Glen Park at Long Beach

Allegation investigated: Staff mismanaged resident's medications. Staff did not administer medication as prescribed.

On 02/05/2025, the department conducted a subsequent complaint visit to amend the original LIC9099 and LIC9099Cs dated 04/18/2024, but this does not change the findings of this complaint. The department met with Office Manager Shenick Jackson and explained the purpose of the visit was to amend the original LIC9099 and LIC9099Cs dated 04/18/2024. The original LIC9099 and LIC9099Cs dated 04/18/2024 are being amended. The revised LIC9099 and LIC9099Cs dated 08/07/2024. On 04/18/2024, Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit to deliver findings regarding the above allegations. LPA Richard met with Receptionist/MedTech Claudia Magana and later was joined with assistant Administrator Tonantzin Marines and Executive Director Michael Mendoza and explained the reason for the visit. The investigation consisted of the following: On 04/18/2024, LPA Richard and Receptionist/MedTech Martinez toured the facility inside and out. LPA Richard reviewed and requested, staff and resident's roster. Preplacement Appraisal Information, Individual Services Plan (ISP), Physician's Report for Residential Care for the Elderly (RCFE). Admission Agreement, Transfer Discharged Report. New Telephoned Prescription. Basic Medication Shadow training. LPA interviewed seven (7), residents (R1-R7), and three (3) staff (S1-S3). LVN, and Med Tech. LPA Interviewed the Nurse Practitioner (NP) Vartan Bekerian. Unsubstantiated Regarding the allegation: Staff mismanaged the resident's medication. The Investigation revealed the following: Regarding the allegation, “Staff mismanaged the resident’s medication”, it is being alleged Resident #1’s (R1) medication A (Haldol) was not discontinued. Medication Administration Record (MAR) revealed medication A was still being administered since R1 was admitted on 03/26/24. Interview with the Med Tech indicated that: on 03/26/2024, R1 was admitted to the facility from a skilled nursing facility with a medication list that included medication A; on 04/12/2024, R1’s Power of Attorney (POA) called the facility requesting medication A to be discontinued, but the facility refused since there wasn’t a doctor’s order; on 04/15/2024, the facility received a new prescription order from the R1’s doctor and pharmacy about discontinuing medication A. The department reviewed the MAR dated 03/26/2024 to 04/18/2024 and observed medication A was discontinued on 04/15/25. The department interviewed three staff #S members (S1-S3) and 3 out of 3 stated that they could not stop giving medications to residents unless it’s from a doctor’s order. The department interviewed seven residents #R (R1-R7) 6 out of 7 stated that they do not have any problem with the facility managing their medications. Based on interviews, and records reviewed the department did not find sufficient evidence to support the allegation. Although the allegations 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. (Evaluation Report Continues LIC 9099-C) Allegation: #2 The staff did not administer medication as prescribed. Regarding the allegation: “The staff did not administer medication as prescribed,” it is alleged that the staff continued to give medication B (Zoloft) in the morning instead of the evening. Medication Administration Record (MAR) revealed that R1’s medication B is to be administered in the morning and staff distributed it in the morning. The department interviewed the Med Tech (MT) about the allegation, and MT denied the allegation and stated that (R1) was admitted to the facility on 03/26/2024 and R1’s medication B was administered per the physician’s directions on time, and the right doses. On 04/18/2024, the department reviewed seven residents' medication administration records (MARs) and 7 out of 7 records show that medication was given to the residents in the correct dosage and at the proper times. The department Interviewed the Licensed Vocational Nurse, (LVN) they denied the allegation and stated that we cannot stop giving or changing the time of administering (R1) medication because a family member or Power of Attorney (POA) wants us to. Based on interviews and records reviewed the department did not find sufficient evidence to support the allegation. Although the allegations 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 (Evaluation Report Continues LIC 9099-C) No deficiencies cited. Exit interview conducted and a copy of this report was provided to Office Manager Shenick Jackson.the state’s words, verbatim · CDSS document, Apr 18, 2024 · control 11-AS-20240412162721

Allegation investigated: Resident abuse. Altering/falsifying records. Resident’s personal supplies being distributed to other residents. Uncleared staff working at facility.

On 01/12/24 at 9:00 am, Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit to deliver complaint investigation findings regarding the allegation above. LPA met with Executive Director (ED) Michael Mendoza as the purpose of today's visit was explained. The investigation consisted of the following; On 03/28/2022 (LPA) Cardenas conducted initial complaint visit. On 05/06/22 LPA Cardenas was unable to interview Resident #1 (R1) due to communication barriers. On 05/18/23 LPA Villegas and LPM Hammond interviewed ED, staff # 2-5(S2-S5) and obtained the following records for R1;admission agreement, Identification and emergency information, physician reports, resident appraisal, preplacement appraisal, consent forms, functional capability assessment and residents incident report notes.LPA obtained (S1) file (resume, job application, health screening, administrator certificate), (S5) file( resume, job description, health screening), (S6) file( resume, job description, health screening, administrator certification), for (S7) LPA obtained Termination statement, and for (S8) LPA obtained employment dates. On 03/08/24 LPA interviewed residents 2-11 (R2-R11) and obtained a copy of the staff Unsubstantiated and resident roster. The investigation revealed the following: Allegation- Resident abuse It is alleged in February or March 2020, NOC shift Staff #1(S1) dragged Resident #1 (R1) across the floor by his feet from the elevator to R1’s bedroom. On 05/18/23, LPA interviewed ED regarding the allegation, ED stated he was not working at the Glen Park at Long Beach in 2020. ED denied any physical abuse occurring since he has been the Administrator. On 05/18/23, LPA interviewed Staff #2-5, 4 of the 4 staff interviewed denied the allegation. On 03/08/24, LPA interviewed R2-R1 regarding the allegation and 10 of 10 residents interviewed denied the allegations. LPA attempted to interview R1 but was unsuccessful due to communication barriers. On 05/18/23, LPA conducted a file review of the facility incident reports from 2020 and a review of R1 file and did not observe any incident reports for physical abuse. LPA conducted a file review of S1 file and did not observe any write ups for physical abuse. Allegation-Altering/falsifying records. It is being alleged the facility engages in fabrication and or forgery of facility records. On 5/18/23 LPA interviewed ED regarding the allegation above, ED denied the allegation stating there has been no falsifying of records at the facility. On 05/18/23 LPA interviewed S2-S5 regarding the allegation above, 4 of 4 staff interviewed denied the allegation above. On 03/08/24 LPA interviewed R2-R11 regarding the allegation above, 10 or 10 residents interviewed denied the allegation above. LPA conducted a review of files obtained and did not observe any alterations made. Allegations- Resident’s personal supplies being distributed to other residents. It is being alleged that residents supplies provided by family members are distributed to other residents. On 5/18/23 LPA interviewed ED regarding the allegation above, ED denied the allegation above. Per ED donations made by family members are distributed to residents who need clothes. On 05/18/23 LPA interviewed S2-S5 regarding the allegation above, 3 of 4 staff interviewed denied the allegation above. 1 of 4 staff interviewed reported that each resident has their own cognitive supplies in their own room. On 03/08/24 LPA interviewed R2-R11 regarding the allegation above, 9 or 10 residents interviewed denied the allegation above and reported never receiving any items that do not belong to the. 1 of 10 residents interviewed reported receiving items that do not belong to resident when laundry is distributed but reports providing the items back to staff right away. Allegation: Uncleared staff working at facility. It is being alleged that S7, former staff did not get a fingerprint clearance. On 5/18/23 LPA interviewed ED regarding the allegation above, ED denied the allegation and reported never meeting the staff in question. On 05/18/23 LPA interviewed S2-S5 regarding the allegation above, 3 of 4 staff interviewed denied the allegation above and reporting not having any knowledge of a staff member by that name. 1 of 4 staff interviewed reported S7 was from a staffing agency during covid and was not directly employed by Glen Park at Long Beach and should have been finger printed by staffing agency. On 03/08/24 LPA interviewed R2-R11 regarding the allegation above, 10 of 10 residents interviewed denied the allegation above and stated not recalling S7. On 05/06/23 LPA Villegas conducted a review of LIC 500 personnel report and compared it to licensing guardian system and confirmed all staff employed by Glen Park at Long Beach are fingerprint cleared. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted with Executive Director Michael Mendoza, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 8, 2024 · control 11-AS-20220325125918

Allegation investigated: Staff did not prevent a resident from physically assaulting another resident in care. Staff did not administer medication as prescribed.

