Fountainview at Eisenberg Village

Allegation investigated: Staff are not providing adequate food service to resident Staff are not meeting resident's needs

Licensing Program Analyst (LPA) Quoc Huynh conducted an initial complaint visit for the above allegations. The LPA arrived at 1:23PM and met with Executive Director (ED) Kathleen Glass and Director of Health Services (DHS) Clarissa Townes. Entrance interview conducted. Between 1:48PM and 2:13PM, the LPA conducted a physical plant tour, interviewed one (1) resident, and reviewed and obtained pertinent documents. The following was then determined: Report Continued on LIC 9099-C Unfounded Allegations: “Staff are not providing adequate food service to resident” and “Staff are not meeting resident's needs” It was reported that a staff was not assisting Resident #1 (R1) with meals and was not attentive to R1’s needs. Interview with R1 confirmed that the staff is not associated with the facility and is a private caregiver. They further reported that the private caregiver is “difficult, not nice, and mean” in addition to not treating R1 gently. R1 did not have concerns about their assistance with meals and stated that the facility provides adequate meals throughout the day. Record review confirmed the private caregiver is not directly employed by the facility. Based on the information obtained, the allegations are deemed UNFOUNDED at this time. A finding of unfounded means that the allegations are either false, could not have happened, and/or are without a reasonable basis. The LPA, ED, and DHS had a discussion on following up with the appropriate agency that employed the private caregiver and they agreed. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Jul 7, 2026 · control 29-AS-20260703095137

Allegation investigated: Staff mismanage resident's medication

At 10:00 A.M, Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced 10-day complaint investigation visit to the facility listedabove. LPA met with Executive Director (ED), Kahtleen Glass and Director of Health Care Services, Clarissa Townes and the reason for the visit was explained. Entrance interview conducted. During today's visit, the LPA conducted a physical plant tour of the community starting at approximately 10:50 A.M. Between 10:15 A.M. and 1:30 P.M. LPA interviewed the the ED, the Director of Heath Care Services, the Med Tech on duty, Resident #1’s (R1’s) family members, a private caregiver and the Kaiser Hospice Registered Nurse (RN). Additionally, LPA gathered copies of pertinent documents. Throughout the course of the investigation, the LPA reviewed all documents obtained and the following was then determined: Continued from LIC 9099-C Unsubstantiated Continued from LIC 9099 Regarding allegation of “Staff mismanage resident’s medication” it was reported that during a routine hospice visit, the Kaiser Hospice Registered Nurse (RN) observed that liquid morphine drawn from the medication bottle appeared altered, noting a difference in color and a fruity odor. Interviews conducted with family members stated that R1 receives hospice care and 24-hour care from several private caregivers in addition with support from facility's care staff. They expressed satisfaction with services provided by this facility. Family members revealed that R1’s medication are not stored, safeguarded, or managed by the facility. Interview with the RN revealed that R1 has been receiving hospice services at this facility for approximately two (2) years. The RN stated that throughout that time there have been no previous concerns regarding missing or tampered medications and confirmed that facility staff have not been responsible for storing, safeguarding, refilling or administering R1’s medication. Interviews with the ED and the Director of Health Care Services confirmed that R1’s medications are managed and dispensed by Kaiser hospice personnel and are not maintained by the facility and/or facility staff. Adding, that facility has a list of medication on file for R1; however, facility does not maintain records of medication administration or dosages dispensed for R1. Based on interviews conducted, all parties consistently reported that facility staff are not responsible for the storage, safeguarding, or administration of R1’s medication. Records reviewed revealed that R1 receives 24 hour one-to-one (1:1) care provided by caregivers hired by the family. Medication management responsibilities are overseen by R1's designated Power of Attorney (POA). There was insufficient evidence to support the allegation or that a violation occurred; therefore, the allegations “Staff mismanage resident’s medication” is deemed unsubstantiated at this time. Exit interview conducted. No citations issued. A copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 10, 2026 · control 29-AS-20260602181714

