Fremont Hills

Type of visit: Case Management - Incident

On 04/23/2026 at 10:00 AM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported death report. The facility sent in a death report on 04/22/2026. LPA met with Executive Director (ED), Beena Kumar, and explained the purpose of the visit. Death Report (LIC624A) indicated that on 04/22/2026, Resident 1 (R1) was found unresponsive by S1. S1 and S2 called 911 and CPR was performed until arrival of paramedics. During the visit, LPA reviewed and obtained the following documents included but not limited to facility’s incident report, facility's observation notes, resident's physician report, resident's assessment, and appraisal needs and services plan. LPA also conducted interviews with 6 staff members and ED. LPA will be requesting for a death certificate and police report by 05/07/2026. LPA may return at a later time. No deficiency cited during today’s visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 23, 2026

Allegation investigated: Staff did not attend to residents' care needs in a timely manner

On 03/16/2026 at 1:35 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to deliver the findings on the above allegation. LPA met with Business Office Director, Mimi Co, and explained the purpose of the visit. Executive Director, Beena Kumar, was not available during this time. During the course of investigation, LPA interviewed staff, residents, and witnesses. LPA obtained and reviewed documents including but not limited to Personnel Report (LIC500), Resident Roster, Staff Schedule, Staff Contact Information, Facility’s Resident Alert Call System, Facility Call Button Log, physician report, Identification and Emergency Information, service plan, resident move in record, and physician communication fax log. Continue to LIC9099-C… Unsubstantiated Continued from LIC9099… Allegation: Staff did not attend to residents' care needs in a timely manner It was alleged that Staff did not attend to residents' care needs in a timely manner. Based on interviews conducted, 6 of 7 residents stated that they have call buttons that they can use if they need staff assistance and have no issues during the daytime with staff responding. Interview with R1 indicated that when R1 uses the call button, staff will take approximately 5-7 minutes to respond. Additionally, interviews with 7 of 8 staff members all revealed that residents may use their pendant for assistance and it will notify the staff through their radio. 7 of 8 staff members stated that the average time to respond to the residents’ call could vary between 5 minutes to 20 minutes. S3, S4, and S6 indicated that when they are busy helping a resident and another resident requests for assistance, other staff members can assist with that request. Interview with W1 revealed that W1 had no issues with the call button when R8 was living in the facility and W2 stated that in the past R4 had issues with the call button response time, however, the issues has been resolved since then. A review of the facility call log report dated 12/04/2025 showed that R1 used the pendant and waited approximately 4 minutes for staff to respond to R1’s call. All the other dates pertaining to R1’s calls had a response time of less than 2 minutes from the dates 12/08/2025 to 12/19/2025. Based on interviews and record reviews conducted, the above allegation is 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. There is no deficiency noted. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 16, 2026 · control 15-AS-20251209152603

Type of visit: Case Management - Incident

On 03/16/2026 at 2:20 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit to follow up on the incident reports sent on 03/06/2026. LPA met with Business Office Director, Mimi Co, and explained the purpose of the visit. Executive Director, Beena Kumar, was unavailable during today's visit. Incident Report (LIC624) for R1 indicated that the incident occured on 02/20/2026 and R2's incident occured on 02/24/2026. Both R1's and R2's Incident Report was reported to the Department on 03/06/2026. Facility did not follow the reporting requirements. LPA and Co discussed the reporting requirements regulation. During the visit, LPA reviewed and obtained Resident Roster, R1's service plan dated 01/20/2026, R2's service plan dated 01/20/2026, and R2's physician fax reports. Per Co, R2 did not return back from the hospital and passed away on 03/14/2026. LPA is requesting for the facility to send R1's after visit summary from the hospital and R2's death certificate by 03/25/2026. LPA may return at a later time. A Technical Violation has been issued for Reporting Requirements, Section 87211(a)(1). No deficiencies cited. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 16, 2026

Type of visit: Case Management - Incident

On 12/15/2025 at 2:30 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported death report. The facility sent in a death report on 12/12/2025. LPA met with Executive Director (ED), Beena Kumar, and explained the purpose of the visit. Death Report (LIC624A) indicated that Resident 1 (R1) had a change in condition and was taken to the Emergency Room per Kaiser Advice Line on 12/08/2025. On 12/10/2025, R1 passed away at the hospital. During the visit, LPA reviewed incident report, death report, R1's service plan, physician report, observation notes, and physician communication log. Observation Notes and facility incident report dated 12/04/2025 revealed that the paramedics came on 12/04/2025 to assessed R1. It also revealed that the Power of Attorney (POA) refused to send R1 to the hospital. A review of the physician communication log dated 12/04/2025 showed that the facility communicated with R1's physician due to R1's change in condition. LPA will be requesting for a death certificate from the facility. LPA may return at a later time. No deficiencies cited. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 15, 2025