On 02/07/24 LPA Villegas conducted a sebsequent visit to render inestigation findings regarding the allegation(s) above. LPA met with Executive director (ED) Michael Mendoza as the purpose of todays visit was explained. The investigation consisted of the following: On 02/02/24 LPA interviewed Executive Director (ED), staff #1-6 (S1-S6), and interviewed residents # 3-8 (R3-R8). LPA obtained copies of the following for R1, R2 and R3; emergency Identification form, care plan, physicians report, med list, E-mar for January 2024, and preplacement appraisal information. On 02/02/24 LPA also obtained a staff and resident roster, a copy of the incident report for 01/19/24, SOC 341, copies of internal incident reports for 01/19/24, and conducted a medication review. The investigation revealed the following: Allegation: Staff did not prevent a resident from physically assaulting another resident in care. It is being alleged staff did not prevent a resident from physically assaulting another resident in care. Unsubstantiated 02/02/24 LPA interviewed ED regarding the above allegation, ED denied the allegation above stating that residents are separated, redirected, investigation is conducted, and additional support is provided. Ed continued to report that the facility has a zero tolerance policy for violence therefore if a assault occurs POA's are contacted immediately and asked to pick up the resident in question. On 02/02/24 LPA interviewed S1-S6 regarding the allegation above, 6 of 6 staff interviewed denied the allegation above stating that staff will separate residents, will talk to each resident individually, offer activities and will report the situation to upper management right away. On 02/02/24 LPA interviewed R3-R8 regarding the allegation above, 6 of 6 residents interviewed denied the allegation and reported feeling safe at the facility. On 02/02/24 LPA was unable to interview R2-R3 as R2-R3 where not in the facility, on 02/05/24 LPA was able to interview responsible party (W2) for R1, W2 reported there are no concerns at this time. On 02/06/24 LPA was able to interview R2, R2 denied having any altercations with R1. R1 was unable to provide details on incident in question. Allegation: Staff did not administer medication as prescribed. It is being reported that staff did not administer medication as prescribed. 02/02/24 LPA interviewed ED regarding the above allegation, ED denied the allegation above stating that medications are being provided as directed by Doctor. ED continued to report that there have not been any complaint regarding medications, however residents have complained about not being able to store medications in their rooms. On 02/02/24 LPA interviewed S1-S6 regarding the allegation above, 2 of the 6 staff interviewed denied the allegation reporting Doctors orders are being followed. 2 of 6 staff interviewed continued to report there is a 1 hour window where the medication can be administered 1 hour before or 1 hour after the documented medication time, 2 of 6 staff also indicated that some residents may be provided their medications first when a resident has an urgency. 4 of the 6 staff interviewed reported not they do not assist with medication administration. On 02/02/24 LPA interviewed R3-R8 regarding the allegation above, 5 of 6 resident's denied the allegation above and reported receiving medications daily and on time. 1 of 6 residents reported medication administration has improved but there are still issues that need to be fix. On 02/02/24 LPA conducted a medication review and did not observe any discrepancies, medication administrations, medication times and signatures were observed. on 02/05/24 LPA was able to interview responsible party (W2) for R1, W2 reported there are no concerns at this time. On 02/06/24 LPA was able to interview R2, R2 denied the allegation above and reported receiving medications daily and on time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. Exit interview conducted with Executive Director Michael Mendoza, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 7, 2024 · control 11-AS-20240124103401

Allegation investigated: Staff did not prevent a resident from physically assaulting another resident in care. Staff did not administer medication as prescribed.

On 02/07/24 LPA Villegas conducted a sebsequent visit to render inestigation findings regarding the allegation(s) above. LPA met with Executive director (ED) Michael Mendoza as the purpose of todays visit was explained. The investigation consisted of the following: On 02/02/24 LPA interviewed Executive Director (ED), staff #1-6 (S1-S6), and interviewed residents # 3-8 (R3-R8). LPA obtained copies of the following for R1, R2 and R3; emergency Identification form, care plan, physicians report, med list, E-mar for January 2024, and preplacement appraisal information. On 02/02/24 LPA also obtained a staff and resident roster, a copy of the incident report for 01/19/24, SOC 341, copies of internal incident reports for 01/19/24, and conducted a medication review. The investigation revealed the following: Allegation: Staff did not prevent a resident from physically assaulting another resident in care. It is being alleged staff did not prevent a resident from physically assaulting another resident in care. Unsubstantiated 02/02/24 LPA interviewed ED regarding the above allegation, ED denied the allegation above stating that residents are separated, redirected, investigation is conducted, and additional support is provided. Ed continued to report that the facility has a zero tolerance policy for violence therefore if a assault occurs POA's are contacted immediately and asked to pick up the resident in question. On 02/02/24 LPA interviewed S1-S6 regarding the allegation above, 6 of 6 staff interviewed denied the allegation above stating that staff will separate residents, will talk to each resident individually, offer activities and will report the situation to upper management right away. On 02/02/24 LPA interviewed R3-R8 regarding the allegation above, 6 of 6 residents interviewed denied the allegation and reported feeling safe at the facility. On 02/02/24 LPA was unable to interview R2-R3 as R2-R3 where not in the facility, on 02/05/24 LPA was able to interview responsible party (W2) for R1, W2 reported there are no concerns at this time. On 02/06/24 LPA was able to interview R2, R2 denied having any altercations with R1. R1 was unable to provide details on incident in question. Allegation: Staff did not administer medication as prescribed. It is being reported that staff did not administer medication as prescribed. 02/02/24 LPA interviewed ED regarding the above allegation, ED denied the allegation above stating that medications are being provided as directed by Doctor. ED continued to report that there have not been any complaint regarding medications, however residents have complained about not being able to store medications in their rooms. On 02/02/24 LPA interviewed S1-S6 regarding the allegation above, 2 of the 6 staff interviewed denied the allegation reporting Doctors orders are being followed. 2 of 6 staff interviewed continued to report there is a 1 hour window where the medication can be administered 1 hour before or 1 hour after the documented medication time, 2 of 6 staff also indicated that some residents may be provided their medications first when a resident has an urgency. 4 of the 6 staff interviewed reported not they do not assist with medication administration. On 02/02/24 LPA interviewed R3-R8 regarding the allegation above, 5 of 6 resident's denied the allegation above and reported receiving medications daily and on time. 1 of 6 residents reported medication administration has improved but there are still issues that need to be fix. On 02/02/24 LPA conducted a medication review and did not observe any discrepancies, medication administrations, medication times and signatures were observed. on 02/05/24 LPA was able to interview responsible party (W2) for R1, W2 reported there are no concerns at this time. On 02/06/24 LPA was able to interview R2, R2 denied the allegation above and reported receiving medications daily and on time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. Exit interview conducted with Executive Director Michael Mendoza, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 7, 2024 · control 11-AS-20240124103401

Allegation investigated: Facility staff did not safeguard resident's personal belongings.

On 01/27/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent visit at this facility to deliver findings for this complaint. LPA was greeted by Receptionist Claudia Magana who contacted the Administrator Michael Mendoza. LPA explained the purpose of the visit and read the findings to Mr. Medoza. Investigation cosisted of the following: Licensing Program Analyst (LPA) Jose Calderon conducted the initial complaint visit on 12/27/23. LPA Calderon interviewed Administrator Michael Mendoza A1, R1-R10, S1-S2. This interview was conducted on 12/27/2023. On 12/27/2023 LPA Calderon obtained and reviewed copies of the following: Incident report (dated 12/09/2023) and (dated 12/11/2023). Physician report (dated 11/15/2021 and 10/19/2021), Needs and Service (dated 10/25/2023), (11/25/2023) Video (date 12/08/2023). *This report serves as an amendment to the report created 12/27/23. This report supersedes the complaint investigation findings reflected in the report created 12/27/23. (Evaluation Report continues LIC 9099-C) Substantiated INVESTIGATION REVEALED THE FOLLOWING: Regarding Allegation #1: Facility staff did not safeguard residents’ personal belongings. This complaint alleged staff did not safeguard R1’s belongings. LPA Calderon interviewed with A1. A1 stated that A1 spoke to R1's family members and was advised that personal items were missing from R1's room. A1 stated that A1 reviewed the video for 12/08/2023 around 8:30 am. A1 reported that A1 watched R2 use a key to enter the room of R1 three times. A1 stated that the video showed R2 taking a stuffed animal, a small painting, and markers. A1 claimed that A1 searched R2's room and found R1's items. A1 expressed that S1 found R1's wallet with money in the laundry area. A1 stated that R1's family members counted the money, and the money was never stolen. A1 stated that R2 was shown the video and R2 stated that the video was not R2 and it someone else. LPA Calderon interviewed with S1-S2. S2 communicated that S2 picked up R1's dirty clothes when R1 was in the hospital. S1 said that S1 found an unknown amount of money, two silver coins, a credit card, and two rings. S1 stated that S1 gave items to the manager for safekeeping. S2 stated that S2 received an order to change all the resident room locks with a self-locking door to prevent residents wandering to enter unlocked rooms. LPA Calderon interviewed with R1-R10. LPA Calderon called R1 at the hospital and left two messages. R2 recalled that R2 did not use any key or enter the room of R1. R2 stated that the video showed R2 entering R1’s room with a key and taking items that are not R2. 8 out of 10 residents reported that no one has taken or stolen any items from the resident room and 8 out of 10 state that staff safeguards their personal belongings. LPA Calderon reviewed the video dated 12/08/2023. The video showed R2 using a key to enter R1's room. The video showed R2 taking items from the room. LPA Calderon reviewed the video with R2 who claimed the unknown person is not R2. LPA Calderon toured the facility with S2 and noted new locks for residents’ doors. LPA Calderon reviewed the needs and service plan for R1 and R2 (date 10/25/2023 and 11/15/2023). R1 has no cognitive issues while R2 has health issues. Reviewed incident reports (dated 12/09/2023 and 12/11/2023). Incident reports suggest that R2 did use a key to enter R1's room. The incident report indicated that $91.00 was returned to R1 and was never stolen or taken by R2. (Evaluation Report continues LIC 9099-C) *This report serves as an amendment to the report created 12/27/23. This report supersedes the complaint investigation findings reflected in the report created 12/27/23. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation that “Facility staff did not safeguard residents’ personal belongings” is found to be SUBSTANTIATED. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiency has been observed and citations issued (ref LIC9099D). An exit interview was conducted, and a copy of the Complaint Report and Appeal Rights were provided to the receptionist Claudia Magana. *This report serves as an amendment to the report created 12/27/23. This report supersedes the complaint investigation findings reflected in the report created 12/27/23.the state’s words, verbatim · CDSS document, Jan 27, 2024 · control 11-AS-20231222170043

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Feb 9, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interview, observation, video, and record review the licensee failed to secure R1’s room after viewing R2 entering R1’s room 3 times and taking R1’s personal property which posed a potential health and safety to residents in care.the state’s words, verbatim · CDSS document, Jan 27, 2024

Plan of correction: Administrator is to change lock for R1’s room and confirm R2 does not have any copies of R1’s door key or keys. Administrator to give notice to R2 regarding taking R1 property. Proof of correction (POC) must be sent to: jose.calderon@dss.ca.gov by due date: 02/09/24

Allegation investigated: Staff did not meet resident's showering needs. Staff did not seek resident timely medical attention. Staff did not ensure security of resident's personal belongings. Staff gave an explanation of circumstances at the time of resident's death, different from what a doctor reported.

