Country View Assisted Living

Allegation investigated: Staff does not ensure the residents are provided a comfortable environment.

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Claudia Cordoba. Administrator Dennise Torres arrived shortly after and assisted with the visit. Reason for the visit was explained. The investigation consisted of the following: LPA obtained copies of the resident and staff rosters, toured the facility including common areas and residents’ rooms, and conducted interviews with Resident 1 (R1) through Resident 12 (R12), Administrator, and Staff 1 (S1) through Staff 3 (S3). Continue 9099C Unsubstantiated Allegation: Staff does not ensure the residents are provided a comfortable environment. It was alleged that staff failed to ensure residents were provided a comfortable living environment due to a motor on all night long, making it hard for residents to sleep. Interviewed Administrator and staff denied the allegation. They stated the facility maintains a comfortable and appropriate living environment for all residents during both daytime and nighttime hours, with no excessive noise that would disturb residents’ comfort or sleep. They stated that they have not heard any loud motor or machine running noises within the facility that would disturb residents’ sleep. Administrator denied receiving complaints regarding excessive/loud noise from any motor or machine running overnight that interfered with residents’ ability to sleep. Interviewed staff stated they have not observed any motor, machine, or equipment causing excessive/loud noise during nighttime hours and did not hear any complaints regarding loud noise that made it hard for residents to sleep. Interviewed Administrator and staff stated the only sounds that may occasionally be heard are from the air conditioning system or maintenance work performed during daytime hours. They mentioned that the air conditioning system operates at a low level to maintain residents’ comfort and all maintenance work is performed during reasonable daytime hours to minimize disruption. Interviewed residents stated they feel comfortable living at the facility and denied hearing any loud noises, including motor or machine-like noises, that would make it hard or difficult for them to sleep. During today’s visit, LPA toured the facility including common areas and randomly selected residents’ rooms. LPA did not hear any loud motor or machine-like noises. LPA observed the A/C was on and noted the noise level was low and not disruptive. Based on interviews conducted and information obtained during the course of the investigation, there was insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated. Exit interview conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Jun 25, 2026 · control 28-AS-20260623181127

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPA met with Administrator, Dennise Torres who assisted with visit. LPA explained the reason for the visit. The facility is licensed to serve 136 non-ambulatory residents ages 60 and over, of which 34 may be bedridden. There is a hospice waiver approved for 20 residents. The facility does not have a dementia care plan and does not accept any residents with dementia. There are some residents utilizing home health services but none on hospice. LPA and Assistant Administrator toured the facility which included a random sample of resident rooms along with the kitchen, dining room, activity room, two laundry rooms, storage rooms, 3 offices, Med Room, library and large movie room. The patio area is well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the patio area. Passageways and exits are free of obstruction. The common areas are clean and have the required furniture. The facility has 69 resident rooms with own bathrooms. LPA observed laundry detergent locked in the laundry rooms and inaccessible to residents. Sharps are locked in the kitchen and inaccessible to residents. Randomly chosen resident rooms were toured. Each room has a bed, linen, dresser, light, and sufficient closet space. The resident bathrooms have the required grabs bars and non-skid mat. The water temperature was tested in a random selection of resident bathrooms and was within the required 105 - 120 degrees F. The kitchen was inspected. LPA observed sufficient food supplies of 2-day perishable and a 7 day of non-perishable food. All the appliances are clean and seem to be operating properly. Continue 809C The smoke detectors are interconnected and there are 2 operable carbon monoxide detectors in the hallways and 1 in the kitchen. The facility has a signal system in place. Fire extinguishers were fully charged and operational. LPA observed the medications are centrally stored in the Med. Room and inaccessible to residents. The facility uses an electronic Medication Administration Record (MAR) log to document medications given. During today’s visit, LPA reviewed resident medications and they are being administered as prescribed by the physician. The first aid kits were observed and found to be in compliance with the Title 22 Regulations. LPA reviewed 5 personnel records and they have the required documents in file. LPA reviewed 5 resident records and they have the following documents in their files such as Admission Agreements, Identification & Emergency Information, Physician's Report with TB test results, Pre-admission appraisal, and Resident rights. Last Fire drill conducted on 05/14/26. Exit interview conducted and a copy of the report was provided to Assistant Administrator.the state’s words, verbatim · CDSS document, Jun 22, 2026

Allegation investigated: Staff are verbally abusive towards residents in care.

Licensing Program Analyst (LPA) Christian Gutierrez conducted an initial complaint visit to investigate the above allegations. LPA met with Wellness Director Claudia Cordoba and discussed the purpose of today's visit. During this visit, LPA Gutierrez obtained a copy of the staff and resident rosters. LPA also obtained R1’s physician report, needs and service plan, and recent special incident reports (SIR). LPA interviewed staff #1-staff #6(S1-S6), and residents# 1-residents #9 (R2-R9). LPA Gutierrez delivered findings. Refer to LIC 9099C Unsubstantiated In regard to the allegation” Staff are verbally abusive towards residents in care”, It is alleged that staff are verbally abuse towards R1 and R2. During interview with staff six (6) out of six (6) staff all deny that staff has ever verbally abused a resident in care. S1 stated that R1 is not compliant with medications and that it may be altering their behavior. During interview with residents eight (8) out of the nine (9) residents interviewed stated that the staff treats them well. R1 stated that staff has never been verbally abusive but have done other things. R2 stated that staff has never verbally abused them but has verbally abused R1. When asked by LPA for examples R2 stated staff is mean. LPA Gutierrez observed staff conducting care and supervision to residents and did not observe staff verbally abusing residents. “Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given to Claudia Cordoba.the state’s words, verbatim · CDSS document, May 15, 2026 · control 28-AS-20260511111735

