Courtyard Terrace

Type of visit: Case Management - Annual Continuation

On September 2, 2026, at 9:10 AM, Licensing Program Analyst (LPA) Sulma Lopez and Licensing Program Manager (LPM) Ariellle Pascua arrived unannounced at the facility to conduct an annual required inspection. LPA Lopez met with Administrator (A1) Magda Luis and explained the purpose of today's visit. The Administrator holds current certificate #7018207740 and expires on January 21, 2027. The facility is licensed for 40 non-ambulatory clients. There are currently (40) residents who reside at this facility. The facility has an approved hospice waiver for (10). There are currently (5) residents on hospice. At 9:15 AM, LPA Lopez conducted record reviews of (10) staff and (10) resident files. Resident files were well maintained and contained current Needs and Services Plans. Staff files were observed to contain the required components and LPA reviewed their updated training records. At 10:50AM, LPA and LPM toured the facility with A1. The dining room was clean and free of odors. The dining tables and chairs were in good repair and there was enough seating available for the current census. LPA inspected the kitchen area and observed a menu posted on the wall. It was learned that the facility works with a dietician every three months to create a menu that meets the needs and preferences of the residents in care. The facility contained at least two-day perishable and seven-day non-perishable food supply. Kitchen appliances and equipment were observed to be operational. The kitchen area remains locked and made inaccessible to residents to ensure safety. Continued on LIC 809-C. The facility hallways were observed to be clean and clear of obstructions. The facility temperature was 72 degrees. LPA toured the activity room and reviewed the September Activity Calendar. The resident bedrooms were observed to contain clean bedding. The resident bedrooms were furnished with beds, chairs, dressers, and a closet. The windows and window springs were in good condition. Each resident bedroom contained a smoke detector on the ceiling. Carbon monoxide detectors were located on the walls. At 10:55 AM, LPA observed resident restrooms contained a toilet in unsanitary condition. The toilet contained dry urine around the base and the caulking was visibly soiled and stained brown. The restroom had a strong urine odor. The showers contained grab bars and non-slip mats for resident safety. LPA observed a soiled incontinence pad in one of the resident showers. The facility' hot water temperature was 120 degrees. LPA toured the facility courtyard. The exterior of facility was clear of hazards. All outdoor passageways were kept free from obstruction. The courtyard contained a shaded seating area with outdoor furniture for resident use. The facility has a space and equipment for laundry. The laundry room remains locked and inaccessible to residents for safety. Medications were stored in a locked medication cart. The facility uses an electronic Medication Administration Record (MAR) sheet to record all dispensed medication to residents. LPA asked for the following documents to be emailed/ faxed to the Regional Office within the next 15 days: - LIC 610E Emergency Preparedness Plan, LIC 308 Designation of Facility Representative. During the visit. LPA and LPM also confirmed that S1 is no longer is working at the facility. A copy of the Exemption Denial Letter was provided to the administrator and a signed Confirmation of Removal was obtained during the visit. As a result of this annual inspection visit, deficiencies were cited. An exit interview was conducted, and a copy of the 809 report, 809D-Page, and Appeals Rights were provided to the facility.the state’s words, verbatim · CDSS document, Sep 2, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(1) · Plan of correction due date: Sep 18, 2026

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Based on observation, interviews, and records review, the Licensee did not ensure that rooms 112 and 113 were clear of urine stains, soiled incontinence pads, and odors which poses a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2026

Plan of correction: The facility agrees to update their cleaning logs and will conduct an in service training on the updated cleaning expectations. The facility will provide copies of the cleaning log and in service training by September 18, 2026 by 5:00PM.

