigated: Staff did not follow resident's hospice care plan

Licensing Program Analyst (LPA) Javier Prieto visited the facility to investigate a complaint. LPA Prieto met with Executive Director Tawfik and discussed the details of the complaint. Allegation #1 - Interview with Memory Care Director (S1) states that facility medical tech staff were following the care plan for dispensing pain medication to resident #1 (R1). Medication orders were obtained during today's investigation which indicates that R1 is to receive pain medication as needed at the duration of every four (4) hours, as needed. The order reads that the form of dispensing this medication are a crushed pill, in 1 ml of liquid, and dispensed in a syringe for oral dispensing. The facility as a crush order from the hospice agency for dispensing in this manner. S1 states that med tech staff were following procedures by dispensing of pain medication per written order and are not allowed to dispense this medication with a verbal order. S1 states that med tech staff were following protocol by not accepting a verbal order and only following orders that were in writing. A copy of R1's Medication Administration Record (MAR) log was obtained at time of investigation. Unsubstantiated Based on the information obtained there is not enough evidence that staff did not follow resident's hospice care plan. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Memory Care Director Annette Buenrostro and a copy was left with the facility.the state’s words, verbatim · CDSS document, Apr 29, 2025 · control 56-AS-20250428092422

Allegation investigated: Staffs are not assisting resident with self administered medications. Staffs not reporting incidents to resident representative Medications given to a resident without primary physician authorization.

Licensing Program Analyst (LPA) Javier Prieto visited the facility to investigate a complaint. LPA Prieto met with Executive Director Tawfik and discussed the details of the complaint. Allegation #1 LPA Prieto addressed the matter of medications being dispensed to Resident #1 (R1) with the Memory Care Director (S1). S1 confirmed that R1’s medication was dispensed as prescribed. During the investigation, S1 provided LPA Prieto with a copy of R1’s Medication Administration Record (MAR) log, which showed that medications were given as prescribed. Allegation #2 Interviews with S1 and Executive Director (S2) revealed that communication was conducted with R1's responsible parties. Proof of this communication was obtained during the investigation. Additionally, S1 provided LPA Prieto with resident Narrative Charting regarding R1’s medication, care, and notifications to the responsible parties. Unsubstantiated Allegation #3 The MAR log for R1, provided by S1, showed that medications were administered as prescribed by a physician. Orders related to changes or discontinuation of R1’s medication were also documented in the MAR log. Narrative Charting concerning R1’s medication, care, and notifications to responsible parties confirmed communication regarding changes in medications as prescribed by the physician. Based on the information obtained, there is insufficient evidence to substantiate the allegations that staff are not assisting residents with self administered medications, not reporting incidents to resident representatives, or administering medications without primary physician authorization. Therefore, these allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Tawfik, and a copy was left with the facility.the state’s words, verbatim · CDSS document, Mar 13, 2025 · control 56-AS-20250307103003

Allegation investigated: Facility did not administer medication as prescribed. Facility did not prevent resident from becoming malnourished while in care Facility did not meet resident’s hygiene needs. Facility did not prevent resident from developing a pressure injury while in care. Resident's health declined while in the care of the facility

*****This is an amendment ******* On 4/4/2025 at 1:00 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Serrano explained the purpose of the visit to the Executive Director Eva Tawfik. The investigation consisted of file review, interviews with staffs and residents as well as observation. The investigation was conducted by LPA Serrano. The allegations indicate: #1 Facility did not administer medication as prescribed. – Based on record review, the electronic medication administration record (EMAR) showed the medication was given as prescribed by the physician. *** Continuation in LIC9099C *** Unsubstantiated #2 Facility did not prevent resident from becoming malnourished while in care - Based on interview, observation, and record review, investigation found that (R8) had a daily assignment that showed meals and snacks are being provided by the facility. Information received during investigation did not corroborate that R8 was malnourished because of facility staff neglect. #3 Facility did not meet resident’s hygiene needs. - Based on interview and file review, the facility has the Daily Assignment for (R8) that showed shower and laundry schedule. Also, information received indicated that R8 was receiving additional services from an outside source from at least 1/20/2023 through 6/6/2023. These services included showers. Information received during investigation did not corroborate that R8s hygiene needs were not being met. #4 Facility did not prevent resident from developing a pressure injury while in care. - Based on record review (R8) was receiving care from outside services from at least 1/20/2023 through 6/6/2023. Services included care for pressure injury. Information received during investigation did not corroborate facility staff neglect resulting in R8 sustaining a pressure injury. #5 Resident's health declined while in the care of the facility. - Based on record review, investigation revealed that (R8) was receiving hospice services from at least 1/20/2023 through 6/6/2023. A review of information received during the course of investigation could not corroborate that R8 health condition declined as a result of facility staff neglect. During the investigation, LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation 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 allegations are unsubstantiated at this time. An exit interview was conducted where this report, LIC9099, LIC909C were discussed and provided to Executive Director Eva Tawfik.the state’s words, verbatim · CDSS document, Feb 28, 2025 · control 56-AS-20230607172908

