Elder Ashram

Type of visit: Required - 1 Year

On 07/13/2026 at 1:25 PM, Licensing Program Analyst (LPA) David Doidge arrived to conduct 1-Year Annual Required inspection. LPA met with Administrator Maria Lourdes Rivera and explained the purpose of the visit. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the common bathroom was measured at 109.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 06/07/2026. First aid kit was observed to be complete. Fire Drill last conducted quarterly last on 05/05/2026. First aid kit was observed to be complete. LPA reviewed five (5) resident records and five (5) staff records; all were complete. LPA also reviewed a sample of residents’ medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 13, 2026

Allegation investigated: Staff interacts inappropriately with resident Staff did not administer resident's medication

On 04/28/2026 at 12:45 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to deliver findings in regards to the allegations above. LPA met with Assistant Executive Director Janelle Ubilas and explained the purpose of the visit. During the course of the investigation, LPA obtained copies of the resident roster, staff roster and schedule, contact information for shift working NOC and PM shifts, Physician’s Reports, Appraisals Needs and Services, the Identification and Emergency sheets, and the Medication Administration Record (MAR) for four (4) residents. LPA also interviewed S1, S2 and S3, S5, as well as R1, R2 a, R3 and R4, in the facility. LPA also observed residents interacting with staff in common areas. Allegation: Staff interacts inappropriately with resident Continued on LIC9099-C Unsubstantiated Continued from LIC9099 Investigation Findings: It was reported to the department that a staff on NOC shift has consistently been rude to a resident. This staff member is "very difficult" and "rude" to a resident in general. It was alleged that the staff member said 'with that attitude you get nothing' and threw pain meds in the garbage. LPA interviewed S1 and S5, both of whom have supervised S4, neither have ever had a complaint against S4. LPA interviewed R1 who said that one staff member in particular is “rude” and will withhold medications thus upsetting R1. R1 reported that staff can be pleasant at times but will get upset when R1 asks for certain medications. R1 said this is why one staff member in particular is rude, as R1 will constantly ask that staff member for R1’s over-the-counter medication and that staff member will flat out refuse to provide them. This will get R1 mad and R1 will voice R1’s opinion. LPA interviewed S4 who said R1 will wake up late at night and demand over-the-counter medications. When S4 explains that R1 can only have certain medications at certain times, R1 will get upset and argue. LPA spoke with S3 who confirmed R1’s behavior. S3 said R1 is usually pleasant and easy to work with, however when R1 wants certain medication at times R1 cannot have them, R1 will get upset and accuse staff of being mean. S1, S2, ad S5 all confirmed R1’s behavior. LPA tried to interview R1’s roommate R2, however R2 was highly medicated and currently non-verbal. LPA interviewed R3 and R4. Both residents are long term residents and reported never hearing or seeing staff being rude. Both R3 and R4 report NOC shift are friendly. LPA walked around facility and observed staff actively engaging with residents and having friendly conversations. Based on interviews conducted, the above allegation is UNSUBSTANTIATED. Allegation: Staff did not administer resident's medication Investigation Findings: It was reported to the department that a staff member threw pain meds in the garbage and would not give a resident requested medication. LPA interviewed R1 who said when R1 asked for over-the-counter medication for pain, the Med-Tech told R1 it was not time for them. R1 reminded the Med-Tech that R1 has a prescription for over-the-counter medication that can be taken for pain and asked for that. R1 said the Med-Tech then said, 'with that attitude you get nothing' and threw away R1’s medication. R1 insisted that S4 threw out R1’s medication. R1 said it was the same cup used to give R1 R1’s medications, and there was no way to confuse it. LPA interviewed the S4. S4 informed LPA that S4 was approached by R1 around 9 or 9:30 PM as S4 was in the Medication room doing inventory. S4 said an hour earlier S4 had given R1 R1’s prescribed medications and R1 asked for over-the-counter pain medication. Continued on LIC9099-C Continued from LIC9099-C LPA reviewed R1’s medication list and confirmed with R1’s Medication Administration Record (MAR) that R1 did receive a prescribed pain medication at 8PM and therefore could not have further medications for another two hours as it would over medicate R1 as indicated in the medication dosage. R1’s Medication Administration Record (MAR) showed R1’s medications had been administered appropriately with no miscounts or missed dosages. S4 informed LPA that S4 did through away empty medication cups as S4 was cleaning out the med room when R1 came in. Based on interviews conducted, the above allegation is UNSUBSTANTIATED. 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. No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 28, 2026 · control 15-AS-20260410124939