Allegation investigated: Staff hit resident resulting in a bruise. Staff do not provide a comfortable room temperature for resident(s). Staff cancel resident’s appointments. Staff disrupt resident’s sleep due to loud music.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 05/08/2026 regarding the above allegations and delivered findings. On 03/02/2026, LPA conducted initial complaint investigation visit and a need further investigation was documented. During today’s visit LPA Ramirez was greeted by Tara Lafez and explained the purpose of the visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1 - 4 interviews (S1 – S4), copy of resident#1 (R1) emergency contact information, Medication Administration Record (MAR), signed statements by S1,S2, and S3, and physical plant tour. SEE 9099-C Unsubstantiated Regarding the allegation “Staff hit resident resulting in a bruise.” It is alleged that one year ago, staff#1 (S1) hit resident#1 (R1) on their elbow, which resulted in R1’s sustaining a bruise. In July of 2025, this Department investigated the allegation: “Staff member pushed resident in care causing an injury”, which involved S1 and R1. Upon investigation, the Department concluded the allegation was Unsubstantiated. The investigation revealed regarding: “Staff hit resident resulting in a bruise” Four (4) out of four (4) staff interviewed denied the allegation. Eight (8) out of ten (10) residents interviewed denied the allegation. Interview with R1 revealed that R1 was walking in the hallway when S1 hit R1 with S1’s arm. R1 revealed that S1 was backing up with both of their hands on a cleaning cart when S1’s arm came into contact with R1’s elbow, which resulted in R1’s obtaining a bruise. R1 revealed that no words were exchanged prior to this incident. Four (4) out of the four staff interviewed denied this allegation. Interview with S1 revealed that S1 was backing out of another resident’s room with a cart and accidentally bumped into R1. S1 revealed that S1 immediately apologized to R1. S1 revealed that R1 did not fall or shout in pain after S1 bumped into R1. Interview with S3 revealed that witnessed S1 walking out of another resident’s room with a cart and accidentally “bump” into R1. S3 revealed they saw S1 immediately apologize and ask R1 if they were okay. S3 revealed they also approached R1 to check on them and reassured R1 it was an accident. S3 revealed that R1 acknowledged S1 accidentally bumped into R1. S3 denied that R1 complained of pain or injury immediately after the incident. Review of R1’s Unusual Injury/ Incident Reports (LIC 624) did not corroborate this allegation. Review of statements signed by S1, S2 and S3 did not corroborate this allegation. 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. “Staff do not provide a comfortable room temperature for resident(s).” It is alleged that staff do not turn on the heater when it’s cold outside. Four (4) out of four (4) staff interviewed denied the allegation. Eight (8) out of ten (10) residents interviewed denied the allegation. Interview with R1 revealed they have requested staff turn on the heater so R1’s room will be warm. R1 revealed staff do not turn the heater on and their room is too cold. During facility on 03/02/2026, LPA observed facility thermostat read 77 degrees at 9:15am. During tour of R1’s room, LPA observed R1’s ac/heating air went, covered with white cardboard and tape. R1 revealed they do not want the vent open and wish to keep it taped up. LPA observed a space heater and portable fan in R1's room. During tour of TV room and activity room, LPA did not observe residents to be shivering or bundled up with multiple layers of blankets or clothing. 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. SEE 9099-C “Staff cancel resident’s appointments.” It is alleged that staff cancel R1’s medical appointments. Four (4) out of four (4) staff interviewed denied the allegation. Eight (8) out of ten (10) residents interviewed denied the allegation. Interview with R1 revealed that they had mail to prove that staff cancel R1’s doctor appointments without R1’s consent. LPA requested R1 to provide mail proof that staff canceled R1’s medical appointment. R1 denied LPA’s request. Review of R1’s Identification and Emergency Information revealed that R1 is self-responsible. Staff interviews revealed that R1 makes their own medical appointments and staff is not aware when R1 makes medical appointments. LPA attempted to contact R1’s medical provider but all attempts were unsuccessful. 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. “Staff disrupt resident’s sleep due to loud music.” It is alleged that staff play loud music at night and R1 is unable to sleep. Four (4) out of four (4) staff interviewed denied the allegation. Eight (8) out of ten (10) residents interviewed denied the allegation. On 5/8/2026, at 8:01pm, LPA Ramirez did not observe staff playing music. LPA observed residents in various areas of the facility watching TV and conversating amongst other residents. Resident interviews revealed that staff will play music during resident karaoke, but this happens in the daytime, and the music is not very loud. 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. No deficiencies were cited. Exit interview was conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, May 8, 2026 · control 28-AS-20260223153823

Allegation investigated: Staff did not distribute resident's medication as prescribed.

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Claudia Cordoba. Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained. The investigation consisted of the following: LPA obtained a copy of the resident and staff rosters, interviewed Resident 1 (R1) through Resident 11 (R11), interviewed Administrator, Staff 1 (S1) and Staff 2 (S2), LPA conducted tour of medication room, reviewed Residents Medication Administration Records (MARs). R1’s file reviewed and relevant documentation were obtained including copies of MAR for the months of March and April 2026. Continue 9099C Unsubstantiated Investigation revealed the following: Regarding allegation, Staff did not distribute resident's medication as prescribed, it was alleged that on 3/20/2026 staff distributed the wrong medication (pill) to R1 and that afterwards resident had a reaction. interviewed Administrator and staff denied the allegation. They stated that they provide residents with their medications as prescribed. They stated no medication error or medication reaction reported for R1 or other residents and there is no history or documentation that there was a reaction for any residents. Interviewed staff stated that it is essential to follow the established safety protocol to ensure each resident receive the correct medication. They stated they carefully check medication labels with the resident's MAR and document immediately after giving the medication. Interviewed Administrator and staff indicated that facility utilized QuickMar program for medication management which requires staff to select the medication pass time and the specific resident and displays the resident's photo along with only medications scheduled for that time, ensuring accurate administration. Resident interviews revealed that staff provide them with their prescribed medications daily on a timely manner. Interviewed residents stated that the staff didn't provide them with the wrong medication and indicated they have not had any issues/concerns regarding this matter. Interviewed residents indicated they have never had any reaction from the medications and have not heard other residents complaining about their medication not being administered as prescribed by the doctor and because of that they had a reaction. LPA reviewed five random residents Medication Administration Records (MAR) including R1's for the months of March and April 2026 and observed that their medications including PRNs to be documented properly and given as prescribed. Records reviewed did not show any past or current issues regarding medication being given out to the residents incorrectly. Documentation reviewed and interviews conducted with staff and residents do not corroborate this allegation. 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 Exit interview conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Apr 2, 2026 · control 28-AS-20260325103229

Allegation investigated: Staff do not ensure that residents have access to facility

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Claudia Cordoba. Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained. The investigation consisted of the following: LPA Margaryan toured the facility, obtained Staff and Residents rooster, conducted interviews with Administrator, Staff 1 to Staff 4 (S1 to S4) and Resident 1 to Resident 13 (R1 to R13). Continue 9099C Unsubstantiated Regarding the allegation: Staff do not ensure that residents have access to facility. It was alleged that facility entrance door is locked and when residents try to enter the facility, they can't open the door. Resident left outside for extended periods of time because staff do not open the door. Interviewed Administrator and staff denied the allegation. They stated that entrance door is locked from outside for safety reason. Residents, visitors and family members must ring the doorbell at the front entrance when arriving. Staff will then unlock the door using electronic door release system. Interviewed Administrator and staff stated that residents never left outside for extended periods of time. Staff respond promptly to the doorbell and buzz them in right away. Also, entrance system can be monitored remotely using an iPad, which allows staff to view and communicate with individuals at the door and unlock the entrance remotely. Interviewed staff stated facility maintains electronically controlled door policy to support safety and timely access to the facility for all residents. Interviewed Administrator and staff indicated that residents are not expected or permitted to open the entrance door for visitors and signs are posted for reminding residents not to open the door for safety purpose. Residents interviewed did not corroborate the allegation. Interviewed residents stated that the entrance door is locked from outside but there is a doorbell that they used. Interviewed residents denied that they have been left outside for long period of time and have never denied entry to the facility. They stated that it took a couple of second staff to open the door. During today's visit LPA observed multiple signs at the front door which stated “Please Ring the doorbell. If you need further assistance, please call. (Number was provided)”, “Wait for the beep. Then pull handle”, “Attention All Residents: Please do not open door, employees will open the door. Thank you” (English and Spanish). 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. Exit interview is conducted and a copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Mar 12, 2026 · control 28-AS-20260310145542

Allegation investigated: Staff inappropriately spoke to resident

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 02/21/2026 to deliver a finding regarding the above allegation. On 02/10/2026, LPA Ramirez conducted an unannounced initial complaint investigation, and a need further investigation was documented. During today’s visit LPA Ramirez was greeted by Tara La Fex and explained the purpose of the visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Staff#1-5 interviews (S1-S5), Resident#1-9 interviews (R1-R9), and physical plant tour. The investigation revealed the following: regarding the allegation “Staff inappropriately spoke to resident.” SEE 9099-C for continued narrative Unsubstantiated It is alleged that S1 spoke inappropriately to a resident. On 02/10/2026, LPA Ramirez conducted nine (9) resident interviews. One (1) out of nine (9) residents interviewed corroborated this allegation. Eight (8) out of the nine (9) residents interviewed revealed they felt well cared for by staff, when asked by LPA Ramirez. On 02/10/2026, LPA Ramirez conducted five (5) staff interviews. Five (5) out of the five staff interviewed denied this allegation. Interview with S1 revealed they have never spoken inappropriately to any resident, family member or visitor. Interview with S5 revealed that they never witnessed S1 or any other staff member speak inappropriately to any resident, family member or visitor. On 02/10/2026, during facility tour LPA Ramirez observed staff conducting care and supervision to residents and did not observe staff speaking inappropriately to residents. LPA Ramirez observed several residents in the facility activities area singing karaoke songs along with two (2) staff. 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. No deficiencies were cited. Exit interview was conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 21, 2026 · control 28-AS-20260203083301

Allegation investigated: Staff removed notice of licensing visit (LIC9213) from wall. Staff threatened to evict residents in retaliation for filing complaints. Staff do not ensure the facility is at a comfortable temperature for residents. Staff did not transport resident to medical appointment . Staff do not ensure facility is free of insects . Staff do not keep the facility free of odor.