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived unannounced at 9:36AM for a required one-year visit. The LPA met with the Executive Director (ED) Kathleen Glass and Director of Health Services (DHS) Clarissa Townes and explained the reason for the visit. Entrance interview conducted. At 10:15AM, the LPA, ED, Business Administrator, and Director of Maintenance toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and facility is in compliance with Title 22 Regulations. The following was observed: RESIDENT ROOMS: The LPA observed ten (10) randomly selected rooms on four (4) floors and no immediate health or safety hazards were observed. Appropriate furniture was also observed in each unit. Restrooms were clean, with properly installed grab-bars in resident bathrooms and non-skid strips in shower tubs. Water temperature was tested throughout the units and measured between 115.3 degrees F and 120 degrees F, which is within the required range. At 11:03AM, the LPA tested the facility’s call system pendant with staff response at 11:05AM. Report Continued on LIC 809-C COMMON AREAS: The facility had five (5) total floors. The basement contained the parking garage, theater, and emergency food and water. The first floor contained resident apartments, fitness center, spa, lobby/concierge, library, coffee bar, business offices, events center, creative arts room, private dining room, lounge, dining room, and kitchen. The second, third, and fourth floors each had resident apartments and lounges. LPA Huynh observed common areas to be clean, clear of obstructions/hazards, and furniture were in good condition. Required postings were observed in the lobby. KITCHEN: The facility’s commercial kitchen was inspected and found to be in compliance with Title 22 regulations. Facility uses third party vendors and receives general food deliveries three (3) times a week and protein deliveries daily. There was a sufficient supply of perishable and non-perishable food. The LPA observed the walk-in refrigerator and freezer; food appeared to be of good quality and labeled with expiration dates. Kitchen sinks had signage of tap water delivering above 125 degrees F. MEDICATION: Medication review began at 11:36AM. The LPA reviewed medications for six (6) residents. Medications were maintained inaccessible to residents in the medication room located on the fourth floor. Resident medications reviewed were documented and stored in compliance with regulation at this time. OUTDOOR AREA: The facility’s outdoor area consisted of four (4) courtyards with one (1) water fountain. The facility also shares outdoor space with Eisenberg Village and a Nursing School. Residents have the option of utilizing the common spaces offered at the connected facility. The exterior perimeter was secured with gates and held multiple emergency exits. All passageways were clear of obstructions. Report Continued on LIC 809-C RECORDS: Record review began at 12:41PM. LPA Huynh reviewed ten (10) resident records for, but not limited to admissions agreements, medical assessment, appraisals, and consent forms. Seven (7) residents did not have consent forms, and four (4) residents did not have signed personal rights. The ED and DHS stated they plan to provide all residents with new forms to complete. The LPA reviewed ten (10) personnel records for, but not limited to job application, health assessments, TB results, criminal record statements and clearances, first aid/CPR certification, and appropriate training. Two (2) direct care staff annual training reviewed did not include dementia, hospice, postural support, and restricted health condition topics. The LPA and ED reviewed training regulations including topics and hours. The LPA advised the ED to ensure training hours are also disclosed on all training documents. INFECTION CONTROL/EMERGENCY DISASTER: The LPA reviewed the facility's Infection Control Plan and Emergency Disaster Plan. LPA noted that the facility is in compliance with regulation with both plans reviewed annually. The facility conducts emergency disaster drills as required, with the last drill documented on 11/29/2025. There were fire extinguishers throughout the facility, which were serviced on 01/30/2025. Fire alarm system is tested annually with the last inspection on 11/24/2025 by AB&A Fire Protection. Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiencies were cited (Refer to 809-D). Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.the state’s words, verbatim · CDSS document, Jan 21, 2026