Allegation investigated: Questionable Death. Lack of supervision resulting in resident fall sustaining a fracture. Resident had unexplained weight loss. Facility failed to assist resident with grooming. Facility did not have enough staff to properly care for the residents. Facility did not report resident fall incidents, hospitalization and death to CCL.

On 02/11/2026, at 9:00 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to deliver findings on the allegation above. The LPA informed Assistant Executive Director (AED) Janelle Ubilas of the reason for the visit. The Department's investigation included but was not limited to a review of facility records, a review of email correspondence between Resident R1’s family and staff, and a review of hospital records. The Department interviewed facility managers, facility care partners, facility residents, and R1’s family. Continued on LIC 9099-C2 . . . Unsubstantiated . . . Continued from LIC 9099-C1 The complaint alleges Resident R1’s death was questionable. On 01/01/2023, R1 sustained a fall and was transported to the hospital. Medical records indicate that, upon admission, R1 was diagnosed with a closed fracture of the right hip. On 01/02/2023, R1 was transferred to another hospital with the same admission diagnosis. On 01/03/2023, R1 underwent surgical repair of the right hip fracture. On 01/08/2023, R1 was discharged to hospice for comfort care due to poor quality of life and inability to participate in life-sustaining therapies. On 01/15/2023, R1 was discharged from hospice following death at the hospital on 01/14/2023. Final active problems included a closed fracture of the right hip and many other health conditions. R1 did not return to Elder Ashram after his fall on 01/01/2023 R1’s death certificate lists the immediate cause of death as acute hypoxia respiratory failure, with the time between its onset and R1’s death listed as days. There were two underlying causes listed: pneumonia and sepsis, both with the time interval between onset and death listed as days. According to interviews, review of facility records, and a review of R1’s medical records, there was not enough information to state that R1’s death was questionable, nor that facility staff were at cause. The data analyzed does not support this allegation. The complaint alleges that lack of supervision from staff resulted in Resident R1 falling and thereby sustaining a fracture while in care. Prior to R1’s admission to the facility, the resident appraisal of 12/03/2022 noted that R1 “is a big fall risk so needs to be helped and watched”. R1 was admitted to the facility on 12/05/2022. On 12/10/2022, 12/16/2022, 12/21/2022, and 01/01/2023, R1 sustained falls. R1 was transported to the hospital emergency department (ED) after each fall. R1 sustained a laceration on his chin and injuries to his forehead on 12/16/2022 and 12/21/2022. 12/16/2022 hospital discharge instructions state, “frequent falls and instability are likely due to dementia and dehydration / deconditioning.” On 12/21/2022, R1 was transported to the ED by his son W2. On 01/01/2023, R1’s fall resulted in a closed fracture of the right hip. On 12/10/2022 and 12/16/2022, facility staff submitted Physician’s Fax Reports to R1’s physician. Facility did not receive a reply to the 12/10/2022 fax with new orders. On 12/16/2022, R1’s physician replied and stated, “Have upcoming appointment with him this week. No new recommendations now.” Continued on LIC 9099-C3 . . . Continued from LIC 9099-C2 On 12/16/2022, according to reviewed email correspondence, facility staff communicated concerns to W2 regarding R1’s high fall risk, frequent