Ellore Senior Living

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to follow up on the Incident Report for resident R1 which the Department received on 07/07/2026. LPA Rai met with Health Services Director, Ann Lee and stated the purpose of the visit. On 07/07/2026, the Department received an self reported SOC 341 Report of Suspected Dependent Adult - Elder Abuse for an incident which occurred on 07/05/2026 at approximately 6:30pm in Memory Care unit in resident (R1)'s bathroom. Per Report, staff (S1) found resident (R1) on their knees facing their bathroom sink while resident (R2) standing behind with their hand on R1's neck. Staff (S1) intervened and escorted R2 out of the room. R1 was assessed and was observed with superficial scratches on the left arm and no active bleed. Per Report, R1 denied pain or discomfort. Facility staff informed physician and resident's responsible party. During visit, LPA Rai interviewed 9 staff (S1-S8), including Health Services Director, Ann Lee. During visit, LPA Rai obtained the following copies to include but not limited to R1 and R2's Physician's Report, Appraisal/Needs and Services Plan and Progress Notes. LPA Rai determined this case management needs further investigation. At this time, this case in under review and Department will conduct a follow up visit, if warranted. This report was reviewed with Health Services Director, Ann Lee and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 22, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Required 1 Year visit. LPA Rai met with Executive Director/Administrator, Sylvia Chu and stated the purpose of today's visit. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed the back up generator on the premise. Per Residents Service Director, the back up generator services both facility and another residential building on the property and the generator is tested every third week of the month. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. Sharps and medications were locked in secured areas. LPA observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPA Rai toured the facility to include 3 resident rooms, common area in Assisted Living & Memory Care, dining room in Assisted Living and Memory Care and kitchen. 3 Out of 3 resident bedrooms had available bedding, drawers, and functioning lights. The facility bathroom had available soap, paper towels, and trash cans with lids. The hot water temperature in the bathroom and kitchen sink ranged from 114.4 - 118.5 degrees F. Fire extinguisher was observed and inspected on 02/18/2026. Facility smoke detectors and carbon monoxide detectors were inspected by a third party vendor on 01/30/2026 and the system was in working condition. The last disaster drill was conducted on 02/04/2026 and 03/10/2026. LPA Rai observed a complete first aid kit at the facility. Continuation on LIC 809-C, page 1 of 2. Page 2 of 2. LPA Rai reviewed facility records for 3 staff and 3 residents. LPA Rai reviewed resident medications and central stored medication records. No deficiencies were cited per California Code of Regulations, Title 22. Technical Violation was issued. This report was reviewed with Executive Director/Administrator, Sylvia Chu and a copy of the report was provided. LIC 858 and LIC 859 were provided.the state’s words, verbatim · CDSS document, Mar 30, 2026

Allegation investigated: Staff are performing tasks outside of their defined scope of duties without designated reliever for coverage resulting in residents not being provided care and supervision. There has been lack of response by Administrator concerning staffing and resident assignments resulting in residents at risk for unusual incidents and/or delay of services.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Executive Director, Slyvia Chu and stated the purpose of today’s visit. On 5/28/2025, the Department received a complaint with the above allegations. On 5/30/2025, the Department conducted an initial investigation at the facility. On 6/23/2025, the Department conducted an additional investigation at the facility. Continuation on LIC 9099-C, Page 1 of 3. Unfounded Page 2 of 3. Staff are performing tasks outside of their defined scope of duties without designated reliever for coverage resulting in residents not being provided care and supervision. It was alleged that the care staff are covering the breaks for the front desk staff. On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated there is 1 staff to 3 residents and the staff have ample time to do their work without issues. Two out of two staff stated the extra staff for the day will help with covering break time for the front desk staff. S2 stated the extra staff (or the third staff on the floor) will be tasked to give front desk their break. The staff will cover the front desk for 10 minutes and are trained to answer phone calls and responding to certain emergencies. On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 stated the staffing ratio has been 1 resident to 1 staff or