Crofton Manor Inn

Type of visit: Required - 1 Year

On August 15, 2026, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Executive Director AMALIA ESQUIVIAS. LPA explained the purpose of today’s visit. The facility is licensed to serve resident age 60 & above and cleared to serve 213 non-ambulatory. Currently, the facility has (118) residents and approved for (12) hospice residents. The facility has (8) hospice residents in care. The facility is a two story structure located in a commercial neighborhood. It consists of the following: (107) residents' rooms and bathrooms, (6) common bathrooms, dining room, commercial kitchen, staff area, office area, laundry room, storage area, (2) activity rooms and (2) outdoor patio area. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected rooms in assisted living #107; #110; #210; #215; #217 #229; #234; #241; #413. #420; #424. Three rooms were inspected in the memory care area: #317; #322, and #324. The water temperature ranges from 105.0–112.6 degrees F, and the room temperature ranges from 74- 75 degrees F; call buttons and smoke and carbon monoxide detectors are all in operating condition. LPA observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there are sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged. Evaluation Report continues on LIC 809C A review of Fire Drills was completed on 07/26/26. Several working landline phones are available on-site. A review of Medication Administration Records and Centrally Store Medication Record LIC 622 found to be in order and accurate. During the visit LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters, including the Activities Calendar and Food Menu, were posted. The facility included stairway all have an evacuation slings. The facility has an inventory of emergency food supplies. An audit of resident service records for resident #1-5 (R1-R5) and staff personnel records for staff #1-#6 (S1-S6) were accurate and complete. The facility is current on Community Care Licensing annual fees. The facility has a current administrator certificate on file for AMALIA ESQUIVIAS - RCFE #0740 08/21/2025 08/20/2027. The facility has a Liability Insurance Certificate valid with policy # 4955 effective 01/01/25 through 01/01/27. The facility has Surety Bond policy #7462 effective 12/01/25 through 12/01/26. No Deficiencies were identified during this inspection visit. An exit interview was conducted, and a copy of this report was provided to AMALIA ESQUIVIAS.the state’s words, verbatim · CDSS document, Aug 15, 2026

Allegation investigated: Staff are interfering with a resident's visitations.

On July 21, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced complaint visit., AMALIA ESQUIVIAS the Administrator, greeted the LPA and explained that the purpose of the visit was to investigate the allegation mentioned above. The investigation involved collecting documents and inspecting the facility. A review was conducted of the Facility Personnel Roster (dated July 16, 2026), the Facilty Resident Roster (dated July 16, 2026). Resident #1 (R1's) Medical Assessment for (RCFE) LIC 602A (dated June 22, 2026), Identification adn Emergency Information LIC 601 (dated October 05, 2022), Notice of Revocaton of Powere of Attorney (dated July 12, 2026), Durable Power of Attorney (dated December 8, 2021) and other pertinent records associated with this complaint. Interviews with Resident #1-#10, Staff #1 and Witness #1. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: ALLEGATION: Staff are interfering with a resident's visitations. It is alleged that staff are interfering with Resident #1 (R1)'s visitation. Reports indicate that (R1) is unable to leave the facility or that visits are restricted to family members. Further reports indicate that the Power of Attorney imposes visitation restrictions for (R1). Additional reports indicate that on July 12, 2026, a Notice of Revocation of Power of Attorney was offered to the facility, and it was denied by the administrator, further preventing visits with (R1). No further information is available. On July 15, 2026, between 12:33 PM and 1:30 PM, the Department interviewed staff member identified as Staff #1 (S1). (S1) is unable to support this claim. (S1) noted that Resident #1 (R1), a participant in Welbe Health is being managed by health and social professionals through the health program. (R1) has had a Durable Power of Attorney for Health Care (DPOA-HC) in place since 2021. This document grants authority to make personal care decisions, including visitation, and explicitly restricts (R1) from leaving the facility with certain family members. Under the directives of DPOA-HC, a family member is allowed to visit (R1) within the facility, but they cannot take R1 out of the facility. (S1) also mentioned that the facility has proof of (R1's) incapacity and a copy of the (DPOA-HC) specifying this authority on file. Furthermore, (S1) noted that on July 12, 2026, the facility was served with a Notice of Revocation of Power of Attorney for (R1), which was notarized on the same day to override the current (DPOA-HC). However, (S1) claimed that they were unable to accept the legal documents because (R1's) medical records indicate that (R1) lacks the clinical or legal capacity to make decisions and is incapacitated due to (R1's) diagnosis with Major Neurocognitive Disorder. (S1) stated that they contacted the Welbe Health Care Team the following day and have an in-person conference set for July 17, 2026, which includes the current (DPOA-HC), Social Worker, Medical Physician, (R1), and the potential (POA) to address and clarify this matter promptly. A follow-up interview with (S1) on July 20, 2026, confirmed the Care Team Conference discussion on the Power of Attorney and visitations and that all parties have reached an agreement. On July 15, 2026, between 01:50 PM and 04:30 PM, the Department interviewed residents identified as Resident #1 through Resident #10 (R1-R10). Ten (10) out of ten (10) resident members cannot corroborate this claim. (R1-R10) confirmed that staff does not interfere with visits. They unanimously assert that no staff members impose limits or restrictions on their visits. (Evaluation Report continues LIC 9099-C) Furthermore, no staff member has discouraged residents from visiting specific individuals. All residents confidently expressed that they feel their visits are private and welcoming to friends or family. (R1) stated that there are open visitations at the facility and in the community for friends and family. (R1) is not aware of any visitation restrictions. (R1) stated to have the ability to leave the facility three days a week to attend day program activities with no restrictions. Although (R1) does not recall signing a legal document on July 12, 2026, (R1) acknowledged that the signature appeared authentic but is uncertain. (R1) could not remember when the last family visit occurred. On July 20, 2026, between 11:52 AM and 12:02 PM, the Department interviewed witness member identified as Witness #1 (W1). (W1) confirmed that a Care Conference meeting took place on Friday, July 17, 2026, with the participation of the Welbe Health Care Team and all relevant parties. While (W1) is unable to share the specific details discussed during the meeting, (W1) did convey that the Notice of Revocation of Power of Attorney has been deemed invalid based on (R1’s) mental capacity. The Department reviewed the Durable Power of Attorney (dated 12/08/21), Notice of Revocation of Power of Attorney (dated 07/12/26), (R1’s ) Identification and Emergency Information LIC 601 (dated 10/05/22), Medical Assessment for Residential Care Facilities for the Elderly and LIC 602A (dated 06/22/26), Resident Appraisal LI C 603A (dated 01/18/26), Individual Service Plan (dated 02/24/26) verified (R1’s) diagnosis with Major Neurocognitive Disorder and is unable to leave the facility unsupervised due to unsafe wandering behavior. Further review of email communications from (S1) and Welbe Health (dated 07/13/26) and the Visiting/Outing Log (dated 07/01/26 – 07/15/26) verified that (R1) received visits on July 12 and 13, 2026, and left the facility with a visitor on July 13, 2026. Based on the gathered information, there is insufficient evidence to corroborate the allegation. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. No deficiencies cited. An exit interview was conducted with AMALIA ESQUIVIAS, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Jul 21, 2026 · control 11-AS-20260715134617