THIS REPORT SUPERSEDES THE REPORT DATED 11/18/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Glen Park at Long Beach on 11/16/2023 and was greeted by Administrator Michael Mendoza (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. Investigation consisted of the following: LPA Calderon interviewed Administrator Michael Mendoza A1, R1-R10, S1-S2. These interviews were conducted on 11/16/2023 and 02/07/2024. On 11/16/2023 LPA Calderon obtained and reviewed copies of the following: Shower log notes (date 11/13/2023), Incident reports (date 10/30/2023, 10/31/2023, 11/02/2023), St Mary’s email (date 11/14/2023), Personal Property Inventory (date 09/28/2023), Physician Report (dated 08/23/2023) for R1. The investigation revealed the following: Unsubstantiated Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “staff did not meet residents showering needs”, “staff did not seek resident timely medical attention”, “staff did not ensure security of residents personal belongings”, “staff gave an explanation of circumstance at the time of residents death different from wat a doctor reported” is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Michael Mendoza A1. Regarding Allegation #3: Staff did not ensure security of resident’s personal belongings. This complaint alleged that staff did not secure R11 purse. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that when R11 passes away on 11/14/2023 R11 personal belongings are collected and stored for safety. A1 states that R11 purse was moved to the office and never was missing or stolen. A1 states that a property log is taken of exactly what the staff collects for the resident’s room. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff state that when an R11 passes away staff collects the personal belongings of the resident, and a property log is kept for the facility records. 2 out of 2 staff state that R11 purse was never stolen or missing and was moved to the office for safety. LPA Calderon conducted an interview with R1-R11. 10 out of 11 residents state that none of their personal belongings have gone missing or been stolen while living at the facility. 10 out of 11 residents state that staff do make sure the facility is secure and safe. LPA Calderon could not interview R11 as R11 had passed away on 11/14/2023. Reviewed personal property inventory (date 09/28/2023). 12 items noted for R11 personal belongings. No mention of R11 purse found. Regarding Allegation #4: Staff explained circumstances at the time of resident’s death, different from what a doctor reported. This complaint alleged that staff gave explanation of R11 passing that was different than the hospital records. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that A1 was called to R11 room by S2. A1 states that R11 was found unresponsive in bed and CPR was performed until the fire department arrived. A1 states that R11 pulse was found, and R11 was transported to the hospital for evaluation. A1 states that that A1 called the R11 family and spoke to R11 son. A1 states that A1 advised R11 son that R11 had a heart attack and was transported to the hospital. A1 states that A1 confirmed a DNR with the hospital and that the hospital would not provide any extraordinary lifesaving procedures due to the DNR. LPA Calderon conducted an interview with S2. S2 states that R11 was found unresponsive, and CPR was performed. S2 states that R11 was transported to the hospital for evaluation. S2 states that the front office contacted R11s’ families and advised of R11 medical status. LPA Calderon conducted an interview with R1-R11. 10 out of 11 residents state that staff inform their families of any medical status or updates. LPA Calderon could not interview R11 as R11 had passed away on 11/14/2023. Reviewed email from A1 to St. Mary’s Hospital (date 11/14/2023). A1 was requesting more information on R11 passing. Regarding Allegation #1: Staff did not meet resident’s showering needs. This complaint alleged that staff did not meet R11 showering needs. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that all residents can take a shower when they want to. A1 states that R11 can take a shower with no help from staff and just need to be reminded by staff when to take a shower. A1 states that the facility keeps a shower log for the residents that do not take a shower or need to be reminded. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff state that R11 could take a shower by themselves. 2 out of 2 staff state the R11 need to be reminded to take a shower. 2 out of 2 staff state that they cannot force a resident to take a bath or shower. 2 out of 2 staff state that the facility keeps a shower log for those residents that refuse or forget to take a shower weekly. LPA Calderon conducted an interview with R1-R11. 10 out of 11 residents state that they can take a shower when they want, and staff have never told them not to take a shower. LPA Calderon could not interview R11 as R11 had passed away on 11/14/2023. LPA Calderon reviewed physician report (date 08/23/2023) for R11. The report states that R11 were able to shower with no aid from staff. Reviewed shower logs (date 11/13/2023) for resident. Log notes suggest that R11 was reminded 2 times to take a shower and records suggest that R11 took a shower 7 days a week. Regarding Allegation #2: Staff did not seek resident timely medical attention. This complaint alleged that staff did not seek CPR timely on R11. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that on 11/02/2023 approximately 8 am S2 found R11 unresponsive in R11 bed. A1 states that S2 called A1 who came to R11 room. A1 states that S2 was performing CPR on R11. A1 states that they moved R11 to the floor where A1 continued CPR on R11. A1 states that 911 was called and A1 was able to find a pulse when the fire department arrived. A1 states that R11 was taken to the hospital and passed away on 11/14/2023. A1 states that R11 had a DNR and A1 and S2 only performed CPR on R11. A1 states that R11 was taken to the hospital and passed away from a heart attack. LPA Calderon conducted an interview with S2. S2 states that on 11/02/2023 around 8:15 am S2 found R11 unresponsive in R11 bed. S2 states S2 started CPR on R11 and called 911. S2 states that S2 called A1 who arrived minutes later. S2 states A1 and S2 moved R11 to the floor and A1 continued CPR and A1 found a pulse. S2 states that R11 was transported to the hospital for evaluation. A1 states that R11 passed away from a heart attack per hospital. LPA Calderon conducted an interview with R1-R11. 10 out of 11 residents state that when residents need medical attention staff provides timely medical services. LPA Calderon could not interview R11 as R11 had passed away on 11/14/2023. Reviewed incident report (date 11/02/2023) report states that S2 found R11 unresponsive in bed. S2 called 911 and helped A1 move R11 to the floor. S2 started CPR on R11 and A1 continued CPR on R11 until fire department arrived.the state’s words, verbatim · CDSS document, Jan 11, 2024 · control 11-AS-20231113122915

Allegation investigated: Staff did not assist resident withing obtaining care. Staff do not answer resident's call button in a timely manner Staff speaks to resident in an inappropriate manner Staff did not allow resident to possess personal belonging Staff do not assist resident with showering

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Glen Park at Long Beach on 01/11/2024 and was greeted by Administrator Michael Mendoza (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. Investigation consisted of the following: LPA Calderon interviewed Administrator Michael Mendoza A1, R1-R8, S1-S3. This interview was conducted on 01/10/2024. On 01/10/2024 LPA Calderon obtained and reviewed copies of the following: Physician Report (dated 10/10/2023), Shower logs (date 12/22/2023), Front desk logs (date 12/24/2023) for R1. The investigation revealed the following: Unsubstantiated Regarding Allegation #5: Staff do not assist residents with showering. This complaint alleged that staff do not assist R1 with showering. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that R1 is given 3 showers per week. A1 states that R1 needs help to shower due to R1 medical issues. A1 states that R1 is never refused by staff to help take a shower. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state that R1 is given 3 showers per week and that staff helps R1 with showering needs. LPA Calderon conducted an interview with R1-R8. R1 states that there are no issues with R1 showering needs. R1 states that staff does help R1 take a shower 3 times per week. 7 out of 7 residents state that they can take a shower any time they want, and staff are there to help if needed. Reviewed the physician report (date 10/10/2023), R1 needs help from staff to take a shower. Reviewed the shower logs (date 12/22/2023), logs note that staff helps R1 take a shower 3 times per week. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “staff did not assist resident with obtaining care” “staff do not answer residents call button in a timely manner” “staff speaks to resident in an inappropriate manner” “staff did not allow resident to possess personal belongings” “staff do not assist resident with showering” is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Michael Mendoza A1. Regarding Allegation #4: Staff do not allow residents to possess personal belongings. This complaint alleged that staff do not allow R1 to have shower towels and extra toilet paper. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that each resident is given 2 shower towels and 2 rolls of toilet paper per week. A1 states that if a resident purchases their own towels or toilet paper there is no reason that residents can not keep them. A1 states that the towels and toilet paper in question are purchased by the facility and no resident can keep more than 2 towels or toilet paper per week. A1 states that A1 spoke to R1 and advised R1 that A1 would replace any personal items owned by R1. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state that residents do purchase extra towels and toilet paper and it is possible when housekeepers clean the resident’s room and pick up the dirty clothes that the residents’ towels are also picked up and taken to the wash. 3 out of 3 staff state that no extra toilet paper is collected unless the resident tells them they purchased the extra rolls. LPA Calderon conducted an interview with R1-R8. R1 states that R1 friend purchased 4 towels and they were a gift from R1 friend. R1 states that R1 friend also purchased toilet paper. R1 states that R1 needs extra towels and extra toilet paper, and the facility only supplies 2 towels and 2 rolls of toilet paper per week. R1 states that staff took the extra towels and toilet paper away from R1 room and would not return R1 belongings. 7 out of 7 residents state that they have purchased extra towels and toilet paper and staff do not take their items. 7 out of 7 residents state that staff does clean their dirty towels and some time they are not returned. 7 out of 7 residents state that staff do allow them to possess personal items that they purchase. Regarding Allegation #3: Staff speaks to resident in an inappropriate manner. This complaint alleged that Administrator Michael Mendoza A1 speaks to R1 in English and not in Spanish which R1 cannot understand. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that A1 does not speak Spanish and many times A1 has spoken to R1 with no issues. A1 states that R1 does understand what A1 is saying and anytime there is something important to tell R1 there is another staff member that speaks Spanish to translate for R1 and A1. A1 states that A1 does not believe that A1 speaks to R1 in an inappropriate manner. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state that they have spoken to R1 in Spanish many times and there are many Spanish speaking staff that R1 can communicate with or help A1 translate if needed. LPA Calderon conducted an interview with R1-R8. R1 states R1 only speaks Spanish. R1 states that A1 speaks to R1 in English and R1 can not understand what A1 is saying to R1. R1 states that R1 does not speak English and R1 has a hard time communicating with A1. R1 states there is no staff R1 can speak to in Spanish. 7 out of 7 residents state that there are many staff that only speak Spanish and they have a hard time communicating with those staff. 7 out of 7 residents state no issues communicating with A1. Regarding Allegation #2: Staff do not answer residents call button in a timely manner. This complaint alleged that staff do not answer the R1 call button in a timely manner. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that A1 has no record of R1 falling on 12/24/2023. A1 states that if R1 had fallen and hit R1 head on the bathroom doorknob 911 would have been called and R1 would have been taken to the hospital for evaluation. A1 states that if R1 had pushed the call button staff would have responded to R1 room within minutes. A1 states that the facility does not keep call log records for residents, but A1 checked the front desk log notes for 12/24/2023 and there is no record of a call or button pushed by R1. A1 states that there is no way staff would take 30 minutes to respond to a call from any resident. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state that they have no record of R1 pushing R1 call button on 12/24/2023. 3 out of 3 staff state that on average it takes 10 to 15 minutes for staff to respond to a residents call for help and 3 out of 3 staff state that if R1 needed help it would not take 30 minutes to respond. LPA Calderon conducted an interview with R1-R8. R1 states that R1 lost R1 balance and fell hitting R1 head on the bathroom doorknob. R1 states that this happened on 12/24/2023 around 9pm. R1 states that R1 pushed the call button for help, and it took staff 30 minutes to arrive and help R1. R1 states that in the 30 minutes that passed R1 got off the floor under R1 own power. 7 out of 7 resident states that they have pushed the call button and it takes 10 to 15 minutes for staff to arrive and help. 7 out of 7 residents state that they are happy with the services provided by staff. Reviewed the front desk log notes (date 12/24/2023), there is no record of R1 calling or pushing the call button for help. There is no record of R1 falling on 12/24/2023. Regarding Allegation #1: Staff did not assist resident with obtaining care. This complaint alleged that staff did not help R1 after falling in room and did not supply pain medication. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that there is no incident report for R1 falling on 12/24/2023. A1 states that A1 checked with A1 staff and no one knew of any unwitnessed fall from R1. A1 states that if R1 had advised staff of a fall, A1 staff would have called 911 and taken R1 to the hospital for evaluation. A1 states that if R1 had pain from the fall and requested Tylenol A1 staff would have given R1 the medication as the Tylenol is on R1 medication list. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state to have no record of R1 falling and hitting R1 head on the bathroom doorknob on 12/24/2023. 3 out of 3 staff state they could not find any incident report for 12/24/2023 regarding R1 falling. 3 out of 3 staff state that if R1 had requested Tylenol for pain that the LVN would have given R1 the medication. LPA Calderon conducted an interview with R1-R8. R1 states that on 12/24/2023 R1 lost R1 balance and hit R1 head on the bathroom doorknob. R1 states that R1 got off the floor under R1’s own power and no staff came to help R1. R1 states that R1 asked for Tylenol for pain and staff would not give R1 the medication for pain. 7 out of 7 residents state that staff does take care of their medical needs and if they request medication staff takes care of their medication needs. Reviewed physician report (date 10/10/2023). R1 medication list lists Tylenol extra strength, dispensed 09/18/2023, 1 to 2 tablets for pain.the state’s words, verbatim · CDSS document, Jan 11, 2024 · control 11-AS-20240102083125