at most, 2 residents to 1 staff. S3 stated they have extra staff on the floor to ensure there is enough coverage of when the facility accepts additional residents. S3 stated the extra caregiver will assist with covering front desk personnel’s 10 minute break. On 6/23/2025, LPA Rai attempted to interview 2 residents (R1-R2), however 2 out of 2 residents refused to speak or answer LPA Rai’s questions regarding the allegation. There has been a lack of response by Administrator concerning staffing and resident assignments resulting in residents at risk for unusual incidents and/or delay of services. On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated the Administrator and Human Resources (HR) have responded to concerns related to resident’s care assignments. S2 stated if there are call-off for the shifts, S2 will help cover the shift. S2 has not seen or heard issues which result in residents at risk to their safety and/or delay of receiving care services. Page 3 of 3. On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 stated the staffing ratio has been 1 resident to 1 staff or at most, 2 residents to 1 staff. S3 stated they have extra staff on the floor to ensure there is enough coverage of when the facility accepts additional residents. S3 stated he/she cannot speak on the behalf of previous Administrator, but S3 has not seen or heard any safety concerns related to staffing and resident assignments which may have resulted in residents at risk or incidents and/or delay of care services. On 6/23/2025, LPA Rai attempted to interview 2 residents (R1-R2), however 2 out of 2 residents refused to speak or answer LPA Rai’s questions regarding the allegation. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the Department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Executive Director, Slyvia Chu and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2025 · control 26-AS-20250528123624

Allegation investigated: Facility did not ensure that resident is accorded dignity in their relationship with staff.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Executive Director, Slyvia Chu and stated the purpose of today’s visit. On 6/17/2025, the Department received a complaint with the above allegation. On 6/23/2025, the Department conducted an initial investigation at the facility. It was alleged the resident R1 was having a smoke break outside and tried to roll themselves in the street and facility staff did not assist and laughed at the resident. Continuation on LIC 9099-C, Page 1 of 2. Unfounded Page 2 of 2. On 6/23/2025, LPA Rai interviewed 1 staff (S1). S1 stated the incident occurred on R1’s first day at the facility 6/5/2025, where R1 was smoking in the front area of the facility and staff asked if R1 needed assistance but R1 was okay and self-propelled the wheelchair with the feet. S1 is not aware of staff not assisting or laughing at the resident. On 6/23/2025, LPA Rai interviewed 1 resident (R1). R1 stated there were no issues with the incident that occurred on 6/5/2025. R1 stated he/she was smoking in the front area of the facility and staff asked if R1 needed assistance and R1 refused assistance. R1 stated no one was laughing at him/her and R1 has no issues with the facility staff. R1 stated the facility staff do protect his/her resident’s rights in the facility. Based on review of R1’s pre-assessment dated 6/4/2025, R1 requires escorting and/or physical assistance to attend meals and/or activities due to using a wheelchair. R1 is generally oriented to person, time and place. Based on review of R1’s addendum to LIC 602A dated 6/2/2025, R1 does not have unsafe wandering, lack of hazard awareness or lack of impulse control and R1 is able to leave the facility unassisted. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the Department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Executive Director, Slyvia Chu and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2025 · control 26-AS-20250617094056

Allegation investigated: Facility staff do not ensure the facility is free from pests. Facility staff engaged in food preparation and services are not observing personal hygiene and food services. Facility staff are not performing hand hygiene before and after resident care. The number of residents assigned to staff scheduled is unbalanced resulting in staff not meeting the care needs of residents in memory care unit. Facility staff left resident's undergarments soiled. Residents' bedrooms were observed unkempt.