Allegation investigated: Staff failed to asssist resident with getting out of bed Staff failed to meet resident's nutritional needs Staff failed to meet resident's hygiene needs Staff member made resident feel uncomfortable

***** This is an Amendment***** On 4/4/2025 at 1:00 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to Excutive Director Eva Tawfik. The investigation consisted of file review, interviews with staffs and residents as well as observation. The investigation was conducted by LPA Serrano. The allegations indicate: #1 Staff failed to assist resident with getting out of bed– Based on record review of the facility Daily Assignment record, it was recorded that the resident’s needs and services plan was followed by the facility. *** Continuation in LIC9099C *** Unsubstantiated #2 Staff failed to meet resident's nutritional needs - Based on record review, the facility has 5-week alternating menu with various foods being served. Resident #8 (R8) has a Daily Assignment that showed meals and snacks as being provided. Furthermore, the facility did an assessment because R8 eating habits had changed. Information received during investigation did not corroborate that staff neglected R8’s nutritional needs. #3 Staff failed to meet resident's hygiene needs - Based on interview and file review, the facility has the Daily Assignment that showed shower and laundry schedule for resident #8 (R8). Information received during investigation did not corroborate that staff neglected R8’s hygiene needs. #4 Staff member made resident feel uncomfortable - Based on information, LPA is unable to interview resident #8 (R8) to corroborate the allegation due to R8 being deceased. Information received during investigation did not corroborate that R8’s personal rights were violated. During the investigation, LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation 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 allegations are unsubstantiated at this time. An exit interview was conducted where this report, LIC9099, LIC909C were discussed and provided to Executive Director Eva Tawfik.the state’s words, verbatim · CDSS document, Feb 28, 2025 · control 56-AS-20231031151000

Allegation investigated: Staff did not follow resident's care plan resulting in resident sustaining a pressure injury Staff handled resident in a rough manner Staff are not properly mitigating the scabies outbreak at the facility Facility's laundry machine is in disrepair Staff did not inform resident's authorized representative of resident's incident

****This is an amendment **** On 4/2/2025 at 1:00 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to the Executive Director Eva Tawfik. The investigation consisted of file review, interviews with staffs and residents as well as observation. The investigation was conducted by LPA Serrano. The allegations indicate: #1 Staff did not follow resident's care plan resulting in resident sustaining a pressure injury – Based on staff interview, and record review, LPA is unable to identify resident #8 (R8) as residing at facility prior to or around the time of complaint initiated. As a result, there is no evidence at this time which can corroborate the occurrence of staff neglect of R8. *** Continuation in LIC9099C *** Unsubstantiated #2 Staff handled resident in a rough manner - Based on interviews. Resident #9 (R9) was unable to recall the incident, therefore LPA cannot corroborate if the alleged incident happened. Additional interview with witnesses and the alleged perpetrator were unable to be conducted at this time due to unavailability. #3 Staff are not properly mitigating the scabies outbreak at the facility - Based on interview and file review, the facility provided the paperwork of the necessary steps that they did to mitigate the scabies outbreak. They provided all the communication/paperwork to the dermatologist, nurses, and other responsible parties. They provided the sanitation procedure/schedule that they did to control the spread and prevention of the outbreak from coming back. #4 Facility's laundry machine is in disrepair - Based on interview and observation, the facility has laundry machine on each cottage and if one laundry machine is out and not working, they can use the other washing machine from other cottages or the main one in the maintenance room. According to information received, there has not been interference with laundry service for residents. #5 Staff did not inform resident's authorized representative of resident's incident - Based on staff interview, 6 out of 6 staff stated that every time there is an incident in the facility, they immediately let the nurse know (if there is an injury), the Resident Care Coordinator and Executive Director and they in turn inform the responsible parties. They also send the Special Incident Report (SIR) to Community Care Licensing. Information received during investigation did not corroborate that reports have not been provided to resident’s representative as required. During the investigation, LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation 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 allegations are unsubstantiated at this time. An exit interview was conducted where this report, LIC9099, LIC909C were discussed and provided to Executive Director Eva Tawfikthe state’s words, verbatim · CDSS document, Feb 19, 2025 · control 56-AS-20221107142123

Allegation investigated: Staffs do not seek timely medical care.