Type of visit: Required - 1 Year

On 07/21/2025 at 8:30am Licensing Program Analyst (LPA) Zina Brown, Lizeth Villegas and Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Amalia Esquivias, Administrator, and Francisca Vallejo, Assistant Administrator and explained the purpose of today’s visit. The facility is licensed to serve resident age 60 & above and cleared to serve 213 non-ambulatory. Currently, the facility has 113 residents. The facilities annual fees are current. The facility has a current administrator certificate (#7001780740) for Amalia Esquivias valid from 08/21/2023 - 08/20/2025. The facility has liability insurance with Crum & Forster Specialty Insurance (NAIC# 44520) with each occurrence at $2,000,000 and general aggregate at $20,000,000 (policy #PKG101882) effective date 12/31/2024 - 01/01/2026. The facility is a two-story structure located in a commercial neighborhood. It consists of the following: (107) residents' rooms and bathrooms, (6) common bathrooms, dining room, commercial kitchen, staff area, office area, commercial washer and dryer room/ storage area, outdoor patio with umbrella, table, and chairs. Between the hours of 10:05am - 2:15pm, LPA conducted a records review of (10) resident records, (10) staff records, and the facility disaster plan was current (last updated on 03/05/2025) and in compliance with Title 22 regulations at the time of visit. All resident & staff records were complete. Between the hours of 11:00am - 11:30am, LPA Iniguez conducted (7) Resident Medication Administration Records did not observe any discrepancies at the time of visit. Report continues on LIC 809-C Between the hours of 9:24am - 10:00am, LPA Villegas and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. Five rooms per floor were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for residents’ personal belongings is available. In the dementia unit, the resident have auditory alarms located on outside patio doors. Between the hours of 2:30pm - 2:40pm, LPA Iniguez tested the water in six of the residents rooms and the water temperature properly measured between 105°F -120°F (113.0 °F) All rooms had the required furniture. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature in each bathroom per room inspected were found to be within Title 22 regulations. LPA observed the facility to have a first aid kits, manual, and emergency supplies. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary, well maintained, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were stored and accessible to residents. The commercial kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. LPA observed the kitchen area to be clean and free from pests. The facilities fire extinguishers were checked and found to be fully charged and accessible; and last serviced on 09/20/2023. All exit doors in the facility have alarm systems. The facility has hardwired and battery-operated smoke and carbon monoxide detectors and are in working condition. A working landline telephone remains available. The last fire drill was conducted 07/13/2025. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe a deficiencies, therefore no citations were issued at this time. Exit interview was held and a copy of the Facility Evaluation Report was provided to Amalia Esquivias, Administrator.the state’s words, verbatim · CDSS document, Jul 21, 2025

Allegation investigated: Staff do not follow procedures to mitigate the spread of illness