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegations listed above. LPA met with Claudia Cordoba. Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained. The investigation consisted of the following: LPA Margaryan toured the facility, conducted interviews with Administrator, Staff 1 to Staff 4 (S1 to S4) and Resident 1 to Resident 10 (R1 to R10). Staff and residents roster were requested. LPA also obtained copies of invoices from "Orkin" pets control company. Continue 9099C Unsubstantiated Regarding the allegation: Staff removed notice of licensing visit (LIC9213) from wall. It was alleged that the staff tore down and crumpled up the papers that was instructed them to hang up in the activity room. Interviewed Administrator and staff denied the allegation. They stated that they are not familiar with the above-mentioned form and all required licensing notices are properly posted in prominent areas. LPA reviewed LIC9213 form and determined that this form is specific to Child Care program. As such, the facility is not required to have this form posted in a public / common area of the facility, including the activity room. Regarding the allegation: Staff threatened to evict residents in retaliation for filing complaints. It was alleged that facility staff threatened to evict resident for filing complaints. Interviewed Administrator and staff denied the allegation. They stated that they have never threatened any resident with eviction for reporting an incident or filing a complaint. They did not hear or witness that any staff retaliated or threatened to evict any resident for complaints. All residents interviewed could not corroborate this allegation. They stated they are not retaliated by staff for making complaints and staff never threatened them with eviction. Regarding the allegation: Staff do not ensure the facility is at a comfortable temperature for residents. It was alleged that facility is extremely cold. Interviewed Administrator and staff denied the allegation. They stated that the temperature in the facility is comfortable setting and didn't hear complaints about facility is cold. LPA observed that the facility temperature was comfortable at the time of the visit (Thermostat in the hallway shows 78-degree F). Interviewed Administrator and staff stated that facility has a centralized AC unit, and the front office manages the temperature and can adjust temperature at any time using company tablets or phones. Administrator stated that when residents report a concern about the temperature, they can adjust quickly and easily. Also, facility provide individual heaters or fans to any residents who request them, ensuring their personal comfort. Residents interviewed were not able to corroborate the allegation. At the time of visit LPA toured the facility and checked the temperature in common areas, activity areas and 6 resident rooms (Rooms #4, 44, 45,48, 53, 63). LPA observed the temperature on the thermostats between 73-degree F - 78-degree F which is within Title 22 regulations. Residents interviewed stated that the facility maintains a comfortable temperature for residents and they don't have any complaints about this matter. Continue 9099C Regarding the allegation: Staff did not transport resident to medical appointment. It was alleged that Staff failed to take resident to a medical appointment, causing resident to miss it. Interviewed Administrator and staff denied the allegation. Interviewed Administrator and staff stated medical appointments are scheduled and handled in an efficient manner and the facility has consistently made every effort to ensure residents attend all scheduled medical appointments. Interviewed staff stated that staff utilize multiple transportation options based on availability and resident’s needs, including Access, Dial-A -Ride, Medical transportation services, and Uber when necessary. Facility staff ensures that all residents attend their appointments. Also staff ensures that residents that are less independent have a companion to their appointment for their safety and support. Residents interviewed could not corroborate this allegation. Nine (9) out of ten (10) residents stated that facility staff assist them with their medical appointments and transportation arrangements and they didn't miss their appointments. They stated that staff will accompany them if needed. One (1) resident out of ten (10) stated that they make their own appointments and staff are not aware of them. Regarding the allegation: Staff do not ensure facility is free of insects .It was alleged that the facility has roaches. Interviewed Administrator and staff denied the allegation. They stated that the facility has a contract with a pest control company, and the facility is serviced every month. Administrator stated that they use "Orkin" pest control services, and the company perform routine treatments throughout the facility twice a month and are available for additional visits as needed (Copies of Invoices were provided to LPA). Residents interviewed were unable to corroborate the allegation. Interviewed residents stated that they have not seen any roaches in their rooms and at the facility. LPA did not observe roaches during facility tour. LPA toured the common areas and found no evidence of roaches. LPA inspected randomly chosen rooms and did not observe any roaches in the residents’ rooms. Continue 9099C Regarding the allegation: Staff do not keep the facility free of odor. It was alleged that facility smells strongly of urine. Interviewed Administrator and staff denied the allegation. They stated there is nor has there been any strong urine odor in the facility. Interviewed Administrator and staff stated the facility maintains a regular housekeeping and maintenance schedule to ensure cleanliness throughout the facility / building. If resident has an accident, staff respond promptly by assisting the resident with hygiene needs, thoroughly cleaning the affected area. Facility staff make sure facility maintains a fresh and clean environment for the residents. LPA toured the facility and entered some residents’ rooms but did not notice any smell of urine. Residents interviewed were unable to corroborate the allegation. Interviewed residents denied the allegation and stated that the facility does not strongly smell urine. Based on interviews, observation, and document review conducted, there was insufficient evidence to prove the allegation(s). Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) occurred, therefore the allegations are Unsubstantiated. Exit interview was conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 15, 2026 · control 28-AS-20260109082302

Allegation investigated: Staff do not ensure residents are accorded dignity and respect in their personal relationships by other adults in the facility. Staff do not ensure residents receive their mail correspondences in a timely manner.

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Claudia Cordoba. Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained. The investigation consisted of the following: LPA Margaryan requested Staff and Residents rooster, conducted interviews with Administrator, Staff 1 to Staff 3 (S1 to S3) and Resident 1 to Resident 11 (R1 to R11). LPA attempted to interview R12 over the phone. R12's phone number was disconnected. Unsubstantiated Regarding the allegation: Staff do not ensure residents are accorded dignity and respect in their personal relationships by other adults in the facility. It was alleged that R8 slams the door hard and messes up the reception on the TV in RP’s room and R9 told RP “You don’t belong here, and you should leave.” RP got into verbal confrontations with residents and staff won’t do anything about the residents being disrespectful to each other. Interviewed Administrator and staff stated that they ensure residents speak to each other with respect and dignity. Administrator stated whenever a complaint regarding residents is received, staff immediately address the situation by speaking with the involved residents to ensure concerns are discussed, resident comfort is maintained, and appropriate steps are taken. Interviewed staff stated that if there is any confrontation between residents, they first calm them down, listening to their concern and trying to find a solution and will notify Administrator about the incident. Interviewed Administrator stated that several months ago one of the residents, R12, reported that R7 would bang on the walls and that effect on the TV reception in R12’s room. Administrator stated that they spoke with R7 which denied the allegation. To prevent further escalation and to ensure resident comfort, R7 was relocated. Recently R12 reported similar concern regarding their current neighbor, R8 indicating wall banging. R8 also denied that they bang on the wall. R12 and R8 were offered to relocate rooms, both have declined. Interviewed R7 and R8 stated they never bang the wall or slammed the door. Interviewed Administrator and staff stated that they didn't hear or witnessed that R9 tell resident(s) “You don’t belong here, and you should leave.” Interviewed Residents stated they get along with each other, sometimes there are disagreements between residents, but staff will speak with residents and will make sure they are respectful to each other. Interviewed residents stated they didn’t get into verbal confrontations with other residents and didn’t hear that any resident tell another resident “You don’t belong here, and you should leave.” Interviewed R9 stated that they never tell anyone “You don’t belong here, and you should leave.” Continue 9099C Regarding the allegation: Staff do not ensure residents receive their mail correspondence in a timely manner. It was alleged that staff don’t make sure residents receive their mail. Interviewed Administrator and staff denied the allegation. Administrator stated that residents mail is distributed daily, depending on the time it arrives. Staff will sort the mail and then distribute it in the dining room or residents rooms, or residents are paged to the front desk if they cannot be located in these areas. Interviewed administrator and staff stated there are assigned staff to pass the mail on a daily basis. The only time mail is not delivered to the residents is when the residents are out of the facility or in the hospital. Staff will hold the mail for them until they return. interviews with residents did not corroborate the allegation. They stated that they received their mail in a timely manner, delivered by facility staff and have had no issues in obtaining their mail. 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, therefore the allegations are Unsubstantiated. Exit interview is conducted and the copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Dec 16, 2025 · control 28-AS-20251211111341