Allegation investigated: Staff did not meet resident's dietary needs. Staff did not clean resident's room. staff yelled at resident. Staff made inappropriate comment toward resident.

On 12/20/2023, Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit to deliver findings regarding the above allegations. LPA Richard met with Administrator Michaell Mendoza and explained the reason for the visit. The investigation consisted of the following: On 12/20/2023, LPA Richard and Administrator Mendoza toured the facility inside and out. LPA Richard reviewed and requested, staff and resident's roster. Internal resident incident report, Individual Services Plan (ISP), Winter Menus 2023, Sanitation and Food Safety Checklist for Assisted Living, Daily Housekeeping Schedule, R1 hand writing note, Physician's Report for Residential Care For the Elderly (RCFE). LPA interviewed tens (R2-R10) residents, and seven staff (S1-S7). LPA Richard toured the kitchen and spoke to S2 about resident's dietary needs. This report is cotinued, please see LIC9099C. Unsubstantiated Allegation #1: Staff did not meet resident's dietary needs. On 12/20/2023, LPA Richard conducted an interview with seven staff (S1-S7), all staff stated that the cook follows a meal plan and serve nutritious meals 3 times per day. 7 days a week. S2 stated that not all resident love the food served but the menu has a choice that resident could choose if they don't like what was the main dish. LPA Richard conducted an interview with S2. S2 states that his has been a cook for over 8 years and a cook for the facility for 1 year. S2 stated that S2 follows a meal plan and serves nutritious meals every day. LPA Richard conducted an interview with R1-R10. R1 stated that staff refuses to serve R1 lunch when R1 is out of the facility. R1 stated that the food is not good and not nutritious. 9 out of 10 residents stated that the food is delicious and 9 out of 10 residents have no issues with the food served. LPA Reviewed facility meal plan of residents. Based on interviews, observations and records reviews 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 of “Staff did not meet resident's dietary needs" is UNSUBSTANTIATED. Allegation #2: Staff did not clean resident's room. On 12/20/23, LPA Richard conducted an interviewed with seven staff (S1-S7) all staff and Administrator Michael Mendoza (S1) stated that staff does clean residents’ room 5 days a week. S1 stated that (S2-S3) clean residents’ room 5 times a week and touch every room 4 times a week by taking out the trash and cleaned the bathroom. LPA Richard conducted an interview with (S2-S7). 3 out of 7 staff stated that they clean R1 room 5 times a week and make sure trash is picked up every time. LPA Richard conducted an interview with R1-R10. 9 out of 10 residents stated that staff clean their rooms 4 times a week. 8 out of 10 residents stated that the staff deep clean twice a week. LPA Richard reviewed R1 admission agreement there is no documentation stated how many time the facility need to clean resident’s room. Based on interviews, observation and record reviews the allegation 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 allegation staff did not clean resident's room is UNSUBSTANTIATED. Allegation #3: Staff yelled at resident. On 12/20/23, LPA Richard conducted an interview with seven staff (S1-S7) and Administrator Michael Mendoza (S1). S1 stated that he has spoken to R1 many times and has never yelled at R1. S1 stated that he has an open-door policy and has spoken to R1 many times with no issues. S1 stated that he treats all staff and resident with respect, yelling at someone wouldn’t resolved any issue. LPA Richard conducted an interview with ten Residents (R1-R10). R1 stated that Administrator Michael Mendoza is very rude and yells at all the residents all the time. R1 stated that most of the staff doesn’t yell at residents R1-R10 when speaking to them R1-R2. 9 out of 10 residents stated they have no issues or concerns about S1. LPA Richard reviewed incident reports there is no mention of yelling at residents. Based on interviews, observations, and record reviews 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 staff yelled at resident is UNSUBSTANTIATED. Allegation #4: Staff made inappropriate comment toward resident. On 12/20/23, LPA Richard conducted an interview with seven staff (S1-S7) and Administrator Michael Mendoza (S1). S1 stated that he has spoken to R1 many times and has never made inappropriate comments towards anyone, staff or resident. S1 stated that he has not spoken inappropriate mean and loudly when speak to resident. LPA Richard interviewed ten Residents (R1-R10). R1 stated that most of the staff are nice and considerate toward residents when speaking to them. 9 out of 10 residents stated they have not experienced inappropriate comment from S1 since they’ve being living here. LPA Richard reviewed incident reports there is no mention of S1 made inappropriate comment toward resident. Based on interviews, observations, and record reviews 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 staff made inappropriate comment toward resident is UNSUBSTANTIATED. An Exit interview was conducted with the Administrator Michael Mendoza and a copy of the report was providethe state’s words, verbatim · CDSS document, Dec 20, 2023 · control 11-AS-20231218161430

Allegation investigated: Staff handled resident in a rough manner. Staff does not respond to resident’s call for assistance. Staff does not serve nutritious meals. Staff served resident expired milk