On 04/30/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Crofton Manor Inn and was greeted by Administrator Amalia Esquivias (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the finding pertaining to the above-mentioned allegation. The investigation consisted of the following: LPA Calderon interviewed Staff S1-S6, resident R1-R12. LPA Calderon obtained the following records: Infection Control Plan (dated 06/29/2024), Cleaning Schedule (dated 12/2024 to 01/05/2025), incident report (dated 12/04/2024 to 12/18/2024), In-service training (dated 11/25/2024 to 03/25/2025). The investigation revealed the following: Unsubstantiated Regarding the Allegation: Staff do not follow procedures to mitigate the spread of illness. This complaint alleged that the facility did not mitigate the spread of Covid19. LPA Calderon toured the facility with S1. LPA Calderon noted staff cleaning floors, bathrooms and rooms. LPA Calderon inspected the dining room and kitchen area and noted that the kitchen and dining rooms were very clean. LPA Calderon noted some staff wearing masks. LPA Calderon did not notice any resident’s that looked or acted sick. Record review indicate the following: Infection control plan indicate that the facility is prepared for any covid19 outbreak. Incident report indicates that the facility had a covid19 outbreak from 12/04/2024 to 12/18/2024 in which 23 residents and 5 staff tested positive for covid19. 23 residents were isolated from other residents and 5 staff were sent home. All residents and staff were tested per the infection control plan. In-service records indicate that staff were given covid19 training. Daily disinfecting log indicate that all common areas have been cleaned. Interviews indicate the following: 6 out of 6 staff deny the allegation. 6 out of 6 staff indicate there was a covid19 outbreak December 2024. 6 out of 6 staff indicate that the infection control plan was followed. 12 out of 12 residents deny the allegation. 2 out of 12 residents indicated that they tested positive for covid19 and were isolated from other residents. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff do not follow procedures to mitigate the spread of illness” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report were provided to the Administrator Amalia Esquivas (S1).the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 11-AS-20250424132231

Allegation investigated: Staff do not ensure adequate care and supervision is being provided Staff do not safeguard residents personal items Staff keep residents door locked

On 03/19/2025, the California Department of Social Services/Community Care Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Socorro Leandro and LPA Jose Anguiano conducted an initial unannounced complaint visit. LPAs met with Administrator Amelia Esquivias and the purpose of the visit was explained. LPAs were granted entry to the facility. Unsubstantiated The investigation consisted of the following: On 03/19/2025, a facility tour was conducted, records were reviewed, and interviews were conducted. The facility tour consisted of the Memory Care Unit. Interviews consisted of 5 staff [Staff 1 (S1) to Staff 5 (S5) were interviewed] interviews, 5 resident [Resident 1 (R1) to Resident 5 (R5) were interviewed] interviews, and 7 witness [Witness 1 (W1) to Witness 7 (W7) were interviewed] interviews. Facility records reviewed consisted of Crofton Manor Inn Facility Plan of Operation, Theft and Loss Policy, Employee Roster, Resident Roster, and Resident Contact Sheet. Resident records reviewed consisted of Identification and Emergency Information, Physicians Reports, Unusual Incident Reports (UIRs), Resident Appraisal, Individual Service Plan & Preference, Individual Service Plan (R1, R2, R6, and R7 records were reviewed). The investigation revealed the following: Allegation: “Staff do not ensure adequate care and supervision is being provided”, it is being alleged that the facility does not provide adequate care and supervision for memory care residents. Interviews conducted with R1 to R5 revealed the following: 2 out 5 residents denied the allegation and 3 out 5 resident interviews were inconclusive. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Interviews conducted with W1 to W7 revealed the following: 7 out of 7 witnesses denied the allegation. Records reviewed revealed the following: no UIRs were found indicating that care and supervision was not provided. Observations of the memory care unit on 3/19/2025 revealed the following: The department observed caregivers providing care and supervision to memory care residents such as conducting room checks, assisting residents in the bathroom, assisting residents with feeding, and repositioning residents. Based on interviews, records, and observations this allegation is unsubstantiated. 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. Allegation: “Staff do not safeguard residents personal items”, it is being alleged that a resident goes into other residents rooms and takes their belongings, eats their food and staff does not safeguard residents personal items in the memory care unit. Interviews conducted with R1 to R5 revealed the following: 1 out 5 residents denied the allegation; 1 out of 5 residents agreed with the allegation and 3 out 5 resident interviews were inconclusive. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Interviews conducted with W1 to W7 revealed the following: 7 out of 7 witnesses denied the allegation. Records reviewed revealed the following: no UIRs were found indicating that residents’ personal items have gone missing. Observations of the memory care unit on 3/19/2025 revealed the following: The department did not observe residents going into rooms that were not theirs. Based on interviews, records, and observations this allegation is unsubstantiated. 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. Allegation: “Staff keep residents door locked”, it is being alleged that staff are locking residents inside their rooms in the memory care unit. Interviews conducted with R1 to R5 revealed the following: 2 out 5 residents denied the allegation and 3 out 5 resident interviews were inconclusive. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Interviews conducted with W1 to W7 revealed the following: 7 out of 7 witnesses denied the allegation. Records reviewed revealed the following: no UIRs were found indicating that residents have been locked in their rooms. Observations of the memory care unit on 3/19/2025 revealed the following: all the resident rooms had an open door; the department did not observe locked or closed resident doors. Based on interviews, records, and observations this allegation is unsubstantiated. 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 No citations were provided. An exit interview was conducted, and a copy of this report was left with the Administrator.the state’s words, verbatim · CDSS document, Mar 19, 2025 · control 11-AS-20250313135625

Allegation investigated: Staff retaliated against resident in care. Wrongful Eviction.