On 01/30/2025 at 10:15 AM, Licensing Program Analyst (LPA), Melody Brown, visited the facility to deliver the investigative findings for the above allegation. LPA Brown identified herself and discussed the purpose of the visit with Executive Director (ED) Eva Tawfik. The investigation of the allegation was conducted by Department staff. The investigation consisted of file review and interviews with relevant parties. The allegation indicates staff do not seek timely medical care. During the Department staff investigation, it was indicated that Resident #1 (R1) had a witnessed fall on 05/07/2021 at approximately 09:00 PM and it was reported that R1 used R1's right hand for balance and R1 complained of hand and wrist pain. In addition, Department staff investigation revealed that the facility contacted R1's Healthcare provider the same day. Moreover, records review indicated that R1's Healthcare provider completed a visit at the facility with R1 on 05/11/2021 and the results were received the same day and were shared with R1's primary physician where a referral was made to an Orthopedic with a first available appointment on 05/18/2021. ***Continuation in LIC9099C*** Unfounded Furthermore, Department staff noted that R1 was seen by the Orthopedic doctor on 05/18/2021 and was placed in a short-arm cast. In addition, Department staff reviewed the facility's Narrative Charting and it indicated that on 05/23/2021, R1 removed the cast and notification was made to R1's doctor and R1 was sent to the Emergency Room to have R1's wrist splinted. Also, Department staff noted that a new appointment with the Orthopedic was scheduled and completed on 06/01/2021. Lastly, Department staff obtained additional verification and documentation through R1's Healthcare provider, R1's primary physician and the Orthopedic doctor. This agency has investigated the complaint alleging staffs do not seek timely medical care. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted with Executive Director Eva Tawfik and a copy of this report (LIC9099) was discussed and provided. The second allegation indicates that responsible parties of residents are not contacted regarding incidents. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with three (3) of three (3) residents indicated that staffs are contacting their family or responsible party regarding the incidents at the facility. Three (3) of three (3) residents interviewed stated that staffs at the facility are communicating regularly with their family and responsible party and they could not remember an incident at the facility that staffs are not reporting incidents to their family or responsible party. LPA Brown unable to interview five (5) residents as two (2) residents were sleeping, and three (3) residents were not oriented. Five (5) of five (5) staffs interviewed indicated that they are reporting all incidents at the facility to a resident family or responsible party the same day it happened. Five (5) of five (5) staffs interviewed stated that all staff at the facility were provided training to report all incidents at the facility to residents family or responsible party and it's the management that report incidents to Community Care Licensing Division (CCLD) and other government agencies if applicable. Interviews with five (5) of five staffs revealed that there's no incident that happened at the facility that a staff did not contact a resident family or responsible party regarding incidents at the facility. The third allegation indicates that staffs are told not to share information about the resident with the families. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interview with three (3) of three (3) residents indicated that staffs at the facility are sharing all information about them to their family or responsible party. Three (3) of three (3) residents interviewed stated that they do not know of an incident at the facility that staffs were told not to share information about them to their family or responsible party. LPA Brown unable to interview five (5) residents as two (2) residents were sleeping, and three (3) residents were not oriented. Five (5) of five (5) staffs interviewed indicated that they were not told by the management not to share information about their residents to their family or responsible party. Interviews with five (5) of five (5) staffs revealed that all staffs are sharing information about a resident to their family or responsible party to keep them updated. The fourth allegation indicates that staff is not giving medications per the doctors order. Interviews with three (3) of three (3) residents indicated that staffs at the facility are giving their medications daily per their doctor's order. Three (3) of three (3) residents interviewed reported that staffs at the facility never missed giving their medications per their doctor's order. LPA Brown unable to interview five (5) residents as two (2) residents were sleeping and three (3) residents were not oriented. Five (5) of five (5) staffs interviewed indicated that they are giving their residents medications per their residents' doctors order. ***Cont. in LIC9099*** Interviews with five (5) of five (5) staffs revealed that they are using electronic medication administration record (MAR) to ensure that they are giving their residents medications per their doctors order. During the facility visit on 01/24/2025 and 01/29/2025, LPA Brown audited five (5) residents medications and LPA Brown observed that residents medications were given per their doctors order. The fifth allegation indicates that food service inadequate. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with three (3) of three (3) residents indicated that they like the food at the facility and staffs are always serving them good portion of food and they can get second serving if they prefer. Three (3) of three (3) residents interviewed reported that the facility staffs are always serving them breakfast, morning snacks, lunch, afternoon snacks, and dinner, and no incident happened at the facility that food service was inadequate. LPA Brown unable to interview five (5) residents as two (2) residents were sleeping, and three (3) residents were not oriented. Interview with five (5) of five (5) staffs indicated that they are serving all their residents healthy and enough amount of food and there's no incident that happened at the facility that their food service is inadequate. During the facility visit on 01/24/2025, ED Tawfic provided LPA Brown the facility Menu. Moreover, LPA Brown conducted a quick tour of the facility and observed that the facility has more than the required two (2) days' supply of perishable food and more than seven (7) days supply of non-perishable food. The sixth allegation indicates that staff is crushing medications without a doctor's order. Interviews with three (3) of three (3) residents indicated that there's no incident at the facility that staffs are crushing their medications without their doctor's order. LPA Brown unable to interview five (5) residents as two (2) residents were sleeping, and three (3) residents were not oriented. Five (5) of five (5) staffs interviewed reported that they are not crushing their residents medication without a doctor's order. Interview with five (5) of five (5) staffs indicated that there's no incident that happened at the facility that a staff is crushing residents' medications without a doctor's order. Five (5) of five (5) staffs interviewed revealed that medication training was provided to medical technician (MedTech) staffs, and they never crushed residents medications without a doctor's order. During the facility visit on 01/24/2025 and 01/29/2025, LPA Brown observed that MedTech staffs are not crushing a resident medication without a doctor's order. The seventh allegation indicates that PPE is not provided. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with three (3) of three (3) residents indicated that staffs at the facility are wearing gloves and mask when they are assisting them. **Cont. in LIC9099C* LPA Brown unable to interview five (5) residents as two (2) residents were sleeping, and three (3) residents were not oriented. Interviews with five (5) of five (5) staffs indicated that they are always provided personal protective equipment (PPE) at the facility. Five (5) of five (5) staffs interviewed stated that they have plenty of PPE supplies on all six (6) cottages at the facility and they never ran out of PPE supplies. Interview with five (5) of five (5) staffs revealed that the PPE supplies are always available to them on each cottage. During the facility visit on 01/24/2025, LPA Brown noted that the facility has sufficient PPE supplies maintained per cottages. Based on the evidence, the allegation that facility residents and staff have scabies (Allegation #1), responsible parties of residents are not contacted regarding incidents (Allegation #2), staffs are told not to share information about the resident with the families (Allegation #3), staff is not giving medications per the doctors order (Allegation #4), food service inadequate (Allegation #5), staff is crushing medications without a doctor's order (Allegation #6), PPE is not provided (Allegation #7) are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 was discussed and provided to ED Eva Tawfikthe state’s words, verbatim · CDSS document, Jan 30, 2025 · control 18-AS-20210524094053