Allegation investigated: Staff do not ensure that facility is maintained at a comfortable temperature for residents Staff prevent resident from leaving the facility Staff do not ensure the facility is free of insects Staff do not ensure the facility is clean and sanitary Staff do not ensure music is maintained at a comfortable volume for residents

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Administrator who assisted with the visit. Reason for the visit was explained. The investigation consisted of the following: LPA Margaryan toured the facility, conducted interviews with Administrator, Staff 1 to Staff 4 (S1 to S4) and Resident 1 to Resident 11 (R1 to R11). Staff and residents roster were requested. LPA also obtained copies of invoices from "Orkin" pets control company. Continue 9099C Unsubstantiated Allegation - Staff do not ensure that facility is maintained at a comfortable temperature for residents. It was alleged that Staff interviewed denied the allegation. They stated that they maintain a comfortable temperature at the facility and didn't hear complaints about this matter. LPA observed that the facility temperature was comfortable at the time of the visit (Thermostat in the hallway shows 73 degree F). Interviewed Administrator and staff stated that facility has a centralized AC unit, and the front office manages the temperature and have the ability to adjust temperature at any time using company tablets or phones. Administrator stated that when residents report a concern about the temperature, they are able to adjust quickly and easily. Interviewed staff stated additionally facility provide individual heaters or fans to any residents who request them, ensuring their personal comfort. Residents interviewed were not able to corroborate the allegation. LPA toured the facility. During tour LPA entered 6 resident rooms (Rooms #2, 6, 48, 49, 55). LPA observed the temperature on the thermostats between 72 degree F - 78 degree F which is within Title 22 regulations. Residents interviewed stated that the facility maintains a comfortable temperature for residents and they don't have any complains about this matter. Allegation - Staff prevent resident from leaving the facility. It was alleged that S1 blocks the door with their body to prevent R1 from leaving. Staff interviewed denied the allegation. They stated that they have never prevented R1 or other residents who wanted to leave the facility from doing so. They stated that facility is open door facility and staff is not allowed to black the entrance for residents at any time whether with their own body or with any objects. Interviewed Administrator and staff stated residents may be redirected if confused, but only through verbal communication, support and encouragement never through physical blocking. Administrator stated that residents are free to come and go as they choose. Staff simply ask that they inform staff of their destination so staff can document it for their safety. Interviewed S1 stated they never blocked the door with their body to prevent R1 or other residents from leaving the facility. During interviews residents denied ever being prevented from leaving the facility when they wish to. Interviewed R1 stated that they has never been prevented from leaving the facility when they wanted to and has never had any issues with S1 or other staff blocking the door with their body to stop them from leaving the facility. Continue 9099C Allegation - Staff do not ensure the facility is free of insects. It was alleged that there are roaches in the hallways. Staff interviewed denied the allegation. They stated that they didn't see roaches at the facility / in the hallway. They stated that the facility has a contract with a pest control company, and the facility is serviced every month. Administrator stated that they use "Orkin" pest control services, and the company perform routine treatments throughout the facility twice a month and are available for additional visits as needed (Copies of Invoices dated 11/18/25, 11/28/25 were provided to LPA). Residents interviewed were unable to corroborate the allegation. Interviewed residents stated that they have not seen any roaches in their rooms and at the facility. LPA did not observe roaches during facility tour. LPA toured the common areas and found no evidence of roaches. LPA inspected randomly chosen rooms and did not observe any roaches in the residents’ rooms. Allegation - Staff do not ensure the facility is clean and sanitary. It was alleged that the facility is very dirty. Interviewed Administrator and staff denied the allegation. Administrator stated that they follows strict cleaning schedule to maintain a clean and sanitary environment. All team members work together to make sure the facility is clean and sanitary. Facility floors cleaned / mop every day. In the event there is any issues, staff work together to clean the area immediately. Interviewed staff stated that facility is cleaned several times a day by cleaning staff. Sometimes the floors get dirty / sticky down the hallways after coffee is served. That is because the clients will spill it as they walk around. Staff will always mop the hallways daily, also walk throughout the day making sure facility is kept clean and sanitary. Interviewed staff stated also housekeeping does weekly deep cleaning for resident's rooms and light cleaning on a daily basis and as needed. Residents interviewed confirmed to see staff cleaning, mopping the hallways daily. LPA observed staff cleaning rooms and the hallways during the visit. All interviewed residents, including R1, stated that facility is clean, and staff is doing good job. Interviewed R1 and R2 mentioned that they clean their room by themselves, but they can ask staff for assistance if needed. Continue 9099C Allegation - Staff do not ensure music is maintained at a comfortable volume for residents. It was alleged that staff are playing loud music in the hallways, and it bothers everyone. Staff interviewed denied the allegation. Interviewed Administrator and staff stated that staff ensure that the volume of music or television is kept at a comfortable level for all residents. They stated that facility has different areas where residents are invited to enjoy the activities, music, karaoke, movies. Also, there are quite areas available for the residents to enjoy. Residents are free to choose which area they want to enjoy. Interviewed Administrator stated while staff host enjoyable activities such as karaoke and movie events, these activities are held in designated areas to prevent disruption. Residents interviewed were not able to corroborate the allegation. They stated that facility staff didn't play loud music. Majority of residents stated they enjoy music and level of the volume is comfortable and not bothering them. Interviewed R1 stated that they stay in their room most of the time and can not hear the music from activity areas. R1 stated that they go to ADP program 3 times a week and participates activities in the Day Program. Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 4, 2025 · control 28-AS-20251202125043

Allegation investigated: Staff prevented a resident from attending a medical appointment.