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, August 14, 2024. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is not cleared of COVID-19 infection. LPA Bunker met with Marketing/LVN Claudia Esquivias and spoke to Administrator Amalia Esquivias via telephone who arrived at the facility later. LPA Bunker explained the purpose of today's visit. The investigation consisted of the following: LPA Bunker interviewed staff members 1-2 (S1-S2) and residents 1-8 (R1-R8). LPA asked questions relevant to the nature of the complaint. S1-S2 and R2-R8 stated staff do not retaliate against residents under their care. S1-S2 stated that the resident did not receive a wrongful eviction. LPA Bunker reviewed the following documents: Admission Agreement, Resident Roster, Staff Roster, Appraisal & Needs Service Plan, Physicians Report, Identification and Emergency Information, Unusual Incident Reports, and other documents associated with this complaint. The investigation also included a facility tour. See continued LIC9099-C page 2 Unsubstantiated Continued LIC9099-C page 2 Allegation #1: Staff Retaliation Against Resident in Care A resident alleged that they had been physically and psychologically abused by another resident and that the administrator failed to report the abuse. The resident stated that this abuse has been ongoing for two years and that the administrator has been notified of these incidents multiple times over the years. The resident informed the Ombudsman that the facility took no action to prevent further abuse. Staff members S1-S2 stated that there is no retaliation against the resident in care and that they have gone above and beyond to assist the resident. They also confirmed that they have communicated with the resident's families or responsible parties, Community Care Licensing, and all appropriate agencies in a timely manner regarding the above incident. Resident R1 reported enjoying living at the facility, finding 99% of the staff to be helpful and accommodating. R1 recounted a recent incident that occurred outside of the facility involving Resident R2, where R2 had a history of taunting R1. R1 claimed that they informed the staff, who then informed management, but felt that no action was taken to remove R2 from the facility due to R2's behavior. R1 explained that Administrator S1 is involved in every incident and that both R1-R2 have been counseled by S1 regarding their behaviors. S1 suggested that R1 document the dates and times of each incident, but R1 found this too time-consuming and did not record any of the incidents involving R2. R1 acknowledged that facility staff have been responsive and did not believe that a lack of supervision was the cause of these incidents. R1 expressed frustration that R2 remains at the facility. R1 mentioned that law enforcement had been dispatched for several incidents involving R2, with S1 assisting in notifying the authorities. R1 refused medical treatment for each incident involving R2, as there were no major physical injuries. R1 stated that S1 had offered to move R1 to a different floor, but R1 declined the offer. See continued LIC9099-C, page 3 Continued LIC9099-C page 3 Allegation #2: Wrongful Eviction: Staff members 1-2 (S1-2) stated resident was never wrongful eviction. S1-S2 stated that the resident was placed on a 5150 hold due to statements made indicating a threat to self-harm, specifically mentioning, "If I had access to a gun, I would shoot myself." The resident had called the Long Beach Police Department (LBPD) multiple times, expressing an intent to self-harm. In response, staff contacted the LBPD, as the resident reiterated a desire to die and mentioned the potential to shoot themself. According to S1-S2, no police report was left by the officers, but the decision to place the resident on a 5150 hold was based on the resident's aggressive behavior, not in retaliation for any previous reports of abuse. S1 and S2 further clarified that the resident is permitted to return to the facility and that staff are not contributing to any additional emotional trauma. The resident has not received either a verbal or written eviction notice, and the claim of wrongful eviction is denied by S1-S2. The investigation consisted of the following: According to S1-S2, the facility is proactive and has been working with R2's family representative and the Assisted Living Waiver (ALW) representative to relocate R2 to another assisted living facility. S1-S2 stated since R1 is at a skilled nursing facility, the environment at the facility has been peaceful and R2 is still residing at the facility. According to R1's Physician's Report dated 03/30/23, R1 is in fair physical condition, can self-care, and is predisposed to aggressive verbal behavior. R2's Physician's Report dated 10/19/23 revealed that R2 is in fair physical condition, can self-care with assistance, and is in a stable mental status. S1-S2 stated they reported the special incident reports to all the appropriate agencies in a timely manner. An analysis of Unusual Incident Reports dated 04/10/24, 05/09/24, and 07/14/24, addressed to the Long-Term Care Ombudsman (LTCO), Adult Protective Services (APS), Community Care Licensing (CCL), and family members, indicates that there is insufficient evidence to corroborate the allegations mentioned above. See continued LIC9099-C page 4 Continued LIC9099-C page 4 S1-S2, emphasizing the facility's zero-tolerance policy on abuse and its commitment to resident welfare and dignity. S1-S2 stated staff does not engage in any form of retaliation against residents and stated that the resident never received a wrongful eviction notice. S1-S2 stated that the facility staff takes all necessary precautions to ensure that residents are safe and protected from harm. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated.the state’s words, verbatim · CDSS document, Aug 14, 2024 · control 11-AS-20240805161857