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Glen Park at Long Beach on 12/18/2023 and was greeted by Administrator Michael Mendoza (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. During this investigation, LPA Calderon interviewed A1, S1-S3, R1-R9. These interviews were conducted on 12/18/2023. On 12/18/2023 LPA Calderon obtained and reviewed copies of the following: PACE level of care determination (date 09/01/2023), Incident report (date 12/08/2023), Meal Plan (date 12/1/2023 to 12/31/2023). On 12/18/2023 LPA Calderon toured the kitchen. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Staff handled resident in a rough manner. This complaint alleged that S1 handled R1 in a ruff manner injuring R1 left leg and arm area. LPA Calderon conducted an interview with A1. A1 states that S1 has been working for the facility for 1 year and helps care for residents. A1 states that S1 was pushing R1 wheelchair who was leaving the facility for the morning. A1 states that that R1 has an old wheelchair and as S1 was pushing R1 chair R1 foot got caught in the front wheelchair wheel and R1 left foot was not injured. A1 states that A1 advised R1 social worker of the situation and that R1 was not injured. A1 states that the incident was an accident and not abuse on S1 part. LPA Calderon conducted an interview with S1 who states that S1 does not remember what happened to R1 foot. LPA Calderon conducted an interview with S3 who states that S1 is a professional and has no history of abuse and the incident was an accident. LPA Calderon conducted an interview with R1-R9. R1 states that S1 was in a hurry to get R1 into the van and R1 foot got caught in the front wheel of the chair. R1 states that this is the second time S1 has rushed and injured R1 body. R1 does not remember the date, but that the incident happened in R1 room and R1 left arm was injured. 8 out of 8 residents states no issues with service provided and staff have never been unprofessional. Regarding Allegation #2: Staff does not respond to residents call for assistance. This complaint alleged that staff does not respond to R1 call for assistance. LPA Calderon conducted an interview with A1. A1 states that the facility does not keep call button logs, but that staff do respond to resident request for services within 10 to 15 minutes depending on the time of the call. A1 states that staff do not take 45 minutes to respond as R1 claims. LPA Calderon conducted an interview with S3. S3 states that depending on when the resident pushes the service button it may take 10 minutes or 15 minutes for staff to respond for service, but staff do not take 45 minutes to respond for residents’ services. LPA Calderon conducted an interview with R1-R9. R1 states that R1 pushed the call button and staff took 45 minutes to respond. R1 states that R1 yelled out from the bathroom area with no response from staff. R1 states that R1 roommate R7 had to help R1 into and out of the bathroom. 8 out of 8 residents state that staff takes 10 to 15 minutes to respond when the call button is pushed. R7 states that R7 does not remember how long it took staff to arrive for service and R7 had nothing to say on the incident. Regarding Allegation #3: Staff does not serve nutritious meals. This complaint alleged that staff do not serve R1 nutritious meals. LPA Calderon conducted an interview with A1. A1 states that A1 has 2 cook who follow a meal plan and serve nutritious meals 3 times per day, 7 days a week. A1 states that not all resident love the food served but A1 states that A1 cooks speak to residents and get feed back on the food served. LPA Calderon conducted an interview with S2. S2 states that S2 has been a cook for over 8 years and a cook for the facility for 1 year. S2 states that S2 follows a meal plan and serves nutritious meals every day. S2 states that S2 has 3 dining staff taste S2 food prior to serving to make sure the food is nutritious and taste good. S2 states that most resident love S2 food but not all. LPA Calderon conducted an interview with R1-R9. R1 states that staff refuses to serve R1 lunch when R1 is out of the facility. R1 states that the food is not good and not nutritious. 8 out of 8 residents state that the food is ok and 8 out of 8 residents have no issues with the food served. Reviewed facility meal plan (date 12/01/2023 to 12/31/2023), meal plan appears to be balanced and meets the needs of residents. Regarding Allegation #4: Staff served R1 expired milk. This complaint alleged that staff served R1 expired milk. LPA Calderon conducted an interview with A1. A1 states that no dining staff would or does serve expired milk to residents in care. A1 states that dining staff check for expired foods and rotate the food stores to make sure no expired food is served. LPA Calderon conducted an interview with S2. S2 states that S2 has been the facility cook for 1 year. S2 states that S2 checks daily food stores and makes sure to rotate foods. S2 states that no dining staff would serve expired food or milk. S2 states that staff taste the milk prior to service and makes sure the milk taste good and is not expired. LPA Calderon conducted an interview with R1-R9. R1 states that R1 eats cold cereal in the morning and the milk served is off and does not taste good. 8 out of 8 residents state to have no issues with the milk served and the milk taste fine. LPA Calderon toured the kitchen and inspected the 1-gallon milk bottles. LPA Calderon could not find any expired milk. Based on interviews, observations and supporting documents. The preponderance of evidence standard has NOT been met; therefore, the allegation of “Staff handled resident in a rough manner” “Staff does not respond to residents call for assistance”, “Staff does not serve nutritious meals”, “Staff served resident expired milk” is found to be UNSUBSTANTIATED. A face-to-face meeting was conducted with Administrator Michael Mendoza and a hard copy was provided.the state’s words, verbatim · CDSS document, Dec 18, 2023 · control 11-AS-20231211112444

Allegation investigated: Staff are allowing residents with prohibited health conditions to reside in the facility. Staff are not preventing residents from sustaining skin tears while in care. Staff are yelling at the residents. Staff are abusing the residents while in care. Staff denied residents the right to get a Covid-19 Vaccine. Staff are stealing money and personal belongings from residents. Staff are stealing residents medications. Staff are denying residents food. Staff are not treating residents with dignity.

Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Staff #1 (S1: Tyshima Bonner, Office Manager); as Administrator (A1: Michael Mendoza) was unavailable. LPA/RA conducted a risk assessment prior to entering facility. S1 informed LPA/RA that the facility has no COVID cases nor do the residents nor staff have symptoms. The purpose for today’s visit is to conduct a subsequent visit to deliver the findings pertaining to the above-mentioned allegations. An initial 10-Day visit was conducted by LPA Martessa Brown on 03/23/23 who was met by the Administrator. During today’s visit, LPA/RA re-interviewed the Administrator (via landline), Staff #1 - Staff #5 (S1-S5) and Residents #1 - Resident #8 (R1-R8). LPA/RA toured the facility's physical plant for health and safety purposes of residents in care. LPA/RA reviewed the following documents: Admission Agreements, Physician’s Reports, Resident Appraisals, Medication Administration Records (October 2023), COVID-19 Vaccine cards, and Personal Property Inventory for Resident #9 - Resident #12 (R9-R12). LPA/RA Unsubstantiated reviewed the Trust Account/P & I Ledgers (March 2023 & October 2023), Incident Reports (02/21/23 – 03/01/23), Staff In-service Training Records, Monthly Menu (October 2023), Facility Staff (S1-S5) and Residents (R9-R12) files, Facility Staff and Residents' rosters (dated 02/23/22 & 10/06/23). LPA/RA toured the facility's physical plant: memory care unit, medication room, and commercial-size kitchen. LPA/RA observed the security monitors and camera system and delayed egress doors. Regarding Allegation #1: this investigation revealed that the facility is a vendor of the Harbor Regional Center (HRC) and participant of the Assisted-Living Waiver program. Residents who require 24/7 level of care reside in the facility’s secured unit on the 2nd floor that requires a key-card system. Interviews conducted of seven (7) staff corroborated that the facility does not have residents with a prohibited health condition. Executive Director stated that whenever a resident requires a higher level of care, facility staff will call 9-1-1 or non-emergency ambulance. If the facility receives a call regarding accepting/returning a resident with a prohibited health condition, they are advised that the facility is not a medical facility. Interviews conducted of eight (8) residents, corroborated that they did not have a prohibited health condition nor had they known of residents living in the facility with a prohibited health condition. Based on the evidence gathered, interviews conducted, and records reviewed, 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 of LEVEL OF CARE: Staff are allowing residents with prohibited health conditions to reside in the facility is found to be UNSUBSTANTIATED. Regarding Allegation #2: this investigation revealed based on interviews conducted of seven (7) facility staff who corroborated that whenever a resident has sustained a skin tear, the med techs will provide first-aid. Interviews conducted of eight (8) residents corroborated that they are provided with first aid by the med techs whenever they have sustained a skin tear. LPA/RA reviewed facility staff in-service training record on the topic of How to Manage Elderly Skin, Skin Integrity, and First Aid. Based on the evidence gathered, interviews conducted, and records reviewed, 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 of NEGLECT/LACK OF SUPERVISION: Staff are not preventing residents from sustaining skin tears while in care is found to be UNSUBSTANTIATED. Regarding Allegation #3: this investigation revealed based on interviews conducted of seven (7) facility staff members corroborated that often a resident cannot hear so facility staff often has to raise their voice in an effort to communicate to the resident(s). There has been no complaints made to facility staff from residents regarding facility staff yelling at them. Interviews conducted of eight (8) of the residents corroborated that they have not been yelled at by a facility staff member nor observed other residents in care being yelled at by facility staff. LPA/RA reviewed the facility staff rosters (dated 02/23/22 & 10/06/23) that did not document a staff member by the first name of “Brenda” or “Marina” or “April”. LPA/RA reviewed facility staff in-service training records on the topic of Mandated Reporting. Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS: Staff are yelling at the residents is found to be UNSUBSTANTIATED. Regarding Allegation #4: this investigation revealed a tour of the facility’s physical plant was conducted upon arrival to ensure the health and safety of residents in care. Interviews conducted of seven (7) facility staff members corroborated that there has not been reports of abuse from residents or their representatives (ALW, PACE, HRC) or responsible person(s). Interviews conducted of eight (8) residents corroborated that they have not been abused by facility staff nor have they observed a resident in care being abused by a facility staff member. LPA/RA reviewed the facility staff rosters (dated 02/23/22 & 10/06/23) that did not document a staff member by the first name of “Brenda” or “Marina” or "April". LPA/RA reviewed facility staff in-service training records on the topics of Non-violent Crisis Intervention and Mandated Reporting. Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS: Staff are abusing the residents while in care is found to be UNSUBSTANTIATED. Regarding Allegation #5: this investigation revealed based on interviews conducted of seven (7) facility staff that 95 of the 97 residents in care have received both of their COVID-19 vaccines. Interviews conducted of eight (8) residents corroborated that they were not denied and have received both of their COVID-19 vaccinations. Administrator stated that residents from the PACE program received their vaccines through PACE and all other residents in care either received their vaccinations from the facility’s in-house doctor or CVS. LPA/RA observed facility’s Incident Reports to CCLD regarding COVID-19, staff in-service training record on the topic of Reducing Risk Keeping Safe & Preventing Spread, and (R9-R12) COVID-19 vaccination cards. Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS: Staff denied residents the right to get a Covid-19 Vaccine is found to be UNSUBSTANTIATED. Regarding Allegation #6: this investigation revealed based on interviews conducted of seven (7) staff members that there has not been complaints from residents in care that staff stole their money or personal belongings. Interviews conducted of eight (8) residents in care corroborated that they have not had money or personal belongings stolen by facility staff. Administrator stated that the facility maintains a trust account for every resident in care. LPA/RA reviewed facility’s Trust Account Ledgers (March 2023 and October 2023) for 45 residents. Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS Staff are stealing money and personal belongings from residents is found to be UNSUBSTANTIATED. Regarding Allegation #7: this investigation revealed based on interviews conducted of A1, A2, S1, and S2 that once the med techs administer residents’ medication(s), the med tech will initial the MAR. Interviews conducted of eight (8) residents corroborated that the med techs do administer their medications and have not been known to have missed medication(s). LPA/RA toured the medication room for observation of the medications and review of the medication administration records for R9-R12 that had been administered during the month of October 2023. LPA/RA reviewed facility staff in-service training on the topic of medication administration for Staff #2. Based on the evidence gathered, interviews conducted, and records reviewed, 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 of MEDICATIONS: Staff are stealing residents’ medications is found to be UNSUBSTANTIATED. Regarding Allegation #8: this investigation revealed based on interviews conducted of seven (7) staff members corroborated that they have not received complaints from residents that they were denied food. Staff #4 (Kitchen Aide/Server) indicated that if a resident should miss their mealtime (breakfast, lunch and/or dinner) there is always optional meals to select. Interviews conducted of eight (8) residents corroborated that they have not been denied a meal nor have they heard of a resident denied a meal. LPA/RA toured the commercial-size kitchen and observed a sufficient food supply of perishables and non-perishables including the posted monthly menu. Based on the evidence gathered, interviews conducted, and records reviewed, 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 of FOOD SERVICE: Staff are denying residents food is found to be UNSUBSTANTIATED. Regarding Allegation #9: this investigation revealed based on interviews conducted of seven (7) staff members corroborated that they have not received a complaint from residents in care that facility staff are not treating them with respect. Interviews conducted of eight (8) residents corroborated that facility staff are compliant and compassionate to their needs and have not been intimidated or bullied or threatened by a facility staff member. LPA/RA reviewed the facility staff rosters (dated 02/23/22 & 10/06/23) that did not document a staff member by the first name of “Brenda” or “Marina” or "April". LPA/RA reviewed facility staff in-service training record on the topics of Non-violent Crisis Intervention, Personal Rights, and Mandated Reporting. Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS: Staff are not treating residents with dignity is found to be UNSUBSTANTIATED. An exit interview has been conducted and a copy of the Complaint Report provided to Staff #1 (Tyshima Bonner, Office Manager).the state’s words, verbatim · CDSS document, Oct 25, 2023 · control 11-AS-20230315135635