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegation listed above. LPA met with Welness Director. Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained. The investigation consisted of the following: LPA Margaryan toured the facility, conducted interviews with Administrator, Staff 1 to Staff 3 (S1 to S3) and Resident 1 to Resident 11 (R1 to R11). Also staff and residents roster were requested. Continue 9099C Unsubstantiated Allegation - Staff prevented a resident from attending a medical appointment. It was alleged that resident had a medical appointment and the staff cancelled resident’s appointment. Interviewed Administrator and staff denied the allegation. Interviewed Administrator and staff stated that facility has a designated case manager who assist residents with scheduling medical appointments and arranging transportation. Interviewed staff stated that they support all residents who request assistance. Interviewed Administrator mentioned all appointments are scheduled and attended as planned. Appointments are never cancelled by staff unless the resident requests the cancellation or medical office contacts the facility to reschedule. All cancelled or rescheduled medical appointments are noted in the calendar that is used in Quick Mar Program (copies of the samples were provided). Eight residents (8) out of eleven (11) residents interviewed stated that facility staff assist them with doctor's appointments. Three (3) residents out of eleven (11) residents stated that they make doctors’ appointments by themselves. Ten (10) residents out of eleven (11) residents stated that staff didn't cancel their medical appointments without the reason or without their knowledge. One (1) resident out of eleven (11) residents stated that staff cancelled their medical appointment. Resident was not able to provide medical appointments day and staff's name who cancelled their medical appointment. Based on the information gathered, there is insufficient evidence to support this allegation. 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. An exit interview was conducted with the Administrator. A copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 4, 2025 · control 28-AS-20251124092808

Allegation investigated: Staff did not prevent a visitor from eating a resident's food.

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Wellness Director. Assistant Administrator Dennise Torres arrived shortly after and assisted with the visit. Purpose of the visit was explained. During today's visit LPA obtained a copies of Staff and Residents roster, Facility Guest Meal Policy, Notification to Residents & Families about dinning areas and policy. interviewed Assistant Administrator, Staff #1 (S1) and Staff #2 (S2), Resident #1 (R1) through Resident #15 (R15). Continue 9099C Unsubstantiated The investigation revealed the following: Allegation - Staff did not prevent a visitor from eating a resident's food. It was alleged that there is a resident’s family member (visitor) that is constantly eating the resident’s food. Interviewed Assistant Administrator and staff denied the allegation. Interviewed Assistant Administrator indicated that Family members / visitors often join residents for meals at the facility but never eat residents food/meal. They stated that visitors / guests may bring their own food or purchase a meal from the facility for a small fee. Assistant Administrator stated per Facility Guest Meal Policy visitors they can dine with residents at permitted spaces or in alternative locations. Interviewed S1 stated that facility residents have a right to have a visitor, and visitors are allowed to bring food and share with the residents they are visiting. S1 indicated that facility also provide meals for a low price so residents can enjoy their time with their family members / visitors. Interviewed S2 stated that they often seen family members join their loved ones for meals in the dining room. S2 stated usually visitors bring their own food, but they also have an option to buy food from the facility. Interviewed Assistant Administrator and staff indicated that there is a one resident (R1) who's family member visits him/her almost every day and eats with R1. They stated R1's family member almost always bring their own food and rarely purchase a meal from the facility. Interviewed staff stated they didn't hear complaints that R1's or other residents family members / visitors eat residents food. LPA interviewed 15 residents. They indicated that visitors could bring food, and they can also buy food from the facility. Interviewed residents stated they have not heard anyone complaining about visitors eating residents food. Residents interviewed could not corroborate the allegation. Based on interviews conducted with facility staff, facility residents and document review there was not enough supportive evidence to concur with the reported allegation. 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. Exit interview was conducted and the copy of this report was provided to Assistant Administrator.the state’s words, verbatim · CDSS document, Oct 28, 2025 · control 28-AS-20251024100616

Allegation investigated: Staff member pushed resident in care causing injury.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced and met with Dennise Torres, the Assistant Administrator. The purpose of the visit was explained. LPA obtained a copy of the staff and resident roster, reviewed documents for Resident #1, and interviewed Staff #1 - #5 and Residents #1 – 10. The investigation revealed the following: Allegation - Staff member pushed the resident in care, causing injury. It is alleged that Staff #1 (S1) pushed Resident #1 (R1), causing a bruise on the right elbow. LPA interviewed five (5) staff regarding this allegation. S1 denied pushing R1 and stated that the incident was accidental. Another staff who witnessed the incident also deemed the incident to be accidental. Unsubstantiated It was described that S1 was backing out of a resident’s room and unintentionally brushed against R1. S1’s hands were on the supply cart at the time of the incident, and did not push R1 as alleged on 7/7/25. R1 did not fall or mention any pain. Staff immediately apologized when contact was made. Staff interviewed stated the police responded to this situation on 7/9/25 and interviewed the resident and staff. The police determined there was no further action warranted as the incident was deemed accidental and no injuries were observed. LPA interviewed ten (10) residents, and eight (8) feel safe residing at the facility. Eight (8) of the residents have not witnessed any staff pushing a resident and feel that the staff treat them well and are respectful. One (1) resident interviewed feels that staff are targeting them and does not feel safe at the facility. Interview with R1 revealed that the incident could have been accidental and that S1 had apologized. R1 stated the bruise was observed a few days later, and cannot be certain that it derived from the prior incident. Based on the information gathered, there is insufficient evidence to support this allegation. 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. An exit interview was conducted with the Assistant Administrator. A copy of this report, along with the appeal rights, was provided.the state’s words, verbatim · CDSS document, Jul 31, 2025 · control 28-AS-20250724161346

Allegation investigated: Staff pushed resident. Staff does not treat residents with dignity or respect.

Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegations listed above. LPA met with Welness Director. Assistant Administrator arrived shortly after and assisted with the visit. Reason for the visit was explained. The investigation consisted of the following: LPA Margaryan conducted interviews with Assistant Administrator, Staff 1 to Staff 3 (S1 to S3) and Resident 1 to Resident 12 (R1 to R12). Also staff and residents roster were requested. At the time of visit R1 was at the Day Program and was interviewed over the phone. Continue 9099C Unsubstantiated Investigation revealed the following: Regarding allegation: Staff pushed resident. It was alleged that S1 pushed R1 and walked away. Interviewed Administrator and staff denied the allegation. They stated that staff never pushed the residents. The interviewed Assistant Administrator stated that on 07/07/25 R1 reported to them that R1 was involved in an accident with S1, during which R1 felt they had been purposely pushed. Assistant Administrator spoke with S1 and S1 explained that as S1 was exiting Room 39, R1 was walking past in the hallway, and they unintentionally brushed against each other. On 07/09/25 Police Officer responded to a complaint regarding an allegation that S1 had pushed R1. Upon arrival the Officer conducted interviews with all parties involved. During the interview the Officer asked R1 if they experiencing any pain or had noticed any bruising, R1 stated that they did not have any pain or bruising. Officer determinate that no further police action was warranted. Interviewed S1 stated that they accidentally brushed against R1 when S2 called S1's name and S1 steeped out from the room 39 after providing care one of the resident, and accidentally brushed against R1. S1 stated they immediately apologized. Interviewed S2 stated that they witnessed the accident that occurred on 07/07/25 between R1 and S1 and based on S2's observation the interaction appeared to be an accident. S2 stated that S1 apologized immediately to R1 and R1 responded that they knew that was an accident. Interviewed S3 stated that they didn't see that S1 or other staff pushed R1 or another resident. LPA interviewed a total of 12 residents and 11 residents stated that staff do not push residents. 11 residents stated that they did not witness any staff pushing any residents. 1 out of the 12 residents stated that S1 accidentally pushed her. Resident stated that it was an accident and they don't have any pain and bruises. Also S1 said sorry to them. Interviewed residents stated that they like the facility, they feel safe, staff treat them with respect, and they do not have any concerns. LPA toured the facility and observed residents in the patio and throughout the facility and residents appeared comfortable. LPA did not observe any bruising on any residents and did not observe anything of concern. Based on statements gathered from interviews conducted with staff, residents and LPA observations there was not enough supportive evidence to concur with the reported allegation. Continue 9099C Regarding allegation: Staff does not treat residents with dignity or respect. It was alleged that S1 is a bully to a lot of the residents. Interviewed Administrator and staff denied the allegation. They stated that staff never bully the residents and treat them with dignity and respect. Interviewed S1 stated they never bully any residents. Interviewed Assistant Administrator and staff stated that they never seen or heard that S1 bully residents. The Assistant Administrator stated they was not informed by residents that S1 or other staff bullying residents. LPA toured the facility and observed residents in the patio and throughout the facility and residents appeared comfortable. LPA observed that staff treat them with respect. LPA interviewed a total of 12 residents and residents stated that staff treat them with respect and didn't bully them. Residents interviewed also indicated they have never observed S1, or other staff members bully residents. They are content and feel safe at the facility. Based on statements gathered from interviews conducted with staff, residents and LPA observations there was not enough supportive evidence to concur with the reported allegation. 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, therefore the allegations are unsubstantiated. Exit interview was conducted with Assistant Administrator and the copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 21, 2025 · control 28-AS-20250716095553