Type of visit: Required - 1 Year

On 08/02/24, at 9:30am Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Amalia Esquivias, Administrator, and Francisca Vallejo, Assistant Administrator and explained the purpose of today’s visit. The facility is approved for (213) elderly adults ages 60 and over, ambulatory, and non-ambulatory. Currently, the facility has (117) residents. The facilities annual fees are current. The facility is a two-story structure located in a commercial neighborhood. It consists of the following: (132) residents' rooms, (132) resident bathrooms, (6) common bathrooms, dining room, commercial kitchen, staff area, office area, commercial washer and dryer room/ storage area, outdoor patio with umbrella, table, and chairs. LPA conducted a records review of (7) resident records, (7) staff records, and reviewed the facility disaster plan. The facility disaster plan was current and in compliance with Title 22 regulations at the time of visit. All resident & staff records were complete. LPA reviewed (4) resident Medication Administration Records and did not observe any discrepancies at the time of visit. LPA and the Assistant Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. Five rooms per floor were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for residents’ personal belongings is available. Report continued on LIC809-C All rooms had the required furniture. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature in each bathroom per room inspected were found to be within Title 22 regulations. LPA observed the facility to have a first aid kits, manual, and emergency supplies. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary, well-maintained, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were stored and accessible to residents. The commercial kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. LPA observed the kitchen area to be clean and free from pests. The facilities fire extinguishers were checked and found to be fully charged and accessible; and last serviced on 09/20/2023. All exit doors in the facility have alarm systems. The facility has hardwired and battery-operated smoke and carbon monoxide detectors and are in working condition. A working landline telephone remains available. The last fire/emergency drill was conducted on 07/22/2024. The facility has current liability insurance. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that sanitizing stations were in common areas and restrooms. LPA further observed the facility to have a 90-day supply of Personal Protective Equipment (PPE). Facility had the proper signage posted (Facility Disaster Plan, Facility License, Administrator Certificate, Residents Personal Rights, etc.). LPA advised the administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. Exit interview was held and a copy of the Facility Evaluation Report was provided to with Amalia Esquivias, Administrator.the state’s words, verbatim · CDSS document, Aug 2, 2024

Allegation investigated: Due to lack of supervision, resident is assaulting another resident.