Allegation investigated: Staff is not following resident's dietary needs Staff is not providing housekeeping services to resident in care Staff do not treat resident with dignity and respect

THIS REPORT SUPERSEDES THE REPORT DATED 10/10/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED. Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Glen Park at Long Beach on 10/10/2023 and was greeted by Administrator Michael Mendoza (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. Investigation consisted of: LPA Calderon interviewed Administrator Michael Mendoza A1, R1-R8, S1-S2. This interview was conducted on 10/10/2023 and 02/07/2024. On 10/10/2023 LPA Calderon obtained and reviewed copies of the following: Admission Agreement (dated 10/25/2022), Physician Report (dated 07/27/2023), Incident report (dated 3/18/23, 8/16/23, 8/17/2023), Dietary Preference (dated 10/25/2022), Menu for February 2024, Tour R1 room for R1. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Staff are not following residents’ dietary needs. This complaint alleged that staff are feeding bell peppers and red meat to R1 and not following a dietary plan. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that R1 is not diabetic and would not have a diabetic meal plan based on R1 physician report (dated 07/27/2023). A1 states that R1 did not report to A1 that R1 was allergic to bell peppers or red meat. A1 has requested an updated physician report for R1 diet needs. A1 states that he has spoken to the dining staff and advised them to not serve R1 with peppers or red meat. A1 has given R1 a weekly food menu so that R1 can decide as to what R1 wants to eat. LPA Calderon conducted an interview with R1-R8. R1 states that R1 never advised A1 or staff that R1 was allergic to bell peppers or red meat. R1 states that he is not diabetic and R1 never received any physician order regarding R1 meal plan. R1 states that dining staff have worked with him regarding the peppers and red meat and A1 has given R1 a copy of the menu so that R1 can decide for R1 meals. 7 out of 8 residents state to have no issues with the food served in the dining room. LPA Calderon reviewed the R1 dietary preferences (dated 10/25/2022). Restrictions none, lactose intolerant, does not like red meat. There is no documentation that R1 is allergic to bell peppers or red meat. LPA Calderon reviewed physician report (07/27/2023) for R1. There is no documentation that R1 is diabetic or allergic to bell peppers or red meat. Reviewed incident report (date 10/25/2022) report mentions R1 not a red meat eater, does not like bones or ham. Regarding Allegation #2: Staff is not providing housekeeping services to resident in care. This complaint alleged that staff are not cleaning R1 room. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that staff do not clean any residents room 7 days a week. A1 states that S1-S2 clean residents’ rooms 3 to 4 times a week and touch every room 6 times a week by taking out the trash. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff state that they clean R1 room 4 times a week and make sure trash is picked up 6 times a week or as needed. LPA Calderon conducted an interview with R1. R1 states that staff do pick up trash from R1 room. R1 states that staff clean R1 room 5 times per week. LPA Calderon conducted an interview with R2-R8. 7 out of 8 residents state that staff clean their rooms 4 times a week. 7 out of 8 residents state that the staff clean their rooms 3 times a week. LPA Calderon reviewed R1 admission agreement (dated 10/25/2022). There is no documentation of how many times staff are too clean R1 room, there is documentation which state, “cleaning bed and bath linens weekly or as often as needed” and “cleaning of residents room”. On 02/07/2024 LPA Calderon inspected R1 room. R1 lives alone and R1 room is clean and there is no trash found on the floor. LPA Calderon noted staff cleaning R1 bathroom and R1 bathroom was clean. Regarding Allegation #3: Staff do not treat residents with dignity and respect. This complaint alleged that Administrator Michael Mendoza A1 has been disrespectful when speaking to R1. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that A1 has spoken to R1 many times and has never been rude or disrespectful. A1 states that A1 has an open-door policy and has spoken to R1 many times with no issues. A1 states that A1 treats R1 with dignity and respect. LPA Calderon conducted an interview with R1-R8. R1-R2 states that Administrator Michael Mendoza is rude and disrespectful to R1-R2. R1-R2 states that all other staff treat R1-R2 with dignity and respect when speaking to R1-R2. 6 out of 8 residents states to have no issues or concerns about A1 or staff and all staff deal with them professionally. LPA Calderon followed up with R1-R2 on complaint. R1 states that A1 had been rude to R1 by interrupting what R1 had to say, but A1 has been professional with R1 and takes care of R1 needs. R2 states that in the past A1 would interrupt what R2 was trying to say, but was never unprofessional with R2. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “staff is not following residents’ dietary needs” “staff is not providing housekeeping services to residents in care” “staff do not treat resident with dignity and respect” is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Michael Mendoza A1.the state’s words, verbatim · CDSS document, Oct 10, 2023 · control 11-AS-20231003150531

Type of visit: Required - 1 Year

On 10/07/2023 at 8:45AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at Glen Park at Long Beach Facility. LPA Calderon was allowed entry into the facility by Administrator Michael Mendoza. The facility is licensed for 208 residents aged 60 and over. Currently, there are (91) residents residing in the facility 60 years or older. LPA Calderon explained to Administrator Michael Mendoza, the purpose of the 1-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: six (6) resident service records, six (6) resident medication records, and LPA Calderon interviewed six (6) residents and six (6) staff members for visit. LPA Calderon inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 09/08/2023. The two-story commercial building consists of one hundred (100) resident bedrooms, one hundred (100) resident bathrooms, three (3) common bathrooms, dining room, commercial kitchen, staff room, office area, library, Media room, Garden area, washer and dryer/ storage area, backyard with umbrella with table and chairs. No weapons are stored in the premises. Commercial Kitchen was inspected and observed to be clean and operational. A 2-day supply perishable and 7-day supply of non-perishable foods are present in the facility kitchen. Emergency Water Storage is in found inside locked shed of the facility grounds. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of resident’s rooms #101, #103, #106, #201, #206, #210: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 113 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 111 degrees Fahrenheit, and Bathroom #3 hot water temperature properly measured at 110 degrees Fahrenheit. Commercial kitchen hot water temperature properly measured at 118 degrees Fahrenheit. Facility sixty (60) Carbon Monoxide and sixty (60) Smoke Detectors hard wired and connected were tested and are working properly. The facility twenty (20) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked medication room. Facility first aid kits (10) is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. Six (6) staff files were checked and have the required documents. The facility does handle resident's money/cash resources. Western Surety Bond Company #7170749 for $10,000.00 was valid at time of inspection. All the required documents are posted in the facility in a clearly visible area. LPA Calderon noted the Administrator Michael Mendoza Certification # 6021836740 expiration date of 12/30/2020 was NOT valid at time of visit (ADMINISTRATOR HAS 83 TRAINING HOURS FROM MARCH TO JUNE 2023 AND IS WAITING HIS NEW ADMINISTRATOR CERTIFICATION). Commercial General Liability Policy #LTC-21200055-02 policy period from 12/05/2022 to 12/05/2023 underwritten by Healthcare Professional Long Term Care Insurance company coverage 1,000,000/3,000,000 is valid at time of inspection. LPA Calderon spoke to Administrator Michael Mendoza who will email full copy of insurance contact which shows all coverages to LPA Calderon no later than 10/20/2023. All the required documents are posted in the facility in a clearly visible area to all staff, clients, and guests. LPA Calderon reviewed LIC500 and noted all staff associated to facility per LIS. LPA Calderon reviewed the resident roster, LPA Calderon confirmed residents’ interview are on resident roster. LPA advised the Administrator Michael Mendoza to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. . According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Michael Mendoza.the state’s words, verbatim · CDSS document, Oct 7, 2023

Allegation investigated: Residents are being sexually abused while in care Residents are being physically abused while in care Staff mismanage residents’ medication Residents are being financially abused while in care Residents are being neglected while in care Residents’ rights are being violated Staff failed to provide adequate food service Residents are being confined to their rooms