Type of visit: Required - 1 Year

On 10/30/2025 at 8:40 AM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Executive Director, Beena Kumar and explained the purpose of the visit. LPAs toured the facility inside and out including but not limited to 7 residents' apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPAs observe lighting in all rooms is adequate for the comfort and safety of the residents. Hallway temperature was maintained at 73 degrees F. The hot water temperature in a sample of residents’ shared bathroom was measured at 105, 106.3 109.2, 110.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid shower pans. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Smoke detectors, fire alarm, and carbon monoxide detectors were last tested on 08/15/2025 by Cintas. Fire extinguisher was last serviced on 06/06/2025. First aid kit was observed to be complete. Fire drills were last conducted on 09/18/2025. At 10:00 AM, LPAs reviewed 6 staff records and 6 of 6 are associated to the facility. At 12:40 PM, LPAs reviewed 6 residents records. At 2:30 PM, LPA reviewed two samples of residents’ medications. Continue to LIC809-C... Continue from LIC809... Updated copies of the following document were requested for facility file and are to be submitted to CCL by 11/07/2025: LIC 500 Personnel Report THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:30 AM, LPAs observed R7's toilet, window blinds, and shower soap bar holder in disrepair. At 11:38, LPAs observed R3 and R4 with a paper towel holding the emergency call light button up. At 10:39 AM, LPAs observed 3 tubs of paint in R1's room. LPA observed Lysol wipes and cleaning spray in R2's room. At 10:44 AM, LPAs observed the tool shed unlocked in the courtyard of the memory care unit. At 10:56 AM, LPAs observed Antibacterial Bissell, Alcohol Antiseptic, staff eyedrop in the backpack, etc. in the memory care unit dining hall. At 11:00 AM, LPAs observed expired sesame sauce, soy sauce, Hershey chocolate powder, etc. At 3:30 PM, LPAs observed that the facility did not have the current liability insurance on file. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Executive Director. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 30, 2025

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

On 10/22/2025 at 12:00 PM, Licensing Program Analysts (LPAs) P.Manalo and K.Nguyen conducted an unannounced Case Management visit regarding a self-reported incident report. Executive Director, Beena Kumar self-reported the incident on 10/15/2025. LPAs met with Judith Gitonga and explained the purpose of the visit. Executive Director was unavailable during today's visit. LPA P.Manalo received a self-reported incident report from facility that indicated that R1 was given a medication in error of an additional dosage that occured on 10/09/2025. During the visit, LPAs interviewed Staff 1 (S1) and Staff 2 (S2) regarding the medication error. S2 admitted there was a medication error due the change of medication dosage after the medication was refilled by the pharmacy. LPAs will be requesting for the following documents such as hospice's Patient Care Order, Medication Administration Record (MAR), Medication Order Summary, Resident Roster, Staff Contact Information, and Narcotic Log by 10/30/2025. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Gotinga. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 22, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Oct 30, 2025

87468.1(a)(2) Personal Rights of Residents in All Facilities (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced: Based on interviews, the licensee did not comply with the section cited above by giving R1 the wrong medication dosage which posed a potential safety risk to person in care.the state’s words, verbatim · CDSS document, Oct 22, 2025

Plan of correction: The Executive Director agrees to do a medication in-service training and send proof to CCLD by POC date.

Type of visit: Case Management - Incident

On 10/22/2025 at 2:05 PM, Licensing Program Analysts (LPAs) P.Manalo and K. Nguyen conducted an unannounced Case Management visit regarding a self-reported incident. Director of Health and Wellness, Judith Gitonga, self-reported the incident on 10/21/2025. LPAs met with Judith Gitonga and explained the purpose of the visit. Executive Director was unavailable during today's visit. LPA P.Manalo received a self-reported incident report from facility that indicated that the Resident 1 (R1) was taken to the hospital for unwitnessed fall and R1 was treated for a hip fracture. R1 had hip surgery and is in a skilled nursing for recovery. The facility will reassess R1 before returning to the facility. During the visit, LPA interviewed Gitonga and stated that R1 had fell in R1's room. LPAs will be requesting for the following documents such as R1's physician's report, previous and new full care plan, staff schedule, progress notes, and care log for R1 by 10/30/2025. LPAs may return at a later time. No deficiencies cited during visit. Exit interview was conducted with Director of Health and Wellness and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 22, 2025