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPA met with Assistant Administrator, Dennise Torres who assisted with visit. LPA explained the reason for the visit. The facility is licensed to serve 136 non-ambulatory residents ages 60 and over, of which 34 may be bedridden. There is a hospice waiver approved for 20 residents. The facility does not have a dementia care plan and does not accept any residents with dementia. There are some residents utilizing home health services but none on hospice. LPA and Assistant Administrator toured the facility which included a random sample of resident rooms along with the kitchen, dining room, activity room, two laundry rooms, storage rooms, 3 offices, Med Room, library and large movie room. The patio area is well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the patio area. Passageways and exits are free of obstruction. The common areas are clean and have the required furniture. The facility has 68 resident rooms with own bathrooms. LPA observed laundry detergent locked in the laundry rooms and inaccessible to residents. Sharps are locked in the kitchen and inaccessible to residents. Randomly chosen resident rooms were toured. Each room has a bed, linen, dresser, light, and sufficient closet space. The resident bathrooms have the required grabs bars and non-skid mat. The water temperature was tested in a random selection of resident bathrooms. The hot water was between 111.5 - 117.1 degrees F which is within the required 105 - 120 degrees F. The kitchen was inspected. LPA observed sufficient food supplies of 2-day perishable and a 7 day of non-perishable food. All the appliances are clean and seem to be operating properly. The smoke detectors are interconnected and there are 2 operable carbon monoxide detectors. The facility has a signal system in place. Fire extinguishers were fully charged and operational. Continue 809C LPA observed the medications are centrally stored in the Med. Room and inaccessible to clients. The facility uses an electronic Medication Administration Record (MAR) log to document medications given. During today’s visit, LPA reviewed resident medications and they are being administered as prescribed by the physician. The first aid kits were observed and found to be in compliance with the Title 22 Regulations. LPA reviewed 5 personnel records and they have the required documents in file. LPA reviewed 5 resident records and they have the following documents in their files such as Admission Agreements, Identification & Emergency Information, Physician's Report with TB test results, Pre-admission appraisal, and Resident rights. Last Fire drill conducted on 07/01/25. Exit interview conducted and a copy of the report was provided to Assistant Administrator.the state’s words, verbatim · CDSS document, Jul 14, 2025

Allegation investigated: Staff do not ensure resident utilizes restroom. Staff do not ensure resident is provided a healthy environment.

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Assistant Administrator Dennise Torres. Purpose of the visit was explained. During today's visit LPA obtained a copy of the Staff and Residents roster, interviewed Assistant Administrator, Wellness Director, Staff #1 (S1) and Staff #2 (S2), Resident #1 (R1) through Resident #8 (R8) and toured the facility with Assistant Administrator. Continue 9099C Unsubstantiated Staff do not ensure resident utilizes restroom. It was alleged that R1 pees from the porch and staff not done anything about it. LPA interviewed Assistant Administrator, Wellness Director, staff, residents and toured the facility inside and out including a sample of rooms / porches. Interviews with Assistant Administrator, Wellness Director revealed that in the past R2 brought on Administrator's attention that R1 is urinating from the porch. Assistant Administrator and Wellness Director stated R1 was spoken to immediately and advised that this behavior is not allowed at the facility and R1's actions made other residents uncomfortable. They stated that Administration ensure that R1 was assisted throughout the day and checked that R1's behavior no longer continued. A urinal was also provided and R1 has been moved closer to the bathroom so that R1 has more accessible access to it. R1 was redirected to use restroom located in R1's room and the general resident's restroom that is located a few steps from R1's room. Interviewed S1 stated that they heard that R1 was urinating from the porch, but it was long time ago and Assistant Administrator spoke with the resident. Lately S1 didn't hear any complaints about this matter. Interviewed S2 stated that they didn't hear about resident urinating from the porch. Interviewed R1 stated that it happened once long time ago that they pees from the porch because staff was cleaning bathroom in R1's room. R3 (R1's roommate) stated that in the past R1 was peeing from the porch and lately R3 didn't noticed that R1 doing that. Interviewed R2 stated that lately it's not smell outside and thinks that R1 is not urinating any more from the porch. (1) out of the (8) resident stated didn't hear about resident is urinating outside. (4) out of (8) residents stated that they heard that one resident was urinating outside of porch, but they believe that issue already under the control. Already mouths they didn't hear anything about it. Continue 9099C Staff do not ensure resident is provided a healthy environment. It was alleged that R1 pees from his porch and because of strong smell R2 cannot be in the porch. LPA interviewed staff, residents and conducted a tour of all facility common areas including residents’ rooms and porch areas. LPA observed that they were clean, did not smell any strong odors that would indicate that clients urinate in the common / porch areas. Intervened Assistant administrator, Wellness Director and staff stated that residents at the facility were provided a healthy environment. They stated that facility conducts daily cleaning inside and outside at night and periodic cleaning during the day and cleaning staff aware and they are reporting any urine smell or any incidents that might occur going forward. Assistant administrator and Wellness Director stated that in the past R2 brought on their attention that R1 is urinating from the porch and R2 cannot go to his/her porch because of strong smell of urine. They stated that they spoke with R1 about this immediately and advised that this behavior is not allowed at the facility and R1's actions made other residents uncomfortable. Interviewed residents stated that staff is cleaning the facility every day. Interviewed residents stated that staff providing a healthy environment to residents. They stated that the common areas, rooms, porches are cleaned every day and staff also check common areas, porches throughout the day. Interviewed R2 stated that lately it's not smell outside and thinks that R1 is not urinating any more from the porch. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegations. 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, therefore the allegations are Unsubstantiated. Exit interview was conduced and the copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 29, 2024 · control 28-AS-20241023105126

Allegation investigated: Staff did not provide resident a copy of the admission agreement in a timely manner.