On 05/29/24, Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced visit to this facility and was greeted by Administrator #1 (A1: Amalia Esquivias). LPA Dabuet explained the purpose of today’s visit is to conduct an investigation into the allegation mentioned above and deliver findings. The investigation consisted of the following: During today’s visit, LPA reviewed the following documents: Resident Roster; Facility Staff Roster; Resident #1- #2 (R1-R2)’s Physicians Report LIC 624A, Identification and Emergency Information LIC 601, Unusual Incident Reports LIC 624 and other documents associated with this complaint. An interview with residents #1-#10 (R1-R10), Administrator #1 (A1), Staff #1 (S1), and witnesses #1-#2 (W1-W2). There was a tour of the facility. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Due to lack of supervision, resident is assaulting another resident. The details of this complaint alleged that due to lack of supervision, resident #1 (R1) was assaulted by resident #2 (R2). The complainant reported that (R1) was physically and emotionally abused by (R2) and informed (R1) that (R2) was not going to hit (R1) anymore, but (R2) hit (R1) with an electric wheelchair on purpose. The complainant stated (R1) reported the incident to law enforcement and claimed (R1) does not feel safe around (R1) especially when they both live in the same assisted living facility. According to (R1)’s and (R2)’s Identification and Emergency Information LIC 601 (dated: 10/07/21 and 03/28/22), (R1) was admitted to Crofton Manor on 03/28/22, while (R2) was admitted to 10/08/21. On 05/29/24, between 11:20 am – 11:50 am, the Department interviewed resident #1 (R1). (R1) claimed to like living at the facility and found 99% of the staff considered helpful and accommodating. (R1) explained an incident that happened most recently outside of the facility with (R2). (R1) explained that (R2) was never considered a friend and that (R2) has a history of taunting (R1). (R1) claimed that (R2) enjoyed harassing (R1) and continues to do so outside and inside the facility. (R1) claimed that (R1) would inform staff and that staff would inform management but felt nothing was done about removing (R1) from the facility due to (R1)’s behavior. (R1) explained that administrator #1 (A1) is involved in every incident, and both (R1) and (R2) have been counseled by (A1) for their behaviors. (A1) suggested that (R1) start writing down the dates and times of each incident. (R1) stated it was too time-consuming and did not record any of the incidents that have occurred with (R2). (R1) claimed that facility staff have been responsive and did not consider it was lack of supervision that may have caused these incidents with (R2). (R1) is frustrated that (R2) is being held back so long by the facility. (R1) stated that law enforcement had been dispatched for several of the incidents involving (R2) and that (A1) assisted with notifying the authorities. (R1) refused to seek medical treatment for every incident involving (R2) due to no major physical injuries were involved. (R1) confirmed that (A1) had offered to move (R1) to a different floor but declined. (Evaluation Report continues LIC 9099-C) On 05/29/24, between 11:10 am – 11:20 am, the Department interviewed resident #2 (R2). (R2) claimed to to have no battles with any residents and get along with all. (R2) expressed that staff supervision is good. The staff are alert to prevent conflicts with other residents. (R2) denied having any issues with (R1). (R2) claimed to feel safe living at this facility. On 05/29/24, between 09:38 am – 11:09 am, the Department interviewed residents #3-#10 (R1-R10). Eight (8) out of eight (8) residents felt safe in their living environment and were complimentary of staff. (R3-R10) have not witnessed any unacceptable behavior between residents. (R3-R10) claimed when on duty the staff are alert and responsive and will step in to prevent any unwarranted behaviors between residents. (R3-R10) reported the facility holds monthly Residents Council Meetings, and concerns are discussed. Suggestion Box is also available for residents who want to address any concerns anonymously. On 05/29/24, between 09:00 am – 11:58 am, the Department interviewed administrator #1 (A1) and staff #1 (S1) both refuted this accusation. (A1) and (S1) both expressed that there is a history between (R1) and (R2). (A1) and (S1) claimed that (R1) and (R2) used to be friendly with one another as they were friends. (R1) and (R2) have been spotted inside the facility and outside to have engaged socially. Their friendship has ended, and they no longer communicate with one another. (A1) has consulted both (R1) and (R2) for their behaviors, and (R2) has been provided verbal warnings that may lead to termination of residency. (A1) claimed the last incident involving (R1) and (R2) was on 05/09/24. The incident happened outside the facility. (R1) claimed that (R2) intentionally bumped into (R1) with (R2)’s wheelchair. (R2) claimed it was not intentional that the act was an accident - the wheelchair was not working correctly. (A1) immediately notified the wheelchair company to examine (R2)’s wheelchair for repairs. While collecting statements from (R2), the Long Beach Police arrived and took statements from both (R1) and (R2). In inclusion, (R2) was ordered to stay away from (R1) and not to communicate or contact (R1) in the police report completed #24-23-424. (A1) stated that incident reports for (R1) and (R2) were submitted, and family representatives for both residents had been notified. (S1) claimed incidents involving (R1) and (R2), and (R1) declined to seek medical assistance. (A1) reported that both residents share the same floor and have been offered to move to different floors - both have refused to move. (A1) stated it is not due to lack of supervision our staff are trained to act to prevent violence amongst residents. Surveillance cameras are installed in all the common areas to capture unwarranted activities. (Evaluation Report continues LIC 9099-C) According to (A1) the facility is being proactive and has been working with (R2)'s family representative and Assisted Living Waiver (ALW) representative to relocate (R2) to another assisted living facility. On 05/29/24, between 12:21 pm – 01:30 pm, the Department interviewed family representatives witnesses #1-#2 (W1-W2). (W1-W2) both confirmed to have been informed by (A1) of the incidents involving (R1) and (R2) and claimed these incidents were not due to a lack of supervision from the facility. (W2) confirmed that (R2) has agreed to be relocated to another assisted living facility and that (A1) is in the process of assisting in the procedure. As a result of the Department reviewing (R1)'s Physicians Report LIC 602A (dated: 03/30/23), revealed that (R1) is in fair physical status, can self-care, and is disposed to aggressive verbal behavior. (R2)’s Physicians Reported (dated: 10/19/23), revealed (R2) is in fair physical condition, can self-care with assistance, and is in a safe mental status. An analysis of Unusual Incident Reports (dated: 04/10/24 and 05/09/24) addressed to the Long Term Ombudsman (LTCO), Adult Protective Services (APS), Community Care Licensing (CCL), and family members. Based on the information gathered, there is insufficient evidence to corroborate the allegation mentioned above. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove NEGLECT/LACK OF SUPERVISION, “Due to lack of supervision, resident is assaulting another resident” did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted with Amalia Esquivias, and a copy of the report is provided.the state’s words, verbatim · CDSS document, May 29, 2024 · control 11-AS-20240520091959

Allegation investigated: Facility staff are not taking proper measures to maintain facility free of roaches Facility staff are not following infection control requirements