Type of visit: Required - 1 Year

On 08/18/2025, Licensing Program Analyst (LPA) Arielle Pascua and Department Representatives, Sarauanan Mani, Naga Chinduluru, Dana Schoppers, and Raj Mudiganga arrived unannounced to this facility to conduct an annual visit. LPA met with Facility Designated Administrator (FDA), Magda Luis and explained the purpose of the visit. The purpose of this visit was to conduct an annual visit. This facility is licensed to serve 40 residents who are deemed non-ambulatory and has a hospice waiver for 10. This facility also obtains Assisted Living Waiver Residents. LPA reviewed 4 resident files and 4 staff files. All staff and resident files were complete and up to date. A tour of the facility was conducted. The administrator has a current and active administrator certificate #7018207740 and expires on 1/21/2027. A tour of the facility was conducted. All rooms designated as activity areas and common areas for resident use were toured. Furniture and furnishings were observed to be present and sufficient to meet the needs of the residents at this time. Office rooms and other areas intended for resident use were toured. Kitchen area was toured. Facility freezer and refrigerator units were toured. LPA reviewed the food storage supply to make sure that there was always a 2-day perishable and 7-day nonperishable food quantities on site at all times. Knives were observed to be locked and made inaccessible to the residents at this time. It was observed in that the facility has cafe areas equipped with a microwave and addition refrigerator present to cool, heat, and warm up food of the residents if necessary. Storage area for chemicals and cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of the facility resident bedrooms was conducted. Furniture and furnishings were observed to sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Medication room was reviewed. It was learned that narcotics and all other medications were housed in medication carts that were used to store and dispense medications to the residents at this time. This facility has an electronic Medication Administration Record system. A brief interview was conducted with facility staff responsible for handling, dispensing, and documentation of the medications at this time. First aid kit was observed to be present and contained all of the required components at this time. First aid kit was observed to be present and contained all of the required components at this time. Exterior grounds of this facility was toured. Perimeter fence and gates were observed to be functional and in good repair at this time. Delayed egress and other safety measures were observed to be functional at this time. Fire extinguishers, located and placed throughout the facility, were observed to have been annually inspected on 03/05/2025 by the local fire extinguisher company noted as Fire Code and in compliance at this time. All smoke and carbon monoxide detectors were present and working at this time. The following forms and documents were requested to be updated and submitted into CCL: -LIC 308 -LIC 400 -LIC 500 -LIC 610e A technical violation was provided for 87303(a). As a result of this visit, no deficiencies were observed or cited during this annual visit. An exit interview was conducted and copy of the 809 and 809-C was provided to Facility Designated Administrator.the state’s words, verbatim · CDSS document, Aug 18, 2025

Type of visit: Required - 1 Year

On 08/14/2024, Licensing Program Analyst, (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct the annual inspection. LPA identified herself upon arrival, stated the purpose of the visit, and asked to speak to the Designated Facility Administrator. LPA spoke to Magda Luis and a brief interview followed. LPA compared guardian roster to the LIC 500 to ensure all staff were background cleared and allowed to care for residents. The two toured the facility. LPA observed 4 caregivers, the Life Enrichment Director, their assistant, 1 housekeeper, 1 maintenance worker and 2 medication technicians (med techs). LPA observed 22 residents sitting in the courtyard participating in chair exercises, puzzles and other table top games. LPA viewed approximately 9 resident rooms as they had their doors open to the main hallway. LPA inspected 4 resident rooms and observed personal care and hygiene items in drawers as well as in plain sight in 2 out of 4 of the rooms. LPA observed grab bars and non-skid matts in the bathrooms. LPA observed soap and paper towel dispensers. LPA observed bathrooms without soap in the soap dispensers and without paper towels. Administrator sought technical assistance with residents clogging plumbing with paper towels. Regulations require non-toxic soap be present in the bathrooms for residents to use. This deficiency was cited on the LIC 809D page. LPA measured the hot water and found it to be 118.1 degrees Fahrenheit and in compliance at the present time. Fire Extinguishers were last inspected on 03/19/24 by the Fire Code Safety Co. and were also in compliance. LPA toured the kitchen. LPA observed food items in storage containers without dates as well as frozen foods, chicken, peas, corn, ravioli, in freezer bags also without labels or dates to ensure quality and freshness. This deficiency was cited on the LIC 809D page. LPA entered a resident room and activated the alert button on the wall. A caregiver responded in 3 minutes and 39 seconds. During a secondary walkthrough of the facility, the LPA observed 21 residents in the lounge watching a Talent TV show under the supervision of the Life Enrichment Coordinator and supported by 1 other caregiver. LPA reviewed a sample of staff records and found them to be in compliance at the present time. LPA also reviewed a sample of resident files and found that 1 out of 4 residents were at risk for having hygiene items in their room. LPA observed Norisc peri-wash through the open doorway to the hallway. The room also contained Seaside Riviera hand soap. These items were prohibited by the Physicians Report as they were a risk to the resident in that room as well as to other residents in care. This deficiency was cited on the LIC 809 D page. LPA observed the Medication Room and reviewed PRN procedures with the Med Tech on duty. LPA also inspected the First Aid kit and found it to be in compliance at the present time. According to the California Code of Regulations, any deficiencies were cited on the LIC 809D pages. A copy of this report and Appeal rights were provided. An exit interview was conducted with the Designated Facility Administrator, Magda Luis.the state’s words, verbatim · CDSS document, Aug 14, 2024