Type of visit: Case Management - Health Checks

On 08/28/2025 at 4:05 PM, Licensing Program Analyst (LPA) P. Manalo conducted a Health & Safety inspection as a result of a priority 1 complaint. LPA met with Director of Health and Wellness , Judith Gitonga and explained the purpose of the visit. Executive Director, Beena Kumar, gave authorization for Gitonga to sign the report. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and courtyard area. Hot water temperature was measured at 109.9, 109.5,112.1, 113.4, and 112 degrees Fahrenheit residents’ bathroom. Residents’ bathrooms are equipped with grab bars and non-skid shower pans. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. First-aid kit was complete. Fire extinguisher was observed to be full and last serviced on 06/06/2025. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 4:46 PM, LPA observed Fluticasone Propionate Nasal Spray and medication syrup on top of the medication cart unsupervised by staff. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 28, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Aug 29, 2025

87309(a) (a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances...locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having Fluticasone Propionate Nasal Spray and medication syrup on top of the medication cart unsupervised by staff which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 28, 2025

Plan of correction: The Executive Director agrees to self certify the regulation and send proof to CCLD by POC date.

Allegation investigated: Staff does not treat resident with respect and dignity Staff did not provide assistance to a resident in a timely manner

On 07/22/2025 at 12:35 PM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to deliver finding on the above allegations. During the course of investigation, LPAs P. Manalo and and L. Fontanilla conducted interviews with 5 residents and 5 staff. LPA P.Manalo obtained the following documents such as the Resident Roster, Staff Schedule, Residents' Service Plan Report, Physician's Report, Rcare Call Volume by Hour Report dated for 03/24/2025 to 03/25/2025, Rcare Incident List Report dated 03/25/2025- 03/26/2025, Hospice Information and facility's Resident Alert Call System policy. Continue to LIC9099-C... Unsubstantiated Continue from LIC9099... Allegation- Staff does not treat resident with respect and dignity. It was alleged that Staff 3 (S3) yelled at R1 when asked for assistance and that S3 would leave R1’s diaper in the trash can beside R1’s bed without lining the basket with a trash bag. 4 out of 5 residents interviewed stated that the staff are nice and that they receive good care at the facility. R5 stated that when they call for help at night, R5 can fall asleep after receiving care. Interview with S2 indicated that it’s rare for S2 to observe wet diapers in the beginning of their shift on the resident and in the resident’s room, however, it could be a possibility that staff would forget to pick it up. LPA attempted to interview S3 and S4 and did not receive any call back. 3 out of 5 staff members interviewed expressed that they have not heard any other staff members speak to residents rudely. Allegation: Staff did not provide assistance to a resident in a timely manner. Based on interviews conducted with residents, each resident is provided with a call button or pendant that can be utilized to call staff, if needed. R1 stated that when R1 needed assistance at night, S3 and S4 took a long time to arrive to R1’s room for assistance. S1 also stated that during night shifts, the staff are supposed to attend to resident’s calls together. Interview with R5 indicated that when R5 needs assistance at night, R5 will use the call button and have not experienced any issues with the care at night. Also, 4 out of 5 residents interviewed stated that staff will assist them when needed. Staff interviewed revealed that when residents need assistance, staff will receive a radio call from which resident and room needs to be tended to. If a staff member was unable to attend the call, they will reach out to another staff member that is available to respond to the resident. Continue to LIC9099-C... Continue from LIC9099-C... A review of the facility’s call log dated 03/25/2025 during the night shift between 1:00 AM to 4:30 AM showed that the response time varied from three seconds to about three and a half hours. S1 stated that during this time the system was having computer issues and could not clear the calls. Staff were able to reset the system at around 5:30 AM on 03/25/2025. After the computer issues were resolved, the response time for when residents would call for assistance varied from seconds to about twelve minutes that night. Although a review of the facility’s Resident Alert Call System policy dated 06/01/2025 does not indicate a response time, interviews with S6 and S7 revealed that staff will attempt to respond within 10 to 15 minutes of a residents’ call. There is no deficiency noted. Based on interviews and record reviews conducted, the above allegation is 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 and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 22, 2025 · control 15-AS-20250325125744