Allegation investigated: Resident died due to staff neglect. Resident developed multiple pressure injuries due to neglect. Facility failed to seek timely medical care for resident. Facility did not meet resident's needs. Facility staff did not follow sanitary precautions during care of resident.

On 01/29/2025 at 01:30 PM, Licensing Program Analyst (LPA), Melody Brown, visited the facility to deliver the investigative findings for the above allegations. LPA Brown identified herself and discussed the purpose of the visit with Executive Director (ED) Eva Tawfik. The investigation of the first allegation was conducted by Department staff. The investigation consisted of file review and interviews with relevant parties. The first allegation indicates resident died due to staff neglect. The Department staff interviewed six (6) of six (6) staffs and six (6) of six (6) staffs indicated that when Resident #1 (R1) was placed in Pacifica Senior Living of Riverside on 05/21/2021, R1 had a documented multiple health diseases and non-ambulatory. Interviews with six (6) of six (6) staffs revealed that R1 was receiving home health with nurse visits three (3) times per week. Staff #3 (S3) and Staff #5 (S5) reported to Department staff that Staff #6 (S6) contacted home health on 07/08/2021 as R1's catheter became dislodged, and a nurse was dispatched to the facility, *** Continuation in LIC9099C*** Unsubstantiated but the home health nurse was unsuccessful to re-insert the catheter and they called for medical emergency. S3 and S5 added that R1 was transported to the hospital. Department staff reviewed R1's medical records and it indicated that R1 was admitted to the hospital with multiple medical issues. Moreover, R1's medical records revealed that R1 passed away on 07/14/2021 at the hospital with the primary cause of death listed. The second allegation indicates resident developed multiple pressure injuries due to neglect. During the Department investigation, six (6) of six (6) staffs interviewed indicated that R1 was placed in Pacifica Senior Living of Riverside on 05/21/2021 and R1 had documented multiple medical issues and non-ambulatory. Interviews with six (6) of six (6) staffs revealed that R1 was receiving home health with nurse visits three (3) times per week. Six (6) of six staffs interviewed reported that R1 was a two person assist and they are using Hoyer lift to transfer R1 from R1's bed to R1's wheelchair. Interviews with six (6) of six (6) staffs indicated that caregiver staffs at the facility are turning or repositioning R1 every two (2) hours. Medical records indicated that a meeting was conducted on 06/25/2021 and meeting notes documented that R1 was doing well, and wounds are healing slowly and R1 would be transferred to home health. In addition, Department staff noted that the pictures taken by the hospital of R1's wounds on or about 07/08/2021 showed that some wounds are improving while others were not. Department staff added that R1's medical records indicated that the wounds on R1's legs were diabetic ulcers. Due to insufficient evidence, the Department was not able to corroborate the allegation that resident developed multiple pressure injuries due to neglect. The third allegation indicates facility failed to seek timely medical care for resident. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with three (3) of three (3) residents indicated that staffs at the facility are always seeking timely medical care for them if they are sick and not feeling well. LPA Brown unable to interview five (5) residents as two (2) residents were sleeping and three (3) residents were not oriented. Interview with five (5) of five (5) staffs indicated that they are always seeking timely medical care for their residents. Five (5) of five staffs interviewed reported that there's no incident that happened at the facility that they failed to seek timely medical care for a resident. Five (5) of five (5) staffs interviewed revealed that there's no incident that they did not seek timely medical care for R1 as any changes they observed on R1 or change of condition were all reported to R1's home health nurse and home health nurse was immediately dispatch to the facility after they notified them. ***Continuation in LIC9099C*** The fourth allegation indicates facility did not meet resident's needs. Interviews with three (3) of three (3) residents indicated that staffs at the facility are meeting their needs. Three (3) of three (3) residents interviewed reported that staffs at the facility are checking on them four (4) to five (5) times in a day, providing them a shower two (2) or three (3) times in a week, brushing their teeth and staffs are making sure that they are wearing clean clothes. Three (3) of three (3) residents interviewed indicated that staffs at the facility are always ready to assist them if they need help. LPA Brown unable to interview five (5) residents as two (2) residents were sleeping and three (3) residents were not oriented. Interview with five (5) of five (5) staffs indicated that they are providing care and supervision to all their residents to ensure that they are meeting their needs. Five (5) of five (5) staffs interviewed reported that there's no incident that happened at the facility that they did not meet R1's needs. Five (5) of five (5) staffs interviewed revealed that they are always checking on all their residents every two (2) hours, more often if needed to ensure that they are providing appropriate care and supervision to their residents and to meet their needs. During the facility visit on 01/24/2025, LPA Brown observed staffs at the facility providing care and supervision to their residents. The fifth allegation indicates facility staff did not follow sanitary precautions during care of resident. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with three (3) of three (3) residents indicated that staffs at the facility are always following the sanitary precautions when they are assisting them and providing care. Three (3) of three (3) residents interviewed reported that staffs at the facility are always wearing gloves when they are assisting them and will take off the gloves when they are leaving their room. Three (3) of three (3) residents interviewed stated that staffs at the facility are following sanitary precautions when they are providing care. LPA Brown unable to interview five (5) residents as two (2) residents were sleeping and three (3) residents were not oriented. Interview with five (5) of five (5) staffs indicated that they always follow the sanitary precautions when they are providing care to their residents. Five (5) of five (5) staffs interviewed reported that when they are providing care to their residents, they are using new sets of gloves and they make sure that when they are leaving the residents room, they are taking off the gloves, throw it in the trash bin and sanitized their hands. In addition, five (5) of five (5) staffs interviewed revealed that they were provided training at the facility on sanitary precautions and infection control when they are providing care to their residents. Five (5) of five (5) staffs interviewed stated that there's no incident that happened at the facility that they did not follow the sanitary precautions when they are providing care to R1. During the facility visit on 01/24/2025, LPA Brown observed staffs at the facility are following sanitary precautions when they are providing care to the residents. ***Continuation in LIC9099C*** Therefore, based on the evidence obtained during the Department staff and LPA Brown's investigation, there is insufficient evidence to prove that resident died due to staff neglect (Allegation #1), resident developed multiple pressure injuries due to neglect (Allegation #2), facility failed to seek timely medical care for resident (Allegation #3), facility did not meet resident's needs (Allegation #4), and facility staff did not follow sanitary precautions during care of resident (Allegation #5) are unsubstantiated at this time. Although the allegations of resident died due to staff neglect, resident developed multiple pressure injuries due to neglect, facility failed to seek timely medical care for resident, facility did not meet resident's needs, and facility staff did not follow sanitary precautions during care of resident may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted where this report (LIC9099) was discussed and provided to Executive Director Eva Tawfik.the state’s words, verbatim · CDSS document, Jan 29, 2025 · control 18-AS-20210803122229

Allegation investigated: Resident sustained unexplained injuries in care Facility staff handled resident in a rough manner Facility spoke inappropriately to resident Facility staff did not follow hospice care plan

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Tawfik and explained the elements if the complaint. Allegation #1, LPA interviews with staff #1 (S1) and staff #2 that reveals resident #1 (R1) sustained an injury due a fall. The fall was documented and R1's responsible party was notified as well as R1's Hospice representative. LPA interviewed R1, who stated that the injury was caused by herself when R1 attempted to stand from a seated position. R1 indicated what the injuries were and that the injuries were treated. The fall was witness by resident #2 (R2), who concurred R1's description of the fall. Allegation #2, the allegation of "facility staff handled resident in a rough manner", stems from the transfer of R1 from her wheelchair to the bed by staff. LPA interviewed S1 who indicated R1 was tranferred properly to the bed. Confirmation of the proper transfer was concurred by S2, Memory Care Director. Unsubstantiated R1 was interviewed by LPA and stated that she was not treated in a rough manner during transfers by staff. Allegation #3, the allegation was made relating to instructions made to R1 during a transfer by staff. Staff spoke to R1 in a loud tone of voice because R1 is hard of hearing. S1 heard these instructions and assisted caregiver during this transfer. S1 confirmed that R1 is hard of hearing. LPA interviewed R1 who confirmed she is hard of hearing. R1 also stated that she only wears her hearing aids when she is visited by her responsible party. Allegation #4, stems from the allegation that R1's air mattress is not properly inflated. This bed was prescribed by the Hospice Agency and has an electronic monitor. S1 interview states the monitor appears to by faulty and called the Hospice Agency to either replace monitor or observe mattress for leaks. This device is provided by the Hospice agency who is responsible for the device to work properly. Based on the information obtained there is not enough evidence that resident sustained unexplained injuries in care, facility staff handled resident in a rough manner, facility spoke inappropriately to resident and facility staff did not follow hospice care plan. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Tawfik and a copy was left with the facility.the state’s words, verbatim · CDSS document, Jan 22, 2025 · control 56-AS-20250117145104