The state marks this report as 9 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Resident sustained an unexplained injury while in care

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to deliver complaint investigation findings. LPA met with Administrator Magda Luis, and explained the purpose of the visit. The following has been determined as it relates to the allegation of Resident sustained an unexplained injury while in care. The investigation consisted of an interview with the Reporting Party (RP), interview with Resident 1 (R1), interviews with Staff 1 (S1) - Staff 2 (S2), and records review. According to an interview with the RP, the RP stated R1 had a bruise all over R1's face. RP did not know when it happened, and was not present when it happened. RP heard it when R1's family member got a call from the facility. RP does not know how it could happen when R1 is able to walk and has never fallen. RP is not listed as a responsible party for R1. Continues on LIC 9099 - C... Unsubstantiated Continued from LIC 9099.. According to an interview with R1, R1 does not remember how a mark got on R1's face. R1 told LPA Valerio multiple times it does not work. R1 stated R1's responsible party took R1 to the doctor. R1 told LPA that R1 does not need to use the walker that was next to R1's bed. R1 enjoys the facility and reports staff are nice. During the interview on 06/03/2024, LPA Valerio observed R1's face. R1 was observed to have a red mark on the right cheek located at the top of the cheek bone. The red mark was not accompanied by any discoloration. R1 was not observed to have any scratches on the face. R1 was not observed to have any bruises on arms, face, or left leg. LPA Valerio interviewed two (2) staff members that were present during the incident. Staff 1 stated the incident was unwitnessed. S1 asked R1 what happened. R1 told S1 that R1 was going to the bathroom and hit the door. R1 stated no fall happened. S1 notified the medication technician right away. S1 said R1's family member came, took R1 to the doctor, and came back stating everything was fine. S2 reported that R1 was seen to have scratches on the face with a bruise. S2 stated it happened in the morning time. S2 could not get a hold of R1's family until the afternoon when they picked up the phone. S2 stated R1 does not know what happened but has reported to be fine and does not complain of any pain. LPA Valerio reviewed facility records. Facility records show that during AM shift on 05/27/2024, R1 was noticed to have a red spot on R1's face. A medication technician was immediately notified to assess R1. The medication technician applied ointment to the cheek and notified the family. According to facility records, the resident sign out sheet showed that the family member arrived to the facility on 05/30/2024 and signed out R1 at 12:30 PM. R1 was returned to the facility at 7:30 PM. Due to the above noted information, 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, and therefore the allegations are unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was left at the facility with Administrator Magda.the state’s words, verbatim · CDSS document, Aug 6, 2024 · control 27-AS-20240531091131