falls, medication concerns, current level of care, and the need for reassessment for a higher level of care, as well as the need to schedule a care conference. On the same date, a second email was sent to W2 indicating that R1’s one-on-one supervision was extended due to R1’s increased ambulation that resulted in his continued falls. On 12/21/2022, W2 emailed facility staff regarding a medication prescribed by R1’s physician and advised that the medication could increase R1’s risk of falling. Facility staff subsequently expressed concern that the medication could further elevate R1’s fall risk. According to interviews, review of facility records, and a review of R1’s medical records, there was no indication that lack of supervision from staff resulted in Resident R1 falling and thereby sustaining a fracture while in care. The data analyzed does not support this allegation. The complaint alleges that R1 had unexplained weight loss of 20 lbs. R1’s weight in his Physician’s Report dated 10/27/2022 is 138 lbs. It was 39 days between the Physician’s Report and the date R1 was admitted into Elder Ashram on 12/5/2022. There is no record of R1’s weight upon admission nor during the 27 days R1 lived at Elder Ashram. Upon admission into the hospital on 1/1/2023, R1’s weight was recorded as 124 lbs. and 9 oz. That was a loss of 13 lbs. and 3 oz. R1 lived at Elder Ashram fewer days than the number of days between the Physician’s Report and his admission into the hospital on 1/1/2023. The data analyzed does not support this allegation. The complaint alleges that facility staff failed to assist R1 with grooming. The AED stated that the staff worked as a team to groom R1, because he was physically aggressive. They used different strategies for approaching him and for working with him. If he was not okay with one staff member at one time, then another staff member would come a little later. He hit and punched staff when they assisted him during grooming. Nonetheless, they kept his body and his clothes clean. The data analyzed does not support this allegation. Continued on LIC 9099-C4 . . . Continued from LIC 9099-C3 The complaint alleges that the facility did not have enough staff to properly care for the residents. Four staff members were interviewed at Elder Ashram about possible understaffing during December 2022 and January 2023. The AED stated that during the time R1 was at the facility, between December 2022 and January 2023, the shift coverage and resident population remained the same. She also stated that Elder Ashram has never had issues with understaffing. Staff member S1, a Licensed Vocational Nurse, stated that the facility is understaffed “sometimes,” but it is only from shift to shift and never for an extended amount of time. Staff member S2, a Care Partner, stated that there has never been an understaffing issue. Executive Director (ED) Maria Lourdes Riera stated that the facility has never been understaffed for an extended period. A review of complaints concerning understaffing at this facility supported these statements, because none were substantiated. The data analyzed does not support this allegation. The complaint alleges that the facility did not report resident fall incidents, hospitalization, and death to Community Care Licensing (CCL). A review of the records shows that the facility did make the required reports to CCL. The data analyzed does not support this allegation. Although the allegations may have happened, or were valid, there is not a preponderance of evidence to prove them; therefore, the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 11, 2026 · control 15-AS-20241206141605