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit at 09:45am. Upon arrival LPA was greeted by front door receptionist, explained the reason for the visit and to inform their Administrator. LPA met with Executive Director Adam Pena and Clarissa Townes Director of Health care services the reason for the visit was explained. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At approximately 10:37am LPA inspected nine (9) randomly selected bedrooms (RM 100, RM 108, RM 110, RM 202, RM 310, RM 317, RM 321, RM 425, RM 429) throughout the four (4) occupied floors. The resident bedrooms were properly furnished with a bed, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Restrooms: The resident restrooms appeared clean, sanitary and in operating condition with grab bars and non-slip surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared in the private rooms. From 10:59 am – 12:02 pm the hot water was measured in all rooms and ranged between 110.0 – 120.4 degrees Fahrenheit all within the required range. At 11:23am, LPA activated a resident pendant, and observed staff respond in approx. 1 min by phone call to the resident’s room. It was noted that the policy is to call the resident rooms first to check if assistance is needed or if it was an accidental call. If the resident does not answer the call staff typically respond within 5 minutes. During the inspection LPA observed, evacuation chairs in each stairwell. (PAGE 1)(Report Continued on LIC 809C PAGE 2...) (PAGE 2)(Report Continued from LIC 809C PAGE 1...) LPA inspected the kitchen/food service area and observed that knives are kept inaccessible to residents in care. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. LPA inspected the common areas throughout the facility inside and out. All areas have been appropriately furnished. The common areas were observed to be properly furnished and relatively clean at the time of the visit. LPA observed sanitizer readily available in areas with high touch surfaces. Dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were observed throughout the facility, fully charged and last serviced Jan, 31, 2024 and are scheduled for service on Jan. 30 2025. LPA observed all required postings throughout the facility. The Administrator provided the fire protection equipment performance report dated 07/18/2024 where all smoke alarms and carbon monoxide detectors were tested and functioned properly. The last emergency disaster drill took place on 12/23/2024 and conducted quarterly reflecting all shifts scheduled. On the basement level, LPA observed a movie theater, two (2) locker room areas for male and female employees along with a food storage pantry. Additional non-perishable foods were also observed in the food storage pantry. The parking garage was accessible from the basement but locked from the outside and monitored by security. LPA observed an adequate supply of emergency food and water stored in this area. LPA did not observe any obstructions or hazards during the visit. Resident Records and Personnel records were reviewed from approx. 11:51 am – 1:30 pm. LPA Mosley reviewed Resident Records at approx. 11:51 a.m. Ten (10) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files in order at the time of the visit. (PAGE 2)(Report Continued on LIC 809C PAGE 3...) (PAGE 3) (Report Continued from LIC 809C PAGE 2...) At approx. 12:38 pm Eight (8) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. All files in order at the time. Medications review began at approximately 1:50pm The medications are centrally stored in a med room on the fourth floor inaccessible to residents in care. Medication assistance is provided to eight (8) residents at this time. LPA conducted a medication review on six (6) randomly selected residents. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. No errors observed during review. Infection Control / Emergency disaster planning: During today’s visit the LPA Mosley reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate. Daily vehicle Inspection report was reviewed for facility vehicles. All records were in order. LPA conducted seven (7) resident and seven (7) staff interviews from approx. 10:55am- 2:04 pm. Staff interviews revealed that staff are knowledgeable in resident rights, different forms of abuse and reporting procedures. Resident interviews revealed that no concerns were noted or voiced at the time of the visit. LPA obtained the following documents – Census, Staff schedule, Emergency Disaster plan and updated Limited Liability insurance. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 23, 2025

Allegation investigated: Facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections

Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit regarding above allegation. Upon arrival LPA met with Administrator Adam Pena and Director of Health Services Clarissa Townes. Reason for visit was stated. Following is a summary of the allegations and investigation findings: Regarding allegation, “Facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections” – It was alleged that a caregiver is providing medication injection to resident #1. On 04/24/20224, Community Care Licensing Division (CCLD) received a complaint with the above allegation. Investigation was initiated on 05/01/2024, a physical plant tour was conducted, and allegation was discussed with administrator. Resident roster and private caregiver list was obtained. A subsequent visit was conducted on 07/17/2024 and 11/21/2024. Interviews were conducted with (10) residents, (3) staff and potential witnesses. Additional interviews were conducted by phone on 07/24/2024 and 07/25/2024. (Continue to LIC 9099c) Unsubstantiated According to the Director of Health Care Services Maria Rona Perez. Facility caregivers and private caregivers are not allowed to provide any type of injection to resident. Executive Director (ED) Adam Pena stated that the facility does have a nursing staff and only a skilled professional would provide injections. Facility staff and private caregivers interviewed reported that they do not provide any injection to residents. Resident #1 (R1) was interviewed and confirmed handling own medications and is not on the facility med-management program at this time. Ms. Perez also confirmed that R1 is not on facility’s med-management program at this time and is not receiving any injections. Centrally stored medication records reviewed did not show R1 on any injections. Ten out ten random residents interviewed did not report any issues or concerns with the facility. All ten residents interviewed stated that they administer their own medications. Ms. Perez stated that they arrange a meeting with the resident, and families, when there is significant change in the resident’s condition, and once every 6 months to determine level of care change including but not limited to med-management. Mr. Pena and Ms. Perez both denied the allegation and stated that they are not aware of any caregiver or private caregiver assisting resident with injections. Mr. Pena stated that they will remind all staff, private caregivers, residents, and families of the facility policy regarding medications specifically “injections” which are to be provided only by the skilled professional (facility nurse). Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections” is deemed UNSUBSTANTIATED at this time.the state’s words, verbatim · CDSS document, Nov 21, 2024 · control 29-AS-20240424152441

Allegation investigated: Facility staff did not comply with reporting requirements.