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Wellness Director Claudia Cordoba. Assistant Administrator Dennise Torres arrived shortly after who assisted with the visit. Purpose of the visit was explained. During this visit, LPA obtained a copy of the resident and staff rosters and reviewed Residents #1 (R1) fille and obtained relevant documentation. LPA also interviewed Staff #1 (S1) and Staff #2 (S2) and Resident #1 (R1) through Resident #11 (R11) . Continued on LIC 9099-C Unsubstantiated Allegation: Staff did not provide resident a copy of the admission agreement in a timely manner. It was alleged that R1 never received a copy of admission agreement and R1 was not aware of any fees R1 would be responsible for at the time of admission. Record review confirm that R1 was admitted to the facility on 06/10/2024. Admission Agreement was signed by R1 with the adjusted monthly rate $823.07 (Basic service rate was $1398.07). Interviewed R1 stated that it was misunderstanding about the fees, and they have a copy of Admission Agreement. R1 stated that they agree to the terms of the admission agreement and signed it on 06/10/24, don't have any concerns about this matter. Residents interviewed were not able to corroborate the allegation. All interviewed residents stated that they or their responsible parties did receive copies of their admission agreement and other paperwork in a timely manner. Interviewed S1 and S2 denied the allegation. They stated that they provide copies of resident’s paperwork, including the Admission Agreement to R1 and other residents or their responsible parties in a timely manner, at the time of admission. Also, residents and their responsible parties were informed that copies of resident’s chart could be provided to their request. S1 and S2 stated R1 was interviewed at Rehabilitation Center from where R1 was transferred and was informed about payment obligations. They stated that facility decided to charge less for the rent to help R1 with their finances. 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. Exit interview was conducted and a copy of this report was provided to Assistant Administrator Dennise Torres.the state’s words, verbatim · CDSS document, Sep 17, 2024 · control 28-AS-20240912111744

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPA met with Assistant Administrator, Dennise Torres who assisted with visit. LPA explained the reason for the visit. The facility is licensed to serve 136 non-ambulatory residents ages 60 and over, of which 34 may be bedridden. There is a hospice waiver approved for 20 residents. The facility does not have a dementia care plan and does not accept any residents with dementia. There are some residents utilizing home health services but none on hospice. LPA and Assistant Administrator toured the facility which included a random sample of resident rooms along with the kitchen, dining room, both laundry rooms, storage room, and large movie room. The patio area is well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the patio area. Passageways and exits are free of obstruction. The common areas are clean and have the required furniture. The facility has 68 resident rooms with own bathrooms. LPA observed laundry room (next to the kitchen) door was open during visit. Laundry detergent and gallon of Bleach were observed and accessible to clients. Randomly chosen resident rooms were toured. Each room has a bed, linen, dresser, light, and sufficient closet space. The resident bathrooms have the required grabs bars and non-skid mat. The water temperature was tested in a random selection of resident bathrooms. The hot water was between 112.6 - 118.2 degrees F which is within the required 105 - 120 degrees F. The kitchen was inspected. LPA observed sufficient food supplies of 2-day perishable and a 7 day of non-perishable food. All the appliances are clean and seem to be operating properly. The smoke detectors are interconnected and there are 2 operable carbon monoxide detectors. The facility has a signal system in place. Fire extinguishers were fully charged and operational. Continue 809C LPA observed the medications are centrally stored in the Med. room and inaccessible to clients. The facility uses an electronic Medication Administration Record (MAR) log to document medications given. During today’s visit, LPA reviewed 6 resident medications and they are being administered as prescribed by the physician. The first aid kits were observed and found to be in compliance with the Title 22 Regulations. LPA reviewed 5 personnel records and they have the required documents in file. LPA reviewed 5 resident records and they have the following documents in their files such as Admission Agreements, Identification & Emergency Information, Physician's Report with TB test results, Pre-admission appraisal, and Resident rights. Last Fire drill conducted on 04/23/24 (Southwest Fire Life Safety & Security LLC) Per California Code of Regulations, Title 22, the deficiency observed is documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided to Assistant Administrator.the state’s words, verbatim · CDSS document, Jun 25, 2024

Allegation investigated: Staff did not provide medical records as requested by resident. Staff changed resident's medical insurance without the resident's consent.

Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Claudia Cordoba. Assistant Administrator Dennise Torres arrived shortly after who assisted with the visit. Purpose of the visit was explained. During this visit, LPA obtained a copy of the resident and staff rosters and reviewed Residents #1 (R1) fille and obtained relevant documentation. LPA also interviewed Staff #1 (S1) and Staff #2 (S2) and Resident #1 (R1) through Resident #11 (R11) . Continued on LIC 9099-C Unsubstantiated Allegations: Staff did not provide medical records as requested by resident. It was alleged that R1's medical records have been erased between 9/1/22 through 11/1/22. No records of hospitalization, medical procedure, nursing facility stay or any medication for that time period can be found. Interviewed staff denied the allegation. They stated that they always provide the medical records to the residents or Representative parties / conservator upon their request. S1 stated that information will be provided to resident /conservator immediately by their request. S2 stated that they provide medical records requested by residents for any hospital discharge, doctor's visits at all times without questions. They did not deny the access to medical records to any of the residents. S1 and S2 stated that it is residents right to be aware of any changes, any new diagnosis, or treatments that they might have. They stated that they provided R1's medical records that they have in the facility files. LPA obtained and reviewed the copy of R1's medical records and SIRs dated 09/01/22, 09/06/22, 09/07/22 and 09/10/22 and observed that R1 was hospitalized on 09/01/22 and left the hospital AMA (against medical advice) on 09/06/22. At the same day R1 was seen by the Facility doctor for an assessment after R1 left the hospital AMA. Home Health was requested because of R1's health condition. (Copies of Referral and doctor's order provided to LPA). On 09/07/22 R1 was transitioned to West Haven Nursing Home, and R1 left the Nursing Home again AMA. With no discharge papers, no plan, no indication. At the time of visit S1 provided copies of the R1's medical records and handle it to R1. Residents interviewed revealed that 10 out of 11 residents could not corroborate with the allegation. Allegation: Staff changed resident's medical insurance without the resident's consent. It was alleged that R1 Blue Shield insurance was cancelled on 8/31/22 without R1's permission to Medical.Net by a doctor at the facility, and R1's account was restricted to R1. Interviewed staff denied the allegation. They stated that Facility staff / doctors do not change insurances without the resident's / conservator's consent. They follow the mandated protocols and rules that protect resident's rights. They stated that facility staff / doctors didn't change R1's medical insurance with or without R1's consent. At the time of visit S1 assisted R1 in contacting Medicare and Blue Shield health plan. R1 spoke to multiply representative for over one hour and representatives informed that R1's insurance plan could only be canceled or switched with R1's consent. Continue 9099C They also told R1 that sometimes insurance plans find them not eligible and that they will switch the plan and inform them of the change. S1 indicated that happened with R3 before and S1 was able to assist with correcting the change. Insurance representatives found no information on any party canceling R1 plan on R1's behalf and R1 was never without coverage during any period. LPA was present at the time of phone conversation, Unfortunately, R1 not want to believe what the representatives are telling R1 and insists that a doctor changed their insurance plan. Residents interviewed revealed that 10 out of 11 residents could not corroborate with the allegation. Based on the interviews conducted with staff, residents, review of client file and facility records, there was not enough supportive evidence to concur with the reported allegations. 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, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Assistant Administrator Dennise Torres and the copy of this report was . provided.the state’s words, verbatim · CDSS document, May 9, 2024 · control 28-AS-20240430113936

Allegation investigated: Staff did not prevent the roof from leaking Staff are not providing adequate food service to resident Staff are unprofessional towards resident Staff did not prevent a resiednt from stalking resident Staff did not safeguard resident's personal belongings