Allegation investigated: Staff did not ensure that resident received medical attention in a timely manner while in care. Staff did not ensure that resident's nutritional needs were met while in care.

On 12/10/2025 at 11:20 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to deliver findings in regards to the allegations above. LPA met with Wellness Director Janelle Ubilas and explained the purpose of the visit. During the course of the investigation, LPA obtained copy of R1’s Physician’s Report (602), Admission Orders, Resident Appraisal, Elder Ashram Careplan for resident, correspondence between the facility and primary care provider, R1’s medication list, and an Unusual Incident Report with a letter to R1’s primary care provider. LPA also interviewed R1, S1, S2 and S3, and inspected the kitchen and food. Allegation: Staff did not ensure that resident received medical attention in a timely manner while in care. Continued on LIC9099-C Unsubstantiated Continued from LIC9099 Investigation Findings: It was reported to the department that the facility did not timely respond to R1’s doctor for a potential UTI. LPA interviewed S2, who was on duty at the end of the day on Friday November 28th S2 reported that R1 informed staff that R1 felt symptoms of a urinary tract infection but not severe enough to need to go to the emergency room. R1’s primary care provider’s office is closed over the weekend. R1’s primary care provider was notified on Monday December first. The order for the urinary test and prescription for antibiotics came in on the first. The urine was collected on the second due to R1 not being able to provide enough urine when the test was available. LPA interviewed S3 who collected the urine sample. S3 reported to LPA that R1 had informed another med-tech that R1 had some discomfort, and mild symptoms of what R1 thought could be a urinary tract infection (UTI). S3 assessed R1’s symptoms. R1 had reported to S3 that R1’s symptoms were mild consisting of mild discomfort while urinating, but not a severe burning sensation. S3 reported no increase in confusion, agitation, nor other severe signs of a UTI being present for R1. R1’s primary physician was informed, and a urine sample and antibiotics were prescribed. S3 did the sample collection the day after the test was received due to R1 not having enough urine to fill the sample. S3 reported that R1 reported no discomfort nor burning sensation while providing the sample. S3 also reported there was no strong smell or other obvious signs of a severe UIT. A five (5) day supply of antibiotics was prescribed and received by the facility on Tuesday December second. Lab results for the urine test were not yet available. LPA interviewed R1. R1 did not recall the incident and stated that staff do respond to needs in a timely manner. As R1 had reported mild symptoms to staff with no urgency to see a health provider, and staff evaluations of R1’s symptoms and temperament were not above base line, staff did act in a timely manner in response to R1’s report of possible a UTI. Therefore, this allegation is unsubstantiated. Allegation: Staff did not ensure that resident's nutritional needs were met while in care. Continued on LIC9099-C Continued from LIC9099-C Investigation Findings: it was reported to the department that staff were encouraging balanced meals, however, W1 reported to the department that when R1 asked for a banana, R1 was offered flan instead. LPA interviewed R1. R1 did not recall the incident but reported to LPA that staff do not withhold snacks or meals and felt that staff do meet R1’s food needs. S1 reported that R1 has not been eating full meals as a way of getting R1’s family’s attention in hopes of being taken home. This was conveyed to R1’s primary care provider and responsible party. LPA interviewed S3 who reported that S3 will follow up with R1 in the late evening to ask if R1 would like something else to eat on days when R1 does not eat a full meal. S3 will provide a sandwich or other requested foods to R1 and ensures R1 is eating. S1, S2 and S3 reported that R1 had expressed depression like thoughts and a want to go home as a reason for not eating as much as before. Staff have been monitoring R1’s food intake and will follow up with R1 throughout the day and evenings to ensure R1 does eat enough. S1, S2 and S3 report that R1 prefers sweets, and asks specifically for sweets such as flan. Staff report trying their best to provide R1 with R1’s requests while encouraging R1 to eat more healthy options. S1 and S3 reported that staff do not withhold nutritional food from R1, and know what R1 prefers. If R1 were to ask for a specific food item, staff will offer an alternative that is readily available but will confirm with R1 if the alternative is acceptable. Staff never force residents to eat anything they do not want to eat. LPA toured kitchen and the facility has nutritional food options available. This allegation is therefore unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations above do not meet Regulation Requirements are unsubstantiated. No deficiencies cited. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 10, 2025 · control 15-AS-20251204103845

Type of visit: Required - 1 Year

On 07/03/2025 at 10:30 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Interim Administrator Janelle Ubilas and explained the purpose of the visit. LPA toured the facility including but not limited to residents’ rooms, bathrooms, multiple activity rooms, kitchen, common areas and courtyard. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 72 degrees Fahrenheit. The hot water temperature in a hallway bathroom was measured at 112 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 07/20/2025. Emergency Disaster Plan was last posted on 04/11/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/30/2025. LPA reviewed five (5) residents records and five (5) staff records, and all were complete. LPA also reviewed a sample of residents’ medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 3, 2025

Type of visit: Case Management - Deficiencies

On 03/24/2025 at 09:30 AM, Licensing Program Analysts (LPAs), D. Doidge and J. Clancy-Czuleger conducted an unannounced visit for a case management. LPAs met with Executive Director Maria Rivera and explained the nature of the visit. While LPAs D. Doidge and J. Clancy-Czuleger conducted a complaint investigation (15-AS-20250306160421) on 3/12/2025, LPAs were informed that a previous one on one caregiver was not fingerprint cleared nor associated to the facility nor a home health agency. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Mar 24, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(e)(1) · Plan of correction due date: Mar 31, 2025

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, ...in a licensed facility. Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidence by: based on interview and records review the licensee did not comply with section sited above by allowing an uncleared individual to provide one on one care to a resident.the state’s words, verbatim · CDSS document, Mar 24, 2025

Plan of correction: Licensee to provide self certifying letter acknowledgeing understanding of regulation cited. Prroof of correction to be sent to CCLD by POC date.