Type of visit: Case Management - Incident

On 03/21/24, at 9:00 AM, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct a case management visit regarding a self-reported incident. The LPA identified herself upon arrival, stated the purpose of the visit, and asked to meet with the Designated Facility Administrator (DFA). The MedTech on duty called the DFA and provided LPA with the file for the resident who eloped (R1)1 to review while waiting for the DFA. On 03/20/24, this facility faxed a report to Community Care Licensing (CCL) that R1 eloped from the community at approximately 8:05 PM on 03/19/24. The report goes on to state the following: The alarms were set off and staff immediately went out to search the neighborhood for the resident. After 5 minutes, the Administrator was notified, after 15 minutes, the responsible party was notified, and the police were notified immediately after that. According to the report that CCL received, R1 was located at 8:30 PM and brought back to the community. LPA conducted a tour of the facility upon arrival. The delayed egress door on the right side of the facility was not alarmed when this LPA exited the building. The gate to the right of the door had broken zip-tie slipped through the latch. LPA opened the gate and an alarm sounded. Maintenance staff re-entered the patio area from the opened gate. LPA continued her walkthrough. The facility was clean and not malodorous. Residents were friendly and offered hugs and smiles. LPA observed 4 Caregivers, 1 MedTech, 1 Cook, and 2 Maintenance/Housekeeping staff workers. The DFA arrived and a brief interview followed. LPA obtained the following documents: LIC 500, LIC 308, LIC 602 dated 01/29/24, Needs and Services plans dated 02/13/24 and 03/21/24. ID/Emergency Contact Information, and documentation from Alpha One refusing transport to the hospital. LPA conducted a second walkthrough with the DFA and again exited the rear on the right side. The alarm was still deactivated on the door. LPA set the alarm off on the rear gate adjacent to that door. The DFA and LPA were able to walk from that area, through the outdoor patio, back inside and to the front of the building where the DFA turned off the alarm. A review of records indicated that R1 was admitted to this memory care facility on 01/30/24, the LIC 602 stated that R1 was unable to leave the facility unassisted and R1 exhibited wandering behavior. The physician's report also stated that R1 was considered non-ambulatory based on their mental state. The facility was aware of the resident's wandering behavior prior to R1 being admitted. This LPA reviewed the Needs and Services plans that were completed prior to the elopement and post elopement. Both stated that staff would redirect R1 in order to prevent elopements. No new strategies were listed in the updated Needs and Services plan. This LPA interviewed R1 and found R1 to be intelligent, alert, and well-spoken. R1 was very fit and guided this LPA on a walk through the common areas. LPA and R1 activated the alarm on the rear back gate and 3 staff responded within 11 seconds. During the course of this investigation, this LPA learned that R1 has talked about or has tried to return home before but staff had previously been able to redirect R1. R1's behavior was not new, there was not a sufficient number of staff to meet the needs of this resident in care. According to the California Code of Regulations, Title 22, this deficiency has been cited on the LIC 809D page and a Civil Penalty was assessed for $500. On 06/12/25, this report was amended to change the citation from a violation of 87705(c)(4) under "Care of Person's with Dementia" to 87411(a) under "Personnel Requirements- General." A trainee (S3), without a walkie-talkie to communicate with coworkers, was sent to investigate the alarm. S3 had to go back to the other side of the building to inform the other staff that they could not locate the missing resident. Staff then had to determine which resident was missing before alerting the Administrator, the local police, the responsible party and Community Care Licensing. A copy of this report was provided along with Appeal Rights and signed by the Designee, as the DFA was out of the building. Exit interview.the state’s words, verbatim · CDSS document, Mar 22, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4) · Plan of correction due date: Jun 13, 2024

Personnel Requirements – General 87411 (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services... The licensee did not ensure that the above regulation was enforced as evidenced by: Based on a review of records, and inter- views, a trainee, S3 was sent, without a walkie-talkie, to investigate the alarm This demonstrated- ed a lack of competency with regard to personnel training. This posed an immediate threat to the health, safety, and/or personal rights of residents in care.the state’s words, verbatim · CDSS document, Mar 22, 2024

Plan of correction: The Administrator was called and after reviewig the amended report over speaker phone, stated that they would provide Community Care Licensing with copies of the new hire trainings that have taken since this incident, along with signature sheets of those who participated to community care licensing by the POC date.

Allegation investigated: Staff left resident soiled for an extended period of time. Staff did not ensure resident's hygiene needs are being met. Staff did not provide resident with clean clothing. Staff does not ensure residents are provided daily activities.

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to follow up on this complaint investigation. LPA Moleski met with facility administrator Magda Luis and explained the purpose of the visit. This investigation consisted of interviews, observation, and record review. During visits to this facility on 11/30/23 and on 12/4/23, LPA Moleski observed ongoing activities in an activities room. During these same visits, LPA Moleski observed residents to be clean and in clean clothes. LPA Moleski reviewed activities calendars and observed activities scheduled for each day. LPA Moleski observed a shower schedule and observed that showers are scheduled for each resident three times per week. [continued on 9099-C] Unsubstantiated LPA Moleski interviewed six residents (R1-R6) and six staff members (S1-S6). During these interviews, S6 said there were “problems” with the activities, but could not explain what they were. S6 said there are no toothbrushes for resident use. LPA Moleski checked three resident bedrooms at random on 12/4/23 and observed toothbrushes in each. S6 said residents’ diapers are sometimes not changed when they should be, but could not provide details as to who or why. During an interview, R3 said that the activities provided were too simple for R3. During interviews, S1-S5, R1-R2, and R4-R6 did not raise concerns regarding the allegations on this complaint. The department has determined the following as it relates to the allegations that staff left a resident soiled for an extended period of time, that staff did not ensure a resident’s hygiene needs are being met, that staff did not provide a resident with clean clothing, and that staff does not ensure residents are provided daily activities: Based on interviews, observation and record review, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Luis.the state’s words, verbatim · CDSS document, Dec 4, 2023 · control 27-AS-20230927090142