On 09/29/23 Licensing program analyst (LPA) Lizeth Villegas and Licensing program manager (LPM) Janae Hammond conduced a subsequent complaint visit to render investigation findings. During todays visit LPA and LPM met with Executive Director Michael Mendoza and the purpose of todays visit was explained. The investigation consisted of the following: On 04/04/23 LPA Gibbs obtained copies of the following documents: Resident Roster, Staff Roster, Staff training in Medication Administration, Staff training in Personal Rights, Menu, Dietician/Nutritionist review of menu report, Assisted Living Waiver Resident list, any resident financial records for money entrusted to the facility and Staff Record (Files to be emailed). On 09/29/23 LPA and LPM conducted interviews with Staff #1-9, interviews with residents # 1-9, obtained copies of staff and resident rosters, P&I ledgers and receipts and conducted review of 9 medication administratoin records. Unsubstantiated The investigation revealed the following: Allegation:Residents are being sexually abused while in care It is being alleged residents are being sexually abused while in care, there was no specific resident identified, no date nor time indicated and no specific details provided. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation and reported being unaware of any resident being sexually abused. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation. LPA conducted file review and there were no incident reports on file for the above allegation. Allegation: Residents are being physically abused while in care It is being alleged residents are being physically abused while in care, there was no specific resident identified, no date nor time indicated and no specific details provided. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation and reported being unaware of any resident being physically abused while in care. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation. LPA conducted file review and there were no incident reports on file for the above allegation. Allegation: Staff mismanage residents’ medication On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. 2 of 9 staff interviewed reported being responsible for conducting quality assurance and reported not findings and discrepancies. On 09/29/23 LPA and LPM interviewed R1-9, 8 out of 9 residents denied the allegation. 1 of 9 residents interviewed reported having 1 pill missing and error was fixed. On 09/29/23 LPA conducted review of 9 medication administration records and did not observe any discrepancies. On 04/04/23 LPA Gibbs reviewed staff records and obtained a copy of medication training for staff that administer medications. Allegation: Residents are being financially abused while in care On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation of being financially abused. 4 out of 9 residents interviewed reported family or self being financially responsible for finances, 5 out of 9 residents interviewed reported the facility is responsible for their finances. On 04/04/23 and 09/29/23 LPA reviewed P&I ledgers and receipts and did not observe any discrepancies. Allegation: Residents are being neglected while in care It is being alleged residents are being neglected while in care, there was no specific resident identified, no date nor time indicated and no specific details provided. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation. Allegation: Residents’ rights are being violated It is being alleged residents rights are being violated, no specific or additional details provided. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation. Allegation: Staff failed to provide adequate food service It is being alleged facility staff is denying residents food. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. S1-9 stated dinning room is always open for residents to obtain food whenever they like. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation and reported receiving meals 3 times a day and snacks 2 times a day. On 04/04/23 LPA Gibbs obtained copies of Menu, Dietician/Nutritionist review of menu report. On 04/04/23 LPA Gibbs conducted tour of facility kitchen and inspected food supply, LPA observed food to be adequately stocked at the time of visit. Allegation: Residents are being confined to their rooms On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. 9 of 9 staff interviewed reported residents were asked to stay in their rooms during Covid per policy. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation. 3 of 9 residents interviewed reported residents were asked to stay in their rooms during covid. 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 with Executive Director Michael Mendoza, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 29, 2023 · control 11-AS-20230403154927

Allegation investigated: Facility staff speak inappropriately to resident's in care

THIS REPORT SUPERSEDES THE REPORT DATED 09/20/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Glen Park at Long Beach on 09/20/2023 and was greeted by Administrator Michael Mendoza (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation. During this investigation, LPA Calderon interviewed Administrator (A1), Residents (R1-R8), Staff (S1-S3). This interview was conducted on 09/18/2023 and 09/20/2023. On 09/20/2023 LPA Calderon obtained and reviewed copies of the following: Incident report (09/09/2023) and (09/15/2023). Admission Agreement (10/25/2022), Housekeeping Zone Logs (date September 2023), Physician Report (date 07/27/2023) for R1. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Facility staff speak inappropriately to resident in care. This complaint alleged that S1 and R1 were yelling at each other inside the facility. LPA Calderon interviewed with A1. A1 expressed that A1 did not witness the conversation between S1 and R1 on 09/09/2023. A1 expressed that R1 was having a conversation with S2 regarding a maintenance issue for R1’s room. A1 explained that S1 interrupted the conversation between R1 and S2 and R1 did not like S1’s actions. A1 reported that R1 cursed at S1 who walked away from R1. A1 explained that on 09/15/2023, A1 had S1 and R1 speak to each other, and both apologized for their actions. A1 believes that it was a miscommunication between S1 and R1. A1 expressed that A1 spoke to S1 and advised that A1 would not approve of any staff being rude or unprofessional with any resident in care. LPA Calderon interviewed (3) out of (3) staff #1-#3 (S1-S3) and reported that S1-S3 witnessed the conversation between R1 and S1 on 09/09/23 and that R1 was rude and cursed at S1. Two out of three staff stated that S1 was professional with R1. LPA Calderon interviewed with S2 who described that S2 and R1 were having a conversation close to the front desk. S2 claimed that S1 interrupted S2 and R1’s conversation. R1 did not like what S1 had done. S2 reported that R1 started to yell and curse at S1. S2 claimed that S1 walked away from R1 and did not yell or curse at R1. LPA Calderon interviewed R1 who expressed that R1 and S2 were having a conversation when S1 interrupted the conversation between R1 and S2 and was rude to R1. R1 expressed that R1 cursed at S1 and later apologized to S1 for R1’s actions on 09/09/2023. R1 expressed that R1 did not want to make a big deal out of nothing and did not want to move forward with the complaint. LPA Calderon interviewed (8) out of (8) residents #1-#8 (R1-R8) and reported that (6) out of (8) residents communicated that S1 has never been rude or yelled at residents. Two out of eight residents expressed that they have issues with S1 and S1 has been rude to residents in the past. On 09/20/2023 LPA Calderon reviewed the internal resident incident report dated 09/09/2023 and 09/15/2023. S1 reported that R1 and S2 were having a conversation. S1 interrupted the conversation as S1 needed S2’s assistance with another resident in care. S1 expressed that R1 got aggressive and cursed at S1. Reviewed summary report 09/15/2023, A1 spoke to R1 and S1 regarding the incident that happened on 09/09/2023. A1 had S1 apologize for interrupting the conversation between R1 and S2. R1 apologized for cursing at S1 and A1 feels this was a miscommunication between both parties. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegation of “facility staff speak inappropriately to residents in care” is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Michael Mendoza (A1).the state’s words, verbatim · CDSS document, Sep 20, 2023 · control 11-AS-20230914152638

Allegation investigated: Resident sustained injuries due to staff handling resident in a rough manner

On 09/19/2023 Licensing Program Analyst (LPA) Mario Leon arrived at the above mentioned facility to conduct a subsequent complaint visit. LPA was met by Administrator, Michael Mendoza (S1) and explained the purpose of the visit. The investigation consisted of the following: On 05/03/2023 LPA toured the facility with Administrator Michael Mendoza (S1). LPA requested a resident roster, staff roster and copies of two resident's (R1-R2) service records which included: Physician’s Report, Appraisals and Medication Administration Records. LPA interviewed two (2) staff and one (1) resident. On 09/19/2023 LPA toured the facility with S1 and interviewed six (6) additional residents, interviewed four (4) additional staff and reviewed 3 staff files. The investigation revealed the following: Report continues, see LIC9099C Unsubstantiated Regarding the allegation: Resident sustained injuries due to staff handling resident in a rough manner. It has been alleged that one resident sustained a cut on their hand, the size of a nickel, while being moved. On 05/03/2023 LPA observed the cut on R1 and interviewed R1 regarding the allegation. LPA interviewed two (2) staff (S1-S2), one (1) which denied the allegation and 1 who denied the interview over the phone, S2. On 09/19/2023 LPA re-interviewed S2, on-site. LPA interviewed three (3) additional staff members (S3-S5), all 3 out of 3 have denied the allegation. LPA interviewed 6 additional residents (R2-R7), five (5) out of six (6) residents denied the allegation. Overall, 5 out of seven (7) residents have denied the allegation. LPA reviewed 3 staff files, 3 out of 3 files contained adequate training records. According to LPA's observations, interviews and record review conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstatiated. An exit interview was held with Administrator, Michael Mendoza, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 19, 2023 · control 11-AS-20230428122858

Allegation investigated: Facility is infested with cockroaches Resident's dietary needs are not being met