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Executive Director, Slyvia Chu and stated the purpose of today’s visit. On 5/22/2025, the Department received a complaint with the above allegations. On 5/30/2025, the Department conducted an initial investigation at the facility. On 6/23/2025, the Department conducted an additional investigation at the facility. Continuation on LIC 9099-C, Page 1 of 5. Unfounded Page 2 of 5. Facility staff do not ensure the facility is free from pests. It was alleged that the facility has an infestation of flying bugs. On 5/30/2025, LPA Rai toured and inspected the facility to include the common areas, resident bedrooms and kitchen. LPA Rai did not observe flying bugs in the facility. On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). S2 stated on 5/15/2025 there have been nats (flying bugs) observed in the building due to Santa Clara County not picking up the compost in the back of the building. S2 stated a third-party vendor, EcoLab was called into the facility to address the nats (flying bugs). On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 stated the facility has a trash compacter inside the building and the nats will come if trash is not taken out daily. The facility has the city pick up trash weekly and a secondary trash service to pick up the other 6 days of the week. Based on review of the EcoLab visit on 5/16/2025, there were no pest activity found in the facility and treatment was conducted in the facility. Facility staff engaged in food preparation and services are not observing personal hygiene and food services. It was alleged that there were half milk and almond milk left out in the lobby area. On 5/30/2025, LPA Rai toured and inspected the facility to include the common areas, resident bedrooms and kitchen. LPA Rai did not observe milk in the lobby area. LPA Rai did observe small packs of creamer, which can be left room temperature. On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated they did not observe milk in the lobby area. On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 stated there is no milk left in the lobby area. Page 3 of 5. Facility staff are not performing hand hygiene before and after resident care. On 5/30/2025, LPA Rai toured and inspected the facility to include resident rooms while staff were performing resident care. LPA Rai observed 1 staff member wearing gloves while providing care to resident. LPA Rai observed the same staff member taking off the gloves and disposing the gloves in a trash can with lid after performing care to the resident. On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated the staff are aware and trained on hand hygiene. Two out of two staff stated they have not seen or heard of staff not using proper hand hygiene before and after resident care. On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 stated the staff are trained in proper hand hygiene and S3 was able to verbally explain proper hand hygiene. S3 stated the facility has hand washing station near the elevator and in the main areas of the building. Based on review of staff training at random, four out of four staff are trained in the following topics which include but not limited to “All About Personal Protective Equipment”, “Hand Hygiene Basics” and “Infection Control” Essential Principles”. The number of residents assigned to staff scheduled is unbalanced resulting in staff not meeting the care needs of residents in memory care unit. On 5/30/2025, LPA Rai toured and inspected the facility to include the common areas, resident bedrooms and kitchen. LPA Rai observed 2 residents and 2 staff in the memory care unit. On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated the staff to resident ratio has been 1:1 or sometimes 2 staff to 1 resident. S2 stated to have assigned the shifts if there needs to be additional assistance with the residents. S2 stated medication technicians will assist with caregiver duties as well to provide care and supervision to the residents. Page 4 of 5. On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 stated there have been 1:1 staff to resident ratio and now with the increase of census the ratio has been 1 staff to 2 residents. Based on review of staff schedule for 05/11/2025 – 05/17/2025 in the memory care unit, every day (Sunday – Saturday) there is one assigned caregiver and one assigned medication technician for the morning shift and afternoon shift and two assigned caregivers for the night shift. On Sundays and Mondays, there is only 1 assigned medication technician for the afternoon shift and 1 assigned caregiver for the night shift. Facility staff left resident’s undergarments soiled. It was alleged in the memory care unit resident’s undergarments were left soiled during the night. On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated they did not see or heard of residents’ undergarments left soiled during the night. Two out of two staff stated they have not seen any notes made by the night care staff on issues of not providing care at night to the residents. On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 stated they did not see or heard of residents’ undergarments left soiled during the night. S3 stated they have not seen any notes made by the night care staff on issues of not providing care at night to the residents. Based on review of R1’s needs and services plan dated 4/30/2025, R1 has an indwelling urinary catheter and requires schedule for toileting and assistance to and from the bathroom; needs