Type of visit: Case Management - Other

On 07/22/2025 at 1:20 PM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to conduct a case management visit. LPA met with Executive Director, Beena Kumar, and explained the purpose for the visit. While LPA P.Manalo was at the facility for a complaint investigation (15-AS-20250325125744) the following deficiency was observed. During the complaint investigation, LPA observed that the call button response time showed there were several incidents where the residents waited for more than 30 minutes for staff assistance. Interview with staff revealed that the facility’s call button system was in disrepair and staff were unable to clear the residents’ call. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report, civil penalty, and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 22, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Aug 5, 2025

87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above by having the call button system in disrepair which posed a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 22, 2025

Plan of correction: The Executive Director agrees to send a log of all the shifts testing the call button system for two weeks and send proof to CCLD by POC date.

Type of visit: Case Management - Incident

On 06/05/2025 at 2:25PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. Director of Health and Wellness, Judith Gitonga, self-reported the incident on 06/02/2025. LPA met with Judith Gitonga and explained the purpose of the visit. LPA P.Manalo received a self-reported incident report from facility that indicated that the Resident 1 (R1) was taken to the hospital for upper leg pain from an unwitnessed fall on 05/29/2025. R1 was treated for a hip fracture. R1 had hip surgery on 05/30/2025 and is in a skilled nursing for recovery. The facility will reassess R1 before returning to the facility. During the visit, LPA reviewed and obtained R1's Physician's Report, Emergency ID Contact Information, Admission Agreement, Service Plan, and the facility's Fall Reduction Program. Admission Agreement showed that the resident was recently admitted to the facility on 05/26/2025. Prior to the resident's fall, the resident was already placed as a fall risk on the service plan for having multiple falls in the last 3 months. However, R1's Physician's Report dated on 05/05/2025 showed that the resident is bedridden. Since R1 is new to the facility, R1 was placed on an hourly check in. LPA may return at a later time. No deficiencies cited during visit. Exit interview was conducted with Director of Health and Wellness and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 5, 2025

Type of visit: Case Management - Other

On 04/16/2025 at 1:55 PM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen conducted an unannounced Case Management Visit. This is a follow up visit that was conducted on 03/14/2025 regarding an incident that was reported to CCLD on 02/27/2025 indicated that Resident 1 (R1) obtained a wound while in the hospital. LPAs met with Interim- Executive Director, Vivian Villegas, and explained the purpose of the visit. The documents that were obtained from the first Case Management visit showed that R1 was discharged from the hospital on 02/25/2025 and was placed on hospice on 03/05/2025. Moving forward, the facility will notify CCLD prior to admitting residents with prohibited or restrictive health conditions. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 16, 2025

Type of visit: Case Management - Other

On 03/27/2025 at 1:38 PM Licensing Program Analysts (LPAs) P.Manalo and L. Fontanilla conducted an unannounced Case Management visit. LPAs met with Interim- Executive Director, Vivian Villegas, and explained the purpose of the visit. While LPAs was at the facility to conduct a complaint investigation (15-AS-20250325125744), LPAs observed construction being done on the front patio in front of the facility. Upon verification made with Interim- Executive Director, she stated that they are working on constructing on 19 residents patios. Vivian stated that this project has been in the plan for over a year, and just got approved with a building permit. Interim- Executive Director was unsure if the construction was reported to CCLD. LPAs obtained the following documents such as building permit, plan of the renovations, and letter to family members notifying the construction. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: Case Management - Incident

On 03/14/2025, at 2:15 PM Licensing Program Analysts (LPAs), P. Manalo and K. Nguyen arrived unannounced to conduct a case management following up an incident that was reported to CCLD on 02/27/2025 regarding R1 obtaining a wound while in the hospital. LPAs met with Director of Health and Wellness, Judith Gitonga, and explained the reason for the visit. LPAs reviewed R1's Physician's Report dated 2022, 2023, and 2025, Senior Living Standard Level of Care and Service Plan, Service Plan Report, Watermark Assessment, Elopement Risk Screening, Outside Agency Documentation, Progress Notes, and Discharge Summary. LPAs interviewed S1 and indicated that they had done an assessment prior to the resident returning back to the facility. LPAs are requesting to obtain Staff Contact information, Staff Schedule, Previous Service Plan Reports, and other notes pertaining to R1's injury (Caregiver's Notes) by 03/19/2025. LPAs will return at a later time. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 14, 2025

Allegation investigated: Staff do not ensure resident has privacy in their room.