THIS REPORT SUPERSEDES THE REPORT DATED 08/10/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: SUBSTANTIATED Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Glen Park at Long Beach Facility on 08/10/2023 and was greeted by Assistant Administrator Tonantzin Martinez (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. During this investigation, LPA Calderon interviewed A1, R1-R8, S1-S4. This interview was conducted on 08/10/2023. On 08/10/2023 LPA Calderon requested copies of the following: Pest control reports for 3 months, home health reports for R1-R8, needs and service plan for C8, LVN information. On 02/07/2024 LPA Calderon obtained and reviewed House Call MD Physician order form (date 4/3/2021, 7/22/2022) for R8. On 08/10/2023 LPA Calderon toured common areas of facility. The investigation revealed the following: Substantiated Regarding Allegation #1: Facility is infested with cockroaches. This complaint alleged facility has a pest control problem. LPA Calderon conducted an interview with A1. A1 relays pest control comes one time per month and sprays for pests in the common areas. A1 relays that staff also will address any reports of roaches and will spray for roaches. LPA Calderon conducted an interview with S1-S4. 4 out of 4 staff relays that there are water roaches that come from the water pipes. 4 out of 4 staff state that they have seen roaches in the hallway, and they also spray roaches. LPA Calderon conducted an interview with R1-R8. R1 and R8 relay that there are no roach problems. R2-R7 relays that they have seen roaches in the hallway, water pipes and inside their bathrooms. R2-R8 relay that pest control does spray for insects and staff also sprays for roaches. On 08/10/2023 LPA Calderon toured common areas of facility; LPA Calderon did not see any roaches. Regarding Allegation #2: Resident dietary needs are not being met. This complaint alleged residents’ dietary needs are not being met. LPA Calderon conducted an interview with A1. A1 relays that the facility does not provide a separate meal plan for diabetic residents. LPA Calderon conducted an interview with R1-R8. R1 states that R1 us diabetic and the facility does not offer a diabetic meal plan. R2-R8 relay that they are diabetic, and the facility does not offer residents a meal plan for diabetic residents. LPA Calderon reviewed the meal plan for the facility, there is no meal plan found for diabetic residents. Based on LPA Calderon observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegations “facility is infested with cockroaches” “residents dietary needs are not being met” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 are cited on the attached LIC 9099D. An exit interview was conducted, and a copy of the Complaint Report and Appeal Rights were provided to the Assistant Administrator Tonantzin Martinez (A1). Regarding Allegation #1: Staff are injecting insulin for residents. This complaint alleged staff are injecting residents with insulin. LPA Calderon conducted an interview with A1. A1 relays that only a LVN is allowed to give insulin injections to residents in care. A1 relays that at no time do staff ever inject residents with insulin as they are not trained. LPA Calderon conducted an interview with S3. S3 relays that at no time does any facility staff other than a trained LVN inject insulin residents in care and that the home health care nurse comes 2 times per day and this person takes care of resident’s insulin needs. LPA Calderon conducted an interview with R1-R8. 7 out of 8 residents relay that they are diabetic and that the nurse with home health care services come to the facility 2 times per day and gives them their insulin injections. 7 out of 8 residents relay that no facility staff has ever given them the insulin injection. R8 relays that R8 is not a diabetic. Reviewed House Call MD (date 4/2/2021, 7/22/2022) House Call MD serviced R8 for catheter, compaction stool and UTI Regarding Allegation #2: Non-skilled staff are performing manual fecal impaction removal on resident. This complaint alleged non-skilled staff are performing fecal removal on resident in care. LPA Calderon conducted an interview with A1. A1 states that Steward Home Health Care LVN staff comes to the facility and performs fecal removal on R8. A1 states that no facility staff have the training to perform the fecal removal on residents in care. A1 relays that no facility staff would be allowed to perform the fecal removal on any resident in care. LPA Calderon conducted an interview with S3. S3 relays that the home health care LVN performs the fecal removal on R8, and no facility staff would be allowed to perform the fecal removal on any resident in care. LPA Calderon conducted an interview with R1-R8. 7 out of 8 residents do not have fecal removal done by staff or home health care nurses. LPA Calderon conducted an interview with R8. R8 relays that Steward Home Health Care LVN performs the fecal removal, and no staff has ever performed the fecal removal on R8. R8 relays that R8 is not a diabetic. Reviewed House Call MD (date 4/2/2021, 7/22/2022, 1/31/2023) House Call MD serviced R8 for catheter, compaction stool and UTI. Regarding Allegation #3: Residents are prohibited from using a home health agency of their choosing. This complaint alleged facility did not allow residents to choose their own health care plan. LPA Calderon conducted an interview with A1. A1 relays that residents are given 5 options for home health care services and one option is Steward Home Health Care. A1 relays that resident is not prohibited from using another home health care company. LPA Calderon conducted an interview with R1-R8. 7 out of 8 residents did not know the name of the home health care company LVN worked for. R8 relays that R8 understood the name of the home health care company LVN worked for. On 08/10/2023 LPA Calderon reviewed the home health care provider's information. 30 total residents have Home Health Care (HHC) services of which 16 have Steward and other have HHC services options. R8 relays that R8 is not a diabetic. Reviewed HouseCall MD (date 4/2/2021, 7/22/2022, 1/31/2023) HouseCall MD serviced R8 for catheter, decompaction stool and UTI. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “staff are injecting insulin for residents” “non-skilled staff are performing manual fecal impaction removal on resident” “resident are prohibited from using a home health agency of their choosing” is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of the Complaint Report was provided to the Assistant Administrator Tonantzin Martinez (A1).the state’s words, verbatim · CDSS document, Aug 10, 2023 · control 11-AS-20230802112635

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80087(a)(1) · Plan of correction due date: Aug 25, 2023

87303Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. . This requirement is not met as evidenced by: Based on interview, observation, and record review the licensee failed to ensure that the facility is free of, cockroaches as reported to LPA on 8/10/23, per 1 of 3 staff and 8 of 8 clients interviewed. Roaches were located in the rooms and hallways, which posed a Potential health and safety to residents in care.the state’s words, verbatim · CDSS document, Aug 10, 2023

Plan of correction: Administrator will provide specific notes from pest control as to where and what type of pest they sprayed for and what plan do they have for future chemical spraying to LPA by 8/25/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(7) · Plan of correction due date: Aug 25, 2023

87555 General Food Service Requirements (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement is not met as evidenced by: Based on interview, observation, and record review the licensee failed to ensure that the facility has a diabetic meal plan for residents in care as reported to LPA on 8/10/23. Per 3 of 3 staff and 7 of 8 residents facility did not provide a diabetic menu meal plan option which poses a Potential l health and safety to residents in care.the state’s words, verbatim · CDSS document, Aug 10, 2023

Plan of correction: Licensee needs to provide 2 meal plans for residents in care. Need to provide a general meal plan and a diabetic meal plan by the POC date to LPA Calderon

Allegation investigated: Staff failled to accept the resident back from the hospital.

On 6/19/23 Licensing program analyst (LPA) Lizeth Villegas and licesnig program manager (LPM) Janae Hammond conducted an intial compaint visit regarging the above allegation and met with Administrator Michael Mendoza as the purose of todays visit was explained. The investigation consisted of the following: On 06/19/23 LPA/ LPM interviewed Adminstrator Michael Mendoza and interviewed wintness #1. LPA/LPM obtained copies of the resident and staff rosters and copies of residents file (facesheet, physicians report, medication list, physicians orders, discharged summary from hospital). The investigation revealed the following: On 06/19/23 LPA/LPM interviewed Administrator Micheal Mendoza regading the above allegation, Administrator stated that on 06/14/23 resident #1 sustained a fall resulting in resident obtaining a bump on back of the head. Administrator reported resident #1 was transported to the hospital following the fall, Administrator reported that on Unsubstantiated Thursday around 3 am stating that resident was going to be discharged back to the facility. Administrator stated that the hospital was informed that additional info is needed prior to resident returning to facility. Administrator stated that the hospital failed to provide additional info on residents assessments for the head injury and possible UTI. Per Administrator, Administrator once again asked for additional info after receiving another call from hospital stating that resident would be transported back to the facility at 11 am, resident arrived back to the facility on 06/15/23 around 11:15 am. Administrator denied informing the hospital that Administrator would not be accepting resident back to the facility. On 6/19/23 LPA/LPM interview witness #1 regarding above allegation, witness #1 denied the allegation and stated that the facility did not deny residents return to the hospital as witness #1 and Administrator had constant communication regarding residents plan of care. LPA and LPM were unable to interview resident #1 as resident #1 is currently at a rehabilitation facility. LPA/LPM reviewed resident #1 discharged paperwork from St. Mary's Medical Center. 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 to Administrator Michael Mendoza and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 19, 2023 · control 11-AS-20230615131524

Allegation investigated: Facility staff intimidated a resident who reported. Facility did not have qualified staff on duty.

On 05/16/23 Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced 10-day visit at this facility to initiate an investigation regarding allegations listed above. LPA spoke with Melissa Flores Quality Assurance Director that there are no Covid-19 cases. LPA met with Michael Medoza Executive Director and Flores and explained the purpose of today's visit is to collect information regarding the allegations. The investigation consisted of the following: LPA toured the facility with Michael Mendoza and did not see any health and safety concerns. LPA interviewed the Executive Director and staff #2-#4 (S2-S4). Interviews with residents #1-#7 (R1-R7). A review of staff and resident roaster, resident medication logs and progress notes, staff training and other documents pertinent or associated with this complaint. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Facility staff intimidated a resident who reported. It is alleged the facility staff intimated a resident who reported. The complainant did not offer additional information on this matter. The complainant did not offer what happened or who was involved. There were no dates or times when the incident occurred. The Department interviewed residents #1-#7 (R1-R7) and were complimentary of the staff. (R1-R7) acknowledged the facility with the new management on board, that problems may exist through the transition phases. However, (R1-R7) recognized there are many benefits to change in management. These benefits included improved communication with residents and staff. (R1-R7) stated they were treated with respect and no staff had used force intimation acts on residents. Interviews with staff #1-#4 (S1-S4) denied this accusation. (S1-S4) reported there is no act or course of conduct directed at any individual to cause that person to fear or apprehend fear. (S2) stated any staff who participates in this act is considered harassment and the company has a zero-tolerance policy for this aggressive behavior. Based on limited information from the complainant and interviews conducted, there is no evidence to support the allegation mentioned above. Allegation: Facility did not have qualified staff on duty. It is alleged the facility did not have qualified staff working. The complainant described the facility had no medication technician staff from 11 pm through 7 am on 5/05/23 and 05/06/23. The complainant did not offer further information and did not present the names of individuals involved. Residents #5-#7 (R5-R7) who specifically require assistance with medications between 11 p.m. through 7 a.m. claim to have no problems and verified that two (2) staff employees were during those days. (R5-R7) reported receiving their PRN (pro re nata) on time at midnight and did not require an additional dose of medication until morning. A review of the Medication Administration Records (MAR) confirmed that (R5-R7) received their PRN medications. Prescription medications were disbursed without any issues or concerns to residents #1-#6 (R1-R6). (S1-S4) reported the staff are fully trained on medications. According to (S1-S2), staff are crossed trained and have completed the basic medication training courses. The Department reviewed staff training records and personnel report found them to be accurate and complete. (S1-S2) stated in case of a staffing crisis, the staff are cross trained to cover caregivers and medication technicians. (S2) reported that in addition to cross-training staff, healthcare staffing agencies will temporarily staff the facility. Based on information gathered, there is no evidence to corroborate the allegation mentioned above. This report serves as an amendment to clarify #27. It does not supersedes the complaint investigation findings reflected on report created 05/16/23. (Evaluation Report continues LIC 9099-C) Based on the information gathered, an inspection of the facility, observation, and interviews conducted, the Department found no evidence to support the allegations mentioned in this complaint. 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 visit. An exit interview was conducted with Michael Mendoza and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 16, 2023 · control 11-AS-20230509075848

Allegation investigated: Staff member is stealing resident's money.

On 03/07/23 Licensing Program Analyst (LPA) Mario Leon conducted an initial 10-day visit regarding the allegation above. LPA was met by Executive Director, Michael Mendoza and Annika Robertson, Assistant Manager. The purpose of the visit was explained. Investigation Consisted of the following: Staff member is stealing resident's money. LPA toured the facility. The following documents were requested and obtained: Admissions agreement, Plan of operations, resident cash resources ledger, resident and staff roster. LPA conducted interviews with staff and residents. The investigation revealed the following: Allegation - Staff member is stealing resident's