assistance with incontinent supplies, hygiene and/or changing linen. Based on review of R1’s bowel record and care provider night shift notes for the month of May 2025, R1 was assisted with toileting according to the schedule. Based on review of R2’s needs and services plan dated 5/7/2025, R2 requires schedule for toileting and assistance to and from the bathroom; needs assistance with incontinent supplies, hygiene and/or changing linen. Based on review of R2’s bowel record and care provider night shift notes for the month of May, R2 was assisted with toileting according to the schedule. Page 5 of 5. Residents’ bedrooms were observed unkempt. On 5/30/2025, LPA Rai toured and inspected the facility to include resident bedrooms. LPA Rai observed 2 rooms that were occupied and 2 out of 2 resident rooms were clean and kempt? On 5/30/2025, LPA Rai interviewed 2 staff (S1-S2). Two out of two staff stated the staff have been cleaning the resident rooms as well as the housekeeping staff. Two out of two staff stated there have been no issues with cleaning the residents’ rooms. On 5/30/2025, LPA Rai attempted to interview 2 residents (R1-R2), but residents refused to answer questions. On 6/23/2025, LPA Rai interviewed 1 staff (S3). S3 the staff have been cleaning the resident rooms as well as the housekeeping staff and there have been no issues with cleaning the residents’ rooms. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the Department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Executive Director, Slyvia Chu and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2025 · control 26-AS-20250522101130

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Simi Rai arrived announced to conduct the facility's pre-licensing visit. LPA met with Applicants, Terry Ervin & Joyce Aquino and stated the purpose of today's visit. There are no residents present on site. The facility has twenty (20) floors - floors four (4) to nineteen (19) consist of assisted living units, and floor three consist of memory care units. The facility has an approved fire clearance for 297 non ambulatory residents and 6 bedridden residents. Two out of two delayed egress doors were alarmed and in working condition. LPA Rai observed a pool outside in the outside patio area on the twentieth (20th) floor. LPA Rai observed two doors leading to the pool outside; one door in the activity room and one door in the hallway next to the gym. LPA Rai observed both doors had locks on them which opened the fob key access. Applicants Terry and Joyce stated the staff are able to restrict the resident's access on the system. LPA Rai discusses California Code of Regulation (CCR) 87307(e)(2)(A) which states the licensee shall ensure that the bodies of water specified above are inaccessible through fencing, covering, or other means when not in active use by residents. LPA toured the facility inside and outside including the apartments, bathrooms, kitchen, dinning room, stairwells and common areas. Resident rooms were equipped with proper furniture and lighting. LPA Rai observed the windows in the resident rooms and each window was restricted with bars on the side, the window opening up only approximately 5 to 6 inches. Facility temperature maintained at 73 degrees Fahrenheit. Bathrooms are equipped with grab bars, nonskid floors, hygiene supplies, and toiletry. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. Battery operated flashlights observed on-site. LPA Rai observed evacuation chairs on the 20th exit door in two of two stairwells. LPA Rai tested the carbon monoxide and smoke detector and it was in working condition. The fire extinguisher was inspected on 07/29/2024. LPA observed supplies of perishable and non-perishable supplies. Refrigerator temperature was maintained at 35 degrees Fahrenheit. Freezer temperature was maintained at 0 degrees Fahrenheit. The kitchen does not have resident access and is separate from the dining area. LPA Rai observed emergency food and water supply at the facility. Facility kitchen is equipped with cups, plates, utensils, and cooking supplies. Hot water temperature was measured between 105.8 to 119.7 degrees Fahrenheit in the resident bathrooms. The facility has designated medication rooms with locked medication cabinets. LPA observed first aid kit with the following supplies: bandages, scissors, tweezers, and thermometer. The following posters observed to include the emergency telephone numbers, personal rights, RCFE compliant poster, complaint information, Rights of Resident Councils and Personal Rights of Residents in All Facilities. COMP III was reviewed and completed with Applicants, Terry Ervin & Joyce Aquino. No issues noted during this pre-licensing inspection. LPA observed the facility is ready to be licensed. However, this report will be submitted to the Central Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. This report was reviewed with Applicants, Terry Ervin & Joyce Aquino and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 5, 2025