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to have Eva Tawfik, Executive Director, sign an amended licensing complaint investigation report (LIC 9099) (56-AS-20240430155237). Report was signed by LPA Prieto and Executive Director Tawfik and a copy was left at the facility.the state’s words, verbatim · CDSS document, Jan 6, 2025

Allegation investigated: Resident sustained unexplained injuries while in care. Resident sustained multiple falls due to lack of care or supervision from staff.

**This is an amended copy. Original 9099 signed and dated on 12/13/2024** On 12/13/2024 at 1:25 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to a staff. Staff informed the Executive Director (ED) Eva Tawfik of the visit. ED met with LPA Serrano and LPA explained the purpose of the visit to ED Tawfik. The investigation consisted of file review, interviews with staffs and residents as well as observation. The investigation was conducted by LPA Serrano. The investigation consisted of records review and interviews with relevant parties. The allegations indicate: #1 Resident sustained unexplained injuries while in care – Based on residents and staff interview, 6 out of 6 residents and 5 out of 6 staff stated that they did not witness or observe any resident that sustained unexplained injuries while in care at the facility. *** Continuation in LIC9099C ***. Unsubstantiated 1 staff (Staff 3) indicated that resident #1 (R1) hands were lightly bruised in the morning because of the staff trying to restrain R1 and prevent R1 from hitting the staff. However, the lightly bruising was not because of abuse but by R1 skin being sensitive. This happened about a year ago and Staff 3 did not notice any bruising lately. #2 Resident sustained multiple falls due to lack of care or supervision from staff - Based on residents and staff interview, 6 out of 6 residents and 5 out of 6 staff stated that they did not witness or observe any resident sustained multiple falls due to lack of care and supervision from staff. 1 staff (Staff 2) stated that they were some fall incidents, however it was not due to lack of supervision or care but by the resident’s medical condition like Parkinson’s disease. During the investigation, LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation 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 at this time. An exit interview was conducted where this report, LIC9099 was discussed and provided to Executive Director Eva Tawfik.the state’s words, verbatim · CDSS document, Dec 13, 2024 · control 56-AS-20241119202411

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Becky Mann and Javier Prieto made an unannounced visit to the facility to conduct a required annual inspection. LPAs met with Eva Tawfik, Executive Director and Annette Buenrostro, Memory Care Director and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). Licensed capacity is 110 with a current census of 76. LPAs conducted an overall inspection of the facility, which included, but was not limited to, the following: LPAs inspected all six (6) resident cottages inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient indoor and outdoor activity space for residents in care. Activities are posted in a common area of each cottage. All cottages are enclosed with self-latching gates. Facility has no bodies of water. LPAs inspected the kitchen. Facility has sufficient non-perishable and perishable food for the number of residents in care. Menus are posted in various areas of the facility. Facility food is stored in a safe and healthful manner. Sharps are stored and kept locked and inaccessible to residents. LPAs inspected resident bedrooms. Bedrooms are equipped with beds, bed linen, chairs, nightstands, storage space and sufficient lighting. LPAs inspected resident bathrooms. Bathrooms were equipped with grab rails and operating bathroom equipment. The hot water in the bathrooms tested between 109-110 degrees Fahrenheit. LPAs observed the facility is equipped with operating carbon monoxide alarms and telephone service. Facility has a complete first aid kit. Posters such as personal rights, Ombudsman Poster, the disaster plan and emergency numbers were posted in a common area. LPAs reviewed ten (10) resident medications and centrally stored medication logs. All medications are labeled and administered as prescribed. LPAs reviewed five (5) staff files for criminal record clearances, trainings, and health screenings. All staff records were up-to-date. LPAs reviewed ten (10) resident records for admissions agreements, physician's report, pre-admission appraisals and emergency contacts. All records had the required documentation. No deficiencies were cited during today's visit and copy of the reports LIC809 and LIC809-C were provided to the Executive Director at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 5, 2024

Allegation investigated: Staff do not ensure that resident's dental needs are met. Staff do not ensure that resident is administered their medications as prescribed. Staff do not ensure that the facility is clean.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Sales Director Julie Schevette and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, document reviews, and facility tour. For the allegation, Staff do not ensure that resident's dental needs are met. LPA conducted 7 staff interviews. 7 out of the 7 staff stated dental services are being provided to their residents. 5 out of the 7 staff informed LPA that occasionally residents will refuse to brush their teeth due to behaviors. During the residents’ interviews, LPA Rico did not find evidence to corroborate the allegation. Unsubstantiated For the allegation, Staff do not ensure that resident is administered their medications as prescribed. During staff interviews, 7 out of the 7 staff stated all residents receive their medications as prescribed. 4 out of the 7 staff informed LPA that they will document when residents refuse their medications. During record review LPA discovered that R1 had received all medications. LPA also noted R1 refusals were also documented. During the residents’ interviews, LPA Rico did not find evidence to corroborate the allegation. For the allegation, Staff do not ensure that the facility is clean. During staff interviews, 7 out of the 7 staff indicated the facility is clean. In addition, all staff members informed LPA that they will clean residents’ room every day when they wake. During facility tour, LPA observed facility to be clean and residents’ bedrooms/bathrooms. Based on evidence obtained during the investigation, the allegations (3) listed above is deemed UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.the state’s words, verbatim · CDSS document, Jun 26, 2024 · control 56-AS-20240126151948

Allegation investigated: Staff do not ensure that residents' toothbrushes are stored in a sanitary manner.

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Sales Director Julie Schevette and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, document reviews, and facility tour. For the allegation, Staff do not ensure that residents' toothbrushes are stored in a sanitary manner. LPA Rico conducted 7 staff interviews. 7 out of the 7 staff informed LPA that residents toothbrushes were not stored in a sanitary manner. 7 out of the 7 staff indictaed all resident’s toothbrushes were stored in a mix bin without a lid and had no name label.1 out of 7 staff stated they indeed provided R1 with a toothbrush that was not stored in sanitary manner to their appointment on 1/24/2024. Substantiated Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because the preponderance of evidence the standard has been met. During today’s visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to Sales Director Julie Schevette, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Jun 26, 2024 · control 56-AS-20240126151948

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jun 28, 2024

87468.1 Personal Rights of Residents in All Facilities (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.the state’s words, verbatim · CDSS document, Jun 26, 2024

Plan of correction: Administrator will send LPA they have understood and read the regulation. POC due date 6/28/2024

Allegation investigated: Staff did not prevent resident from harming another resident in care Staff did not provide adequate supervision to resident in care resulting in a fall

Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to initiate a complaint investigation regarding the mentioned allegations. LPA Prieto met with Executive Director Eva Tawfik to discuss the complaint elements. The investigation included interviews with staff and residents, observations, and a review of relevant documents.Regarding the allegation that staff did not prevent a resident from harming another resident in care, LPA Prieto interviewed residents R1 and R2, who were involved in the incident. Both residents stated that they do not recall any incident or altercation occurring and did not express any concerns about a lack of staff or care.LPA Prieto also interviewed staff member S1, who was present during the altercation. S1 observed the incident but was unable to prevent it as it occurred quickly. S1 took the appropriate steps by calling other staff members and ensuring that R1 received medical attention by sending them to a medical facility. ***continued on LIC 9099C*** Unsubstantiated LPA Prieto interviewed S2, who was present at the time of the altercation. S2 stated that there was proper supervision in accordance with regulations and that the appropriate follow-up steps were taken after the incident. LPA Prieto also interviewed S3, who works with R1, and confirmed that staffing was adequate per regulations and that there had been no previous instances of aggression from R1 or R2. Regarding the allegation that staff did not provide adequate supervision, resulting in a fall, LPA Prieto interviewed S1, S2, and S3, all of whom were present at the time of the altercation. Administrator Tawfik provided the names of S4 and S5, who were working in the cottages where the altercation occurred and met the required supervision standards according to regulations. Based on the information obtained, there is insufficient evidence to support the allegations that staff failed to prevent a resident from harming another resident and that staff did not provide adequate supervision resulting in a fall. Therefore, these allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Tawfik, and a copy was left with the facility.the state’s words, verbatim · CDSS document, May 1, 2024 · control 56-AS-20240430155237

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Javina George made an unannounced case management visit to the facility. The purpose of the visit was to review and obtain copies of documentation pertaining to an open complaint for the facility. LPA met with Eva Tawfik and explained the purpose of the visit. In addition LPA conducted interviews with staff. No health and safety concerns were observed at the time LPAs visit. An exit interview was conducted and a copy of this report was provided to Eva Tawfik, Executive Director.the state’s words, verbatim · CDSS document, Nov 6, 2023

Allegation investigated: Staff failed to provide resident food. Resident suffered from dehydration while in care. Facility failed to observe resident's change in condition. Staff failed to meet the resident's needs.

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to deliver findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Executive Director Eva Tawfik. The investigation consisted of resident interviews, staff interviews, and document review. For allegation, Staff failed to provide resident food: Interviews with residents and the staff revealed that the residents are provided with food. The staff denied not providing the residents food. The residents stated that they are provided food throughout the day. The residents are provided three (3) full meals a day and three (3) snacks throughout the day. If a resident is still hungry after their meals and snacks, the residents can request additional food at any point during the day or night. A document review of the facilities menu revealed that the residents are served three (3) meals a day that includes protein, vegetables, fruit, and carbohydrates, as well as snacks throughout the day. Unsubstantiated During document review of R1’s records, LPA did not find information to collaborate that R1 was not provided food while in care. For allegation, Resident suffered from dehydration while in care: Interviews with the residents and the staff revealed that the residents are provided with water and other liquid options throughout the day. The staff denied not providing water and or other liquids to ensure the residents stay hydrated. The residents stated that the staff provided the residents with plenty of water and other liquids to stay hydrated throughout the day. The facility provides a pitcher of water outside each cottage where the residents can access water on their own. If a resident needs assistance getting water from the pitchers, the residents can ask a staff member to bring water to their room or their current location. The facility also provides juice, coffee, milk, and tea as liquid options. During document review of R1’s records, LPA did not find information to collaborate that R1 was dehydrated while in care. For allegation, Facility failed to observe resident's change in condition: Interviews with the residents and the staff revealed that the staff checks on the residents frequently throughout the day. The residents are checked on average every thirty (30) minutes to two (2) hours depending on the residents’ needs. The staff denied that they do not observe the changing conditions of the residents’ needs. If a staff notices a change of condition, the change is escalated to the nurse for review. The nurse will analyze the resident and escalate the situation to their doctor, family, and call for emergency medical help if necessary. During document review of R1’s records, LPA did not find information to collaborate that R1 had a change in condition that was not observed. For allegation, Staff failed to meet the resident's needs: Interviews with the residents and the staff revealed that the staff are meeting the needs of the residents. The staff denied not meeting the needs of the residents. The residents stated that the staff is very caring, and the staff helps them with their daily needs. During document review of R1’s records, LPA did not find information to collaborate that R1’s needs were not being met. Overall, there was not enough evidence to collaborate the allegations listed above. Based on evidence obtained during the investigation, the four (4) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Executive Director Eva Tawfik, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Nov 2, 2023 · control 18-AS-20200813151731

Allegation investigated: Due to staff negligence, resident has an unexplained bruise Staff is not allowing resident to have visitors

Licensing Program Analyst (LPA) Javier Prieto made an unannounced visit to investigate the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Executive Director Eva Tawfik. The investigation consisted of a facility tour, resident interviews, staff interviews, and document review. For allegation, Due to staff negligence, resident has an unexplained bruise : Interviews with staff and documentation revealed that resident #1 (R1) did have a fall and was witnessed by staff. The fall was documented and the responsible party notified. R1 did sustained a bruise, which is explained in detail in the incident report obtained during today's investigation. Unsubstantiated For allegation, Staff is not allowing resident to have visitors : LPA interviewed R1's responsible party, who has instructed facility staff to only limit visitations to the responsible party, who is also R1's Power of Attorney (POA). Interviews with staff and POA state the visitations from other parties, aggravate R1 who has shown aggression towards staff after visitations or facetime calls from other parties. Overall, there was not enough evidence to collaborate the allegations listed above. Based on evidence obtained during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. This report was signed by LPA Prieto and Executive Director Tawfik and a copy was left with the facility.the state’s words, verbatim · CDSS document, Oct 26, 2023 · control 56-AS-20231024105428

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility for the purpose of collecting a signature on licensing report LIC412BG issued on 10/04/2023 during an annual inspection. LPA met with Eva Tawfik, Executive Director and discussed the purpose of the visit. An exit interview was conducted where reports LIC421BG/LIC809 were discussed and copies provided to the Executive Director at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 5, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Eva Tawfik, Executive Director, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). Licensed capacity is (110) with a current census of (89). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: LPA inspected all six (6) resident cottages inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient indoor and outdoor activity space for residents in care. Activities are posted in a common area of each cottage. All cottages are enclosed with self-latching gates. Facility has no bodies of water. LPA inspected the kitchen. Facility has sufficient non-perishable and perishable food for the number of residents in care. Menus are posted in various areas of the facility. Facility food is stored in a safe and healthful manner. Sharps are stored and kept locked and inaccessible to residents. LPA inspected resident bedrooms. Bedrooms are equipped with beds, bed linen, chairs, nightstands, storage space and sufficient lighting. LPA inspected resident bathrooms. Bathrooms were equipped with grab rails and operating bathroom equipment. The hot water in four (4) bathrooms tested below regulation requirement. Bathrooms in rooms 202, 203, 404, 506 tested between 86 to 96 degrees F. LPA observed the facility is equipped with operating carbon monoxide alarms and telephone service. Facility has a complete first aid kit. Posters such as personal rights, Ombudsman Poster, the disaster plan and emergency numbers were posted in a common area. LPA reviewed six (6) client medications and centrally stored medication logs. All medications are labeled and administered as prescribed. LPA reviewed six (6) staff files for criminal record clearances, trainings, and health screenings. Employed staff 1 (S1) did not have a criminal record clearance. LPA reviewed six (6) resident records for admissions agreements, physician's report, pre-admission appraisals and emergency contacts. All records had the required documentation. Deficiencies were cited during today's visit and a plan of correction was discussed with Executive Director Tawfik. Copies of reports (LIC809/809-D/LIC9102) with appeal rights were provided to the Executive Director at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 4, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.