On 12/13/2024 at 10:30 AM, Licensing Program Analyst (LPA) James Sampair arrived unannounced to conduct this initial 10-day complaint investigation concerning allegations above. LPA met with Interim Executive Director (IED) Vivian Villegas and informed her of the allegations. The complaint alleges staff do not ensure resident has privacy in their room. The LPA interviewed Witness W1, Residents R2 and R3, Staff Members S1 and S2, and Vibrant Life Director Jessica Doerr. The data collected confirms the allegation that staff members are not ensuring resident privacy. Continued on LIC 9099-C . . . Substantiated ....Continued from LIC 9099 The complaint alleges staff do not ensure resident's personal belongings are safeguarded. The LPA interviewed Witness W1 who stated that Resident R1's belongings had not been stolen or removed from their room. They had been placed in a different location in their room than R1 was used to them being located. The data collected does not confirm the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided. ...Continued from LIC 9099 A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099-D. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 13, 2024 · control 15-AS-20241203124531

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Dec 20, 2024

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) … residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, … and meetings of resident and family groups. This requirement is not met as evidenced by: Resident statement, "They may knock, but then do not wait long enough for me to tell them to come in. It doesn't respect my privacy when they do that."the state’s words, verbatim · CDSS document, Dec 13, 2024

Plan of correction: On or before the due date, the Administrator shall inform CCLD that the entire staff have been retrained on on resident personal privacy.

Type of visit: Required - 1 Year

On 11/15/2024 at 8:30 AM, Licensing Program Analysts (LPAs) P. Manalo and J. Sampair arrived unannounced to conduct the Required Annual inspection. The LPAs met with Generations Program Director, Molly Young, and explained the purpose of the visit. The facility’s fire clearance was approved for one hundred and forty (140) all may be non-ambulatory, of which ten (10) may be bedridden, and ten (10) may be on hospice. The LPAs toured the facility with the Director, including, but not limited to, residents' apartments, bathrooms, multiple activity rooms, kitchen, common area, and courtyard. The LPAs observed that the lighting in all rooms is adequate for the comfort and safety of the residents. The residents' room temperature was maintained at 70 degrees Fahrenheit. The hot water temperature in a sample of residents’ shared bathroom was measured at 109.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of one week supply of nonperishable and 2 days of perishable foods. Centrally stored medications, sharps, and toxic cleaning materials are locked and inaccessible to residents in care. Fire extinguishers were last serviced on 06/06/2024. Emergency Disaster Plan was last reviewed on 11/15/2024. First aid kit was observed to be complete. Fire drill was last conducted on 08/27/2024. At 9:30 AM, LPAs reviewed 6 residents records. At 10:05 AM, LPAs reviewed 5 staff records and 5 of 5 have current first aid training and 5 of 5 associated to the facility. At 12:00 PM, LPAs reviewed a sample of resident’s medications. Continue to LIC809-C... Continued from LIC809... Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 11/22/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Inspection Report of Fire Alarm and Carbon Monoxide THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 10:15 AM, LPAs observed S1 and S2 did not have LIC 503 in the files. At 10:17 AM, LPAs observed S1, S2, and S5 did not have a TB test on file. At 12:45 PM, LPAs observed that there was no personal rights and nondiscrimination notice information posted. At 12:50 PM, LPAs observed that the Complaint and Ombudsman poster was not the correct poster size. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Generations Program Director. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 15, 2024

Type of visit: Case Management - Other

On this day 09/27/2024 at 3:35 pm, Licensing Program Analysts (LPAs) Patricia Manalo and Luisa Fontanilla arrived to the facility to conduct a case management visit regarding an elopement and met with Generations Program Director, Molly Young and explained the purpose of the visit. During the visit, LPAs interviewed R1, S1, S2, and Generations Program Director. LPAs obtained R1's Physician's Report and Needs, Services Plan, and updated Care Plan. Based on interviews conducted, R1 was found outside the facility. The Union City Police Department brought R1 back to the facility. The Director states R1 was brought to the doctor the next day. R1 did not sustain any injury during the incident. Generations Program Director stated that the facility will hire additional staffing for AM and PM shifts. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 27, 2024

Allegation investigated: Staff do not ensure that residents’ hygiene needs are being met while in care. Staff do not ensure that residents’ clothing needs are being met while in care. Staff do not provide assistance to residents in a timely manner. Staff do not ensure that resident is provided with clean bedding while in care. Facility is odiferous. Facility is unsanitary.