Allegation investigated: Facility is violating resident’s personal rights Staff do not ensure the residents intaking an appropriate amount of liquid

On 03/12/2025 at 09:10 AM, Licensing Program Analysts (LPAs), D. Doidge and J. Clancy-Czuleger conducted an unannounced visit to open a complaint. LPAs met with Interim Administrator Janelle Ubilas and explained the nature of the visit. During the visit, LPAs reviewed and obtained records for three (3) residents, including appraisal needs and services, physician's report, other medical information, and internal incident reports from February 22nd to March 11th. LPAs interviewed residents, staff and witnesses. Allegation: Facility is violating the resident's personal rights Continued on LIC9099C Unsubstantiated Continued from LIC9099 Findings: Based on interviews it was found that R1 was receiving additional care from an outside individual that was paid for and chosen by the family. The facility informed the family of concerns and recommended an agency for more contestant care. LPAs were informed that the personal caregiver was not associated to the facility nor a home health agency. Furthermore the facility confirmed that the care provider would not walk around the facility and would only stay in the resident's room. This individual did not have any contact with any other resident, was never caught sleeping during shift, and was very professional with staff. Staff was informed by the care provider if the resident required any assistance. The care provider was more of an overnight companion than health care provider. Allegation of: Staff did not enure residents were in taking an appropriate amount of liquids Findings: Based on interviews and observations the facility has hydration stations located throughout the facility and staff regularly remind residents to drink water and observe them for signs of dehydration. Upon observation and interview, LPAs found that there were no violations of personal rights and that residents were appropriately hydrated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegations above do not meet Regulation Requirements are un-substantiated. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 12, 2025 · control 15-AS-20250306160421

Allegation investigated: Staff did not treat resident with dignity or respect Staff did not ensure that residents were accorded privacy while in the facility Staff mismanaged resident medication Staff did not provide adequate food service

*Amended to remove double information* On 3/5/2025, at 1:30pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegation above. LPA met with Janelle Ublias, Assistant Executive Director and explained the reason for the visit. During the course of the investigation the Department conducted interviews with staff, witnesses, obtained and reviewed records. Allegation: Staff did not treat resident with dignity or respect During intake interview W1 stated there was anti-Semiticism from the staff. An Continued on LIC9099C. Unsubstantiated Continued from LIC9099. example was the dining room tables were reserved and W1 was not allowed to sit there or would make W1 move. The six (6) staff that were interviewed all stated tables are not reserved. S1 and S4 stated there are residents that have their favorite seat, but it’s not reserved. The three (3) residents that were interviewed stated they sit wherever they please. One (1) resident have lived at the facility for several years and stated she has never observed a reserved table in the dining areas. Allegation: Staff did not ensure that residents were accorded privacy while in the facility W1 stated during interview that the shower room and none of the other rooms locked so anyone could walk in at any time. S3 stated the residents that do not require assistance with showering are able to lock the door, and the staff carries a key in case of an emergency. S6 stated the two showers, and both can lock, but has a key to open the door is necessary. S3 and S4 stated the showers are small but a resident and client can fit. S4 also stated staff try to give as much privacy as possible but it is hard with the rooms being shared rooms. Allegation: Staff mismanaged resident medication W1 stated during initial interview the staff often forgot to provide medication. S1 stated she had no knowledge of staff not providing medication, however, if this happened it would be reported to the appropriate parties. During record review of the medication administrative record (MAR) LPA did not observe any mismanaging of medication. Continued on LIC9099C. Continued from LIC9099C. Allegation: Staff did not provide adequate food service W1 stated the food is unhealthy but didn’t provide any details. S1 stated she was aware of sometimes resident wants something other than what was cooked, and the cooks would try to accommodate but they are not able to please everyone. R1 stated the cooks do not have a problem making something different if requested and they have the food items available. R2 and R3 stated the food is good and they are served enough. LPA toured kitchen and observed a variety of perishable and non-perishables for residents. 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 provided.the state’s words, verbatim · CDSS document, Mar 5, 2025 · control 15-AS-20241017091349