On 04/18/24, Licensing Program Analyst, Wendy Gibbs, conducted an unannounced complaint visit to the facility listed above. LPA met with Administrator, Amalia Esquivias, and the purpose of today’s visit was explained. During today’s visit LPA toured the facility, interviewed Staff (S1-S12), interviewed Residents (R1-R12), and received documents pertinent to the investigation. Documents received and reviewed include a Staff Roster, Resident Roster, Orkin Pest control receipts, Infection Control Plan, and cleaning schedule. The investigation revealed the following: Unsubstantiated Allegation: Facility staff are not taking proper measures to maintain facility free of roaches It is alleged the facility has a roach infestation and are seen in the hallway and it has been six months since the last pest control service was provided. During record review, LPA received and reviewed the facilities Service Reports from Orkin that show service dates on 04/03/24, 03/25/24, 02/21/24, 02/09/24, 01/17/24, 01/03/24, and 12/21/23. LPA observed on the Service Reports, in the comments about the day’s service, states “no signs of rodent or crawling insect activity were found during this visit.” During the facility tour, LPA did not observe any signs of insects inside the facility. During interviews with the Administrator S1 stated there is an exterminator through Orkin who comes in every two weeks or as needed to treat. During interviews with Staff S1-S12, they were asked if they have seen any insects (besides gnats and flies) inside of the facility in the past six (6) months, twelve (12) out of twelve (12) stated they have not seen any insects inside the facility. Additionally, during interviews with Staff S1-S12, were asked what procedures are there to keep the facility free of insects, twelve (12) out of twelve (12) stated they clean every room in the facility daily, take out the trash from every room daily, vacuum, sweep, and mop all rooms to ensure there are no food crumbs on the floor, and to remind all residents and staff to try to keep doors closed so nothing can get inside. During interviews with Residents R1-R12, were asked if they have seen any insects in the facility recently, R1, R3, R5, R7, and R10 stated they have not seen a cockroach or water bug inside for a few months and R2, R4, R8, R9, R11, and R12 have not seen a cockroach or water bug inside the facility at any time. Additionally, during an interview with Residents R1-R12, were asked if they know if the facility has an exterminator they use, seven (7) out of twelve (12) stated they have seen an exterminator at the facility. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. Allegation: Facility staff are not following infection control requirements It is alleged the pads on the patio chairs in the sunroom have not been cleaned, they have been soiled with feces and urine and staff only flip the pad over. During the facility tour, LPA observed all common room and furniture to be clean. During file review, LPA received and reviewed the facility’s Daily Disinfecting Logs that show what has been cleaned, when and initialed by who did it. During interviews with Staff S1-S12, were asked how fabric furniture is cleaned if a resident has an accident, twelve (12) out of twelve (12) stated maintenance takes the piece of furniture outside to clean it and bring it back in when it is dry. During an interview with Staff S1-S4, were asked how the fabric furniture is cleaned, four (4) out of four (4) stated a machine is used to clean it. Additionally, S2, and S4 stated they use the Extractor to clean the fabric material which is like a carpet cleaner and the chair is placed in the sun to dry. During interviews with Residents R1-R12, were asked if the common rooms and furniture were cleaned regularly, eleven (11) out of twelve (12) stated they see staff cleaning the common rooms multiple times a day. Additionally, twelve (12) out of twelve (12) stated they have seen the furniture outside drying once in a while. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. During today’s visit LPA did not observe or cite any deficiencies. An exit interview was conducted with Assistant Administrator, Francisca Vallejo, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 18, 2024 · control 11-AS-20240410104942

Allegation investigated: Staff did not follow quarantining protocol Facility does not meet resident's incontinence needs Staff did not regularly monitor resident for change in condition Staff do not answer resident call button in a timely manner

On 02/29/2024 at around 8:20 AM Licensing Program Analyst (LPA) Socorro Leandro initiated a complaint investigation regarding the allegations listed above. LPA met with the Administrator Amalia Esquivias and the purpose of the visit was explained. The investigation consisted of the following: During today’s investigation LPA and the Administrator conducted a tour of the facility which included the dining room, living room, activity room, patio, and random resident bedrooms. LPA interviewed 5 out of 114 residents and 4 out of 72 staff members. LPA conducted a record review which consisted of 5 Residents Files, Personnel Report, Resident Roster, Facility Infection Control Requirements, and Inspection Guidelines for Infection Control. Unsubstantiated The investigation revealed the following: Regarding the allegation "Staff did not follow quarantining protocol” it is being alleged that during resident’s quarantining staff refused to enter resident’s room. 3 out 5 residents indicated that staff provided in person services to them during their quarantining. 5 out of 5 staff interviews indicated that for residents who are quarantining, staff go into their bedrooms and provide them with services. Record reviews demonstrate that the facility has a Facility Infection Control Requirements Plan and an Inspection Guidelines for Infection Control. The investigation revealed the following: Regarding the allegation "Facility does not meet resident's incontinence needs” it is being alleged that staff failed to provide incontinence care and due to this a resident developed a UTI and blisters on their genital area. 3 out of 3 residents who receive incontinence care indicated that staff assist them with their incontinence needs. 4 out 4 caregivers interviewed indicated that they check residents every 2 hours but, in some cases, they check them every 30 minutes. Record review shows Resident’s 1 Resident Call Log and Bowel Movement Log and it demonstrates a daily log of how often they are checked and changed. The investigation revealed the following: Regarding the allegation "Staff did not regularly monitor resident for change in condition” it is being alleged that staff did not observe blisters on resident’s genital area. 5 out 5 residents indicated that staff check up on them every day. 4 out of 4 caregiver interviews indicated that they continuously observe their residents for change of condition and if there is a change they notify the medical technician, licensing vocational nurse, or the Administrator. Record Reviews of Resident 1 demonstrate various daily logs of their Resident Call Log, Bowel Movement Log, and Meal/Fluid Intake. The investigation revealed the following: Regarding the allegation "Staff do not answer resident call button in a timely manner” it is being alleged that sometimes staff answers the call button in 30 minutes, and it takes them another 30 minutes to arrive to the residents’ room. 3 out 5 residents who use the call button indicated that they come in a timely manner to their room. 4 out 4 caregiver interviews indicated that they go to residents’ rooms in an adequate amount of time and if they are unable to go then another staff member will assist the resident. LPA checked random call buttons and found that the average response time was in less than 1 minute, there was only one call button that took about 4 minutes for staff to respond. Regarding the allegation "Staff did not follow quarantining protocol,” “Facility does not meet resident's incontinence needs,” “Staff did not regularly monitor resident for change in condition,” “Staff do not answer resident call button in a timely manner” The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 29, 2024 · control 11-AS-20220824113729