Licensing Program Analyst (LPA), Valeria Conway conducted unannounced subsequent complaint investigation for the above allegation. LPA met with Executive Director (ED), Adam Pena, and Director of Health Service, Maria Ronna Perez, and explained the reason for the visit. During the initial complaint visit conducted on 7/25/24, LPA conducted interviews with the Executive Director and Nurse Director at 11:15 a.m. and 11:30 a.m.,. Additionally, during the visit LPA obtained resident records and other pertinent documents relevant to the investigation. On 08/16/2024, between 9:00 A.M. and 11 A.M, LPA conducted interviews and gathered other relevant documentation. On 8/16 at 9:59 a.m, LPA also interviewed Resident #1 (R1) and R1’s Responsible Parties (RPs). Conitinues on LIC 9099-C Unsubstantiated Continued from LIC 9099 Allegation “Staff did not comply with reporting requirements:” The complaint alleged that the facility staff did not comply with reporting requirements as they failed to notify the residents responsible party when the resident was sent to the hospital/Emergency Room (ER). Interviews conducted and records reviewed reflected that facility staff follows their protocol for reporting requirements and notifies all parties including but not limited to residents RPs, Community Care Licensing (CCL), and Long-Term Care Ombudsman (LTCO). Moreover, interviews conducted with R1’s RPs reflected that two (2) out of the three (3) RPs are notified of anything related to R1 and it is the family’s responsibility to communicate between the RPs. LPA did not find any documentation specifying who the facility should notify or a specific order of who to contact in case of emergency. However, facility ED agreed to ensure all three (3) RPs are informed of any future incident related to R1. Based on interviews and record review, the Department does not have sufficient evidence to determine that the staff did not comply with reporting requirements. Therefore, the above allegation is deemed UNSUBSTANTIATED at this time. No deficiencies cited. Exit interview conducted. Copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 26, 2024 · control 29-AS-20240719154743

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Brian Balisi and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at 09:30am. Upon arrival LPAs met with Executive Director Adam Pena and explained the reason for the visit. The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The LPAs began the inspection in the kitchen/food service area. Knives are kept inaccessible to residents in care. Kitchen appliances were observed to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. LPAs inspected the common areas throughout the facility inside and out. All areas have been appropriately furnished. The common areas were observed to be properly furnished and relatively clean at the of the visit. LPA observed appropriate signage regarding infection control posted throughout the facility. LPA observed sanitizer readily available in areas with high touch surfaces. Dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were observed throughout the facility, fully charged and were last serviced Jan, 31, 2024. At approximately 10:07am LPAs inspected nine (9) randomly selected bedrooms throughout the four (4) occupied floors. The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPAs observed all bathrooms in each resident bedroom were clean, properly supplied and had functional fixtures. continued from 809 At approx. 10:11am, LPAs observed the water temperature above 120 degrees Fahrenheit in four (4) resident bathrooms on the first floor. Maintenance staff lowered temperature during the inspection. At approx. 1pm, LPA observed the water temperature to still be above 120 degrees Fahrenheit. The hot water was measured in each bathroom within 105 - 120 degrees Fahrenheit from the second floor to the fourth floor. Resident bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. At 10:19am, LPAs activated a resident pendant, and observed staff respond in approx 5 mins. During the inspection LPAs observed, evacuation chairs in each stairwell. On the basement level, LPAs observed a movie theater, two (2) locker room areas for male and female employees along with a food storage pantry. LPAs observed a sufficient supply of PPE stored in the storage pantry. Additional non-perishable foods were also observed in the food storage pantry. The parking garage was accessible from the basement, but locked from the outside and monitored by security. LPAs observed an adequate supply of emergency water stored in this area. LPAs did not observed any obstructions and hazards during the visit. Records review began at 11:28 am, six (6) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. At 1pm, six (6) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were observed to be in order at this time. Last emergency disaster drill was conducted in April of 2023. Executive Direcotr stated emergency disaster drill will be conducted before the end of the month. Medications review began at approximately 1:00pm The medications are centrally stored in a med room on the fourth floor inaccessible to residents in care. Medication assistance is provided to nine (9) residents at this time. Medications are properly documented on the centrally stored medications and destruction record. Infection control: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of a communicable disease. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. Continued from 809-C The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate each resident bedroom as a single isolation rooms if the facility has a confirmed case of a communicable disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time. Between 11am - 03:00pm the LPAs interviewed six (6) staff members and six (6) residents. LPAs obtained the following documents - Census, Staff schedule, Emergency Disaster plan and updated Limited Liability insurance. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 8, 2024