Type of visit: Case Management - Health Checks

On 12/11/2024 at 10:20 AM, Licensing Program Analysts (LPAs), D. Doidge and L. Fontanilla conducted an unannounced health and safety check related to complaint 15-AS-20241206141605. LPAs met with Interim Administrator Janelle Ubilas and explained the nature of the visit. The LPAs inspected the facility inside and outside. All outdoor and indoor passageways were free of obstruction. Outside, there were no bodies of water. Inside, the temperature was measured at 73 degrees Fahrenheit. The LPAs observed adequate lighting in all of the rooms for the comfort and safety of the residents. The hot water temperature in a common bathroom was measured at 114.7 degrees Fahrenheit. Kitchen was observed to be clean with food for 2 days of perishables and 7 days of non-perishables. Central storage for medications and cleaning supplies were observed locked. Sharps were stored inaccessible to residents. Fire extinguisher was observed to be fully charged and last serviced on 02/16/2024. No citations issued. A copy of this report was provided to Janelle Ubilas, Interim Administrator.the state’s words, verbatim · CDSS document, Dec 11, 2024

Allegation investigated: Resident sustained unexplained bruising while in care

On 11/12/2024 at 1:30 PM, Licensing Program Analyst (LPA) L. Alexander conducted a subsequent visit and met with Executive Director, Maria Rivera, to deliver the findings of above allegation. LPA explained the purpose of the visit with Executive Director. During investigation, the Department obtained the following documents from the facility – personnel record, residents’ roster, admission agreement, physicians report, needs & services plans, Physicians orders, narrative charting, medication calendar. Allegation: Resident sustained unexplained bruising while in care Investigation Finding: Unsubstantiated On 1/16/2024 and 3/7/2024 the Department interviewed the Reporting Party (RP) who stated that on or around 12/1/2023 had observed bruising to R1s arms and reported it to facility staff. RP did not have knowledge of how the bruising may have happened. On 2/13/2024, the Department interviewed S2, S3, S4, and S5; and on 3/7/2024 interviewed S6, S7, and S8. All staff stated having observed the bruising to R1s arms, but not having specific knowledge as to how it happened – with some reporting that R1 wears her wristwatch and bracelets tightly. S7 further stated that R1s bruising to the arm was “constant” and had observed other residents attempting to assist R1 with getting up from chairs by grabbing R1s arms; and S8 stated having observed R1 hitting herself with spoons. S3 reported that an inconclusive internal investigation was performed. All staff reported that R1 bruises easily. On 2/13/2024, the Department interviewed R1 who exhibited memory issues (confirmed by Physician's Report) and was unable to state what had happened and did not recall the bruising. The Department observed in video supplied by the RP and in facility progress notes that at the subject time, the RP had stated that a group of men had tried to remove her from the facility at night. Progress notes further reflect that the facility was in communication with family regarding the bruising, and unwitnessed falls documented during the subject time period. On 2/13/2024, the Department interviewed W1 who stated having had observed the bruising, discussed the situation with the facility, and knew that an internal investigation was performed. W1 did not believe that R1 had been mistreated by staff. Based on records review, interviews conducted, and observations made, the Department has investigated the above allegation Resident sustained unexplained bruising while in care and found it to be Unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit Interview conducted and a copy of report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 12, 2024 · control 15-AS-20231206085902