Allegation investigated: Staff did not safeguard resident's funds

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Crofton Manor Inn facility on 12/11/2023 and was greeted by Administrator Amalia Esquivas (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation. During this investigation, LPA Calderon interviewed A1, S1-S2 and interview R1-R12. These interviews were conducted on 12/11/2023. On 12/11/2023 LPA Calderon requested copies of the following: P&I Records for R1-R5 (date 2023), physician orders for R1(date 4/13/2020). ISP Individual Service Plan for R1 (date 3/7/2022), Billing history for R1 (date 2/28/2021 to 8/31/2022), Copies of Stimulus check for R1 (date 2/8/2021 and 9/8/2021) On 12/11/2023 LPA Calderon toured the facility. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Staff did not safeguard residents’ funds. This complaint alleges that the facility staff cashed R1 stimulus check in 2022. LPA Calderon conducted an interview with Amalia Esquivas A1. A1 states that S1 keeps records of all deposits received for residents and that per their records no stimulus check was received in 2021 or 2022 for $1400.00. A1 states that S3 would not take or cash a resident check. A1 states that R1 would sometimes deposit R1 checks, but for most of the time staff would deposit all checks and keep accurate records. A1 states that they keep records of all monies received from resident’s accounts including R1. LPA Calderon conducted an interview with S1-S2. S1 states that S1 keeps records of all deposits and checks received by the facility. S1 states that S1 nor S2 did not received a $1400.00 stimulus check from the US Treasury that R1 claims. S1 states that they did receive 2 stimulus checks for $600.00 each in 2021 and the money was deposited into R1 account. S1 states that S2 did not handle the stimulus checks as S1 was working at the time the checks came into the office. S1 states that S2 would only handle the checks when she was not in the office but would not make any deposits. S1 states that S2 made A1 and S1 aware of R1 accusation of the missing $1400.00 check and A1 and S1 investigated and could not confirm that any check for that amount was received. S2 states that R1 spoke to S2 and accused S2 of taking R1 stimulus check. S2 states that S2 advised A1 and S1 of the accusation by R1 and there is no truth in what R1 is claiming. S2 states that S2 did not handle R1 stimulus check and at that time in 2022 S2 was front desk help and could not have cash any resident’s check. S2 states that R1 is confused, and the facility has records of each check received and deposited. LPA Calderon conducted an interview with R1-R12 on 12/11/2023. R1 states that R1 received a US treasury check for $1400.00 in 2022 and that R1 signed the check and S2 cashed the check and did not give R1 any money. R1 states that normally S1 handles R1 checks and S1 would deposit R1 checks and pay rent with the money. R1 states that R1 is not confused and R1 complained to A1 with no action taken. R1 states that R1 does not have any record of the $1400 check that R1 signed. LPA Calderon conducted an interview with R2-R12 on 12/11/2023. 11 out of 11 residents state that staff deposits their checks, and they can obtain money by asking S1. 11 out of 11 residents state to have no issues with S1 and their money. On 12/11/2023 LPA Calderon reviewed resident cash resources (P&I) (date 12/10/21 to 7/29/2022) for R1, records show 12 withdraws by R1, none after 7/30/22 after resident moved to Edgewater. Reviewed cash resources (P&I) records (date 2023) for R2-R4. LPA Calderon noted deposits and withdrawals and confirmed by staff for each resident. LPA Calderon reviewed billing history (dated 2/28/21 to 8/31/22) for R1, 2 stimulus checks for $600.00 dated 2/8/21 and 9/8/21). Records note deposits received from resident and resident son for different amounts for R1. Reviewed deposit logs (date 3/1/21 to 6/1/22), noted 14 deposits for R1. None found for $1400.00 in 2021 or 2022. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegation of “Staff did not safeguard residents’ funds” is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Amalia Esquivas (A1).the state’s words, verbatim · CDSS document, Dec 11, 2023 · control 11-AS-20231204154801