On 11/14/2023, at 11:50 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct a subsequent complaint investigation visit and to deliver findings on the above allegations. LPA met with Molly Young- Memory Care Director (MCD) and explained the purpose of today’s visit. During the course of the investigation, LPA interviewed three (3) staff members and four (4) residents. LPA requested and obtained the following documents: Physicians reports, needs and service plans, housekeeping log, Point of care logs (POC) for July 2023 and August 2023, and Response care logs (July 2023 and August 2023) for a sample of 10 of 10 residents. Contnue on Lic9099-C... Page 1 of 3 Unsubstantiated Continue from Lic9099... It was alleged that; Staff do not ensure that resident's hygiene needs are being met while in care and Staff do not ensure that resident's clothing needs are being met while in care. Based on interviews and record review, residents’ activities of Daily living (ADLs) are being cared for and staff are meeting all residents care needs in the morning by care givers. S1 stated that residents’ are on an ADL schedule which indicates that each residents’ ADLs are preformed twice or 3 times a week; some residents’ can request ADLs to be performed if needed. LPA reviewed the facilities point of care logs, which indicates that the residents’ ADLs are being met by care staff. All 3 staff stated ADLs are preformed every day to residents. All 4 residents’ stated that staff care for residents’ ADLs every day and residents’ do not have a problem with their needs being met. Some residents’ are independent and can preform their own ADLs as well. It was alleged that; Staff do not provide assistance to residents in a timely manner and Staff do not ensure that resident is provided with clean bedding while in care. Based on interviews with staff and residents, all 3 staff stated that when a resident calls for assistance, staff will go to the resident’s room to see what assistance the resident needs, and staff will assist resident with their care needs. Staff stated it takes about 5 minutes or less to response to a residents call after a resident pushes their call button or little longer if a staff is assisting other residents. All 4 residents stated that staff come to their room after the call button is pressed, and sometimes it takes little longer but staff do come to their room shortly after. All 4 residents also mentioned that staff clean their rooms and makes sure all bed sheets are clean and new for the resident to use. Page 2 of 3 It was alleged that, the facility is odiferous, and the facility is unsanitary. Based on observation and interviews, LPA observed that the facility is clean and sanitary. LPA did not observe the facility to be dirty and is kept clean and smells good. LPA toured the facility, and entered resident’s rooms and observed that the rooms of the facility are kept clean, sanitary and did not have any smell. Staff stated to LPA that care staff makes sure that the facility and the resident’s rooms are kept clean and do not have an odor to them. Based on Interviews and observation conducted, Although the allegation may have happened or are 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 with MCD, and a copy of this report provided. Page 3 of 3the state’s words, verbatim · CDSS document, Nov 14, 2023 · control 15-AS-20230809111810

Type of visit: Required - 1 Year

On 9/29/2023 starting at 2:50 PM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required Inspection. LPA met with Viray, Bernadette, administrator (ADM) and explained the purpose of the visit. The facility’s fire clearance was approved for One Hundred Forty (140) non-ambulatory residents, of which Ten (10) may be bedridden. Upon entry, LPA observed three (3) staff and two (2) residents present during inspection. Starting at 2:56 PM, LPA toured facility with ADM including but not limited to one hundred nine (109) bedrooms, 109 bathrooms, kitchen, common area and backyard. The facility consists of 109 total bedrooms, which eighty five (85) bedrooms are private, and twelve (12) bedrooms are shared. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 73 Degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents'. The hot water temperature in residents’ bathroom on the second floor was measured at 119.8 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day supply of perishable foods. Sharps and toxins were locked and inaccessible to residents'. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was observed last serviced on 6/6/2023. First aid kit was observed to be complete. Continue on Lic809-C Continued from Lic809 Starting At 4:03 PM, LPA reviewed 10 of 10 staff records. At 5:14 PM, LPA reviewed 10 of 10 residents' records. At 6:25 PM, LPA reviewed 10 of 10 residents' medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/6/2023: · LIC 308 Designation of Administrative Responsibility · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (9 Pages) · Liability Insurance No deficiencies cited during visit. Exit interview conducted with ADM, and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 29, 2023