Type of visit: Case Management - Other

On 10/24/2024 at 3:50pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Marie Rivera, Executive Director. and explained the purpose of the visit. While LPA L. Hall was conducting a complaint investigation 15-AS-20241017091349 on 10/24/2024. LPA observed facility did not have a certified administrator. S1 stated that her certificate is in process. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Oct 24, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(a) · Plan of correction due date: Oct 25, 2024

87405 (a) All facilities shall have a qualified and currently certified administrator... The administrator shall... be on the premises a sufficient number of hours... When the administrator is not in the facility, there shall be coverage by a designated substitute.. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having a certified Administrator, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 24, 2024

Plan of correction: Executive Director (ED)agreed to hire a new Administrator for the facility. ED agreed to submit documents to CCLD by POC date.

Type of visit: Required - 1 Year

On 7/30/24 at 10:45 AM, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator Janelle Ubilas (cert exp 9/18/24) and explained the purpose of the visit. LPA toured the facility including but not limited to 5 residents’ rooms, bathrooms, multiple activity rooms, kitchen, common areas and courtyard. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70 degrees F. The hot water temperature in a hallway bathroom was measured at 118.8 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 7/20/24. Emergency Disaster Plan was last posted on 6/06/24. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 6/09/24. LPA reviewed 5 residents records and 5 staff records, and all were complete. LPA also reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 30, 2024

Type of visit: Case Management - Incident

On 7/10/2024 at 12:05pm, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 7/9/2024. LPA met with Malou Rivera, Executive Director and explained the purpose of the visit. The regional office received an incident report stating R1 had expired but report did not indicate a cause of death. S1 stated R1 moved into facility on 5/8/2024. S1 also stated R1 was always complaining of pain and the facility was trying to connect with R1's doctor or pain management. LPA L. Hall collected the following documents: physician's report, case notes, death report, care plan for R1, physician's fax reports, Oakland police report number, and staff schedule July 4, 2024. S1 stated she would notify the regional office when the facility receives a cause of death. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 10, 2024

Allegation investigated: Staff do not allow resident to have visitors Staff do not allow resident to go out with family member

On 3/07/24 at 1:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPA met with Maria Loudes-Rivera, Associate Executive Director and explained the purpose of the visit. During the course of the investigation LPA attempted to interview the reporting party (RP) but the RP’s phone was disconnected, and no email was provided. LPA interviewed S1 at the facility. LPA reviewed R1’s file. R1 was admitted to the facility on 5/21/18 and moved out on 5/15/23. There were no notes in R1's file regarding the RP. The complaint provided no specifics as to when the allegations might have occurred. S1 stated that all family members are allowed to visit during regular visiting hours. The facility does not have a policy that excluded visitors. ***report continues on LIC9099C*** Unsubstantiated ***report continues from LIC9099*** This agency has investigated the complaints alleging staff do not allow resident to have visitors and staff do not allow resident to go out with family member. We have found that the complaint was unsubstantiated. 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, a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 7, 2024 · control 15-AS-20240226103804

Type of visit: Case Management - Health Checks

On 12/08/2023 at 12:30pm, Licensing Program Analyst (LPA), L. Alexander arrived unannounced to conduct a health and safety check as a result of the department receiving a complaint. LPA met with Maria Rivera, Associate Executive Director and explained the reason for the visit. Upon arrival, LPA observed total of two (2) residents sitting down in the common area, and one (1) staff sitting down at the front desk. During the health and safety check, LPA toured the building including but not limited to common areas, bathrooms, bedrooms and outdoor area. Facility is noted to be clean and in good repair and clients in care appear to be safe. There are no imminent health/safety concerns on today's date. No deficiencies were cited today. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 8, 2023

Type of visit: Required - 1 Year

On 11/29/23 at 2:00 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Malou Rivera, Asst. ED and explained the purpose of the visit. The facility’s fire clearance was approved for 90 residents. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 111.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors, carbon monoxide detectors and fire extinguishers were in operating condition during visit. Emergency Disaster Plan was last posted on 6/08/23. First aid kit was observed to be complete. LPA reviewed 5 residents records and 5 staff records; all were complete. LPA also reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 29, 2023