Licensing Program Analyst (LPA) Nune Margaryan conducted a visit in response to the above allegations. On today's visit, LPA met with staff Fatima Hernandez. Assistant Administrator Dennise Torres arrived shortly after, who assisted with the visit. Purpose of the visit was explained. The investigation consisted of the following: Interview(s) with Assistant Administrator, and staff #1 -staff #4, interviews with resident #1- resident #7, tour the facility, kitchen, review of facility food supply, and facility menu. Facility Staff and Residents roster were obtained. Continue 9099C Unsubstantiated The investigation revealed the following: Regarding the allegation that Staff did not prevent the roof from leaking, it was alleged: the roof is leaking in room #57, by the Coke machine, and the front office. At the time of visit LPA tour the facility and observed that Maintenance staff working at the front area. Area was closed off with the yellow caution tapes and was inaccessible to residents and visitors. Interviewed Assistant Administrator stated that roof was leaking because of heavy rains. Facility contacted with 2 construction companies and roof was fixed 2 times. On 12/23/24 Sky Tech Roofer Inc. fixed the roof, but in January roof started leaking again and on 01/18/24 facility hired YAY Construction INC. to fix the roof again. Per Assistant Administrator, there are currently no roof leaks reported. Stated that maintenance staff is patching the ceiling now and it will be painted after. Invoices were provided to LPA. Interviewed staff denied that staff does not prevent the roof from leaking. They stated that Facility administration is working on this issue since heavy rains started. Interviewed residents stated that roof is leaking in the front area but not in their rooms. LPA inspected 6 rooms (#54, #56, #57, #61, #62, #64) and did not observe any water damage or leak in the residents’ rooms. At the time of visit LPA did not observe any health and safety issues for the residents. Regarding the allegation that Staff are not providing adequate food service to resident, it was alleged that the food is not good, specifically the coffee. Staff interviewed denied the allegation. There is adequate food service to resident. Staff stated that the food served is sufficient and of good quality. No one complaints about the food or coffee. Residents interviewed were unable to corroborate the allegation. 7 out of 7 residents interviewed stated that staff providing adequate food service. They stated that food served is of sufficient quantity and quality and coffee is good. LPA observed that the facility had a sufficient amount of food during today's visit, and it was of good quality. Regarding the allegation that Staff are unprofessional towards resident, it was alleged that the staff are unprofessional and don’t say, “Hi.” Staff interviewed denied the allegation. Staff stated that staff communicate with residents, and they speak to them in a respectful, polite manner. They always say "Hi", "Hello" to residents. Residents interviewed were unable to corroborate the allegation. 7 out of 7 residents stated that staff communicate with them in a polite manner. Continue 9099C Regarding the allegation that Staff did not prevent a resident from stalking resident, it was alleged that a resident (no name) is stalking another resident. Staff interviewed denied the allegation. Interviewed Assistant Administrator stated that staff are doing everything to prevent residents from engaging in inappropriate behaviors / stalking and staff always ensure to provide a safe environment for all residents in care. Assistant Administrator stated that the facility ensures that the facility environment is safe at all times. Stated no one reported that resident stalking to another resident. Interviewed staff stated that staff do prevent residents from engaging in inappropriate behaviors / stalking and the facility does provide a safe environment for residents in care. 7 out of 7 residents stated that they didn't witness or heard that residents stalking another resident. Regarding the allegation that Staff did not safeguard resident's personal belongings, it was alleged that resident glasses and watch were stolen. Interviewed Assistant Administrator stated that residents have their own keys, and they recommend residents to lock their rooms whenever they leave and do not leave things unattended. Interviewed staff stated that they didn't hear complaints from any residents that their glasses or watch were stolen. They stated residents usually misplaced items and staff looks and will find items in residents' rooms. Staff stated that they respect the residents, they do not go inside the resident's room without permission and do not touch their items. 7 out of 7 residents stated to not have lost or missing items from their rooms. They stated sometimes they misplaced items and staff help to look and find them. They did not hear that someone complains about missing, stolen items. Based on the observation, documents review, and interviews conducted with residents and staff, there was not enough supportive evidence to corroborate the allegations. 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, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, and a copy of report was provided to Assistant Administrator Dennise Torres.the state’s words, verbatim · CDSS document, Feb 27, 2024 · control 28-AS-20240220153225

Allegation investigated: Facility staff is not providing medication as prescribed.

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced 10 day complaint visit at the facilty and met with Dennise Torres to explain the purpose for todays visit. Investigation consisted of the following: LPA requested Resident Roster, Staff Roster, visited the medication room, interviewed residents, and interviewed staff and gathered paperwork according to the complaint. Regarding allegation: Facility staff is not providing medication as prescribed. During the investigation LPA Wesley interviewed 9 out of 10 residents who said they receive their medication on time, and 9 out of10 residents indicated, their medication is given according to the doctors orders. LPA reviewed medication and computerized medication logs, review physician orders, interviewed medication staff, including LVN Claudia Cordoba. Investigation continued on LIC 9099C, Unsubstantiated Investigation revealed the following, It appears that resident #1, has refused medication since August 1 2023, and indicated that he refuses to receive medication from LVN Cordoba, and refusing meals. Based on the interviews conducted with staff, clients, review of client files and facility records, there was not enough supportive evidence to concur with the reported allegation. 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, therefore the allegations are UNSUBSTANTIATED. A copy of this report was given to Administrator Dennise Torres, during the exit interview.the state’s words, verbatim · CDSS document, Feb 1, 2024 · control 28-AS-20240126110717

Allegation investigated: Staff are not transporting resident to appointments Staff are not providing residents with mail in a timely manner

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint vist to provide additional information for report dated 6/13/23. investigation visit regarding the above allegations. LPA met with Fatima Hernandez and explained the reason for the visit. The investigation consisted of the following: On 10/6/22 LPA Katrdzhyan conducted an initial investigation visit and requested pertaining documents. On 6/13/23 LPA Katrdzhyan conducted a subsequent complaint investigation visit and delivered findings for the above allegations. On 6/14/23 LPA Katrdzhyan delivered findings for additional allegations regarding this complaint. On 10/9/23 LPA Flores conducted interviews over the phone with 8 residents and 5 staff to obtain additional information regarding the above allegations. On 10/14/23 LPA Flores delivered and obtained signatures for this report. (CONTINUED ON LIC 9099C) Unsubstantiated The investigation revealed the following: Regarding allegation: Staff are not transporting resident to appointments. It is alleged facility staff keep canceling resident’s rides to appointments. Interviews conducted with residents revealed 8 out of 8 residents stated to received assistance with transportation to appointments. Residents stated appointments to medical or dental services are only cancel when the residents are not feeling well. When their transportation is late, facility staff either reschedule their appointment or if possible, they provide an Uber for them to make it to their original appointment. Interviews with staff revealed 5 out of 5 staff stated residents transportation depends on their medical insurance. Transportation is provided for their medical appointments and if their transportation is late, facility schedules an Uber ride to their appointments. The only time residents miss an appointment is if the residents stated they don’t feel well to go to their appointment or when their scheduled transportation is late, and the medical offices is not able to take them because they are late. Facility then reschedules the appointment for the residents. Per interviews conducted when a resident misses an appointment it is rescheduled to ensure the resident goes to their medical or dental appointments. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding allegation: Staff are not providing residents with mail in a timely manner. It is alleged that residents don’t get their mail timely. Interviews conducted with residents revealed 8 out of 8 residents stated that they received their mail in a timely manner, delivered by facility staff. Interviews conducted with 5 out of 5 staff revealed that the activity director delivers residents mail during mealtimes or take it to their rooms Monday through Friday and a Med-Tech provides their mail on the weekends. Administrator stated the mail comes to the facility and they pull out mail for the facility, it is then given to the activity director or Med-Tech who provides it to the residents on the same day. The activity director stated that the only time mail is not delivered to the residents is when the residents are out in the hospital. Per interviews conducted there are no concerns about mail being provided late to the residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. *All findings concerning this complaint were addressed on 6/14/23 and remained the same. * Exit interview was conducted with Fatima Hernandez and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 14, 2023 · control 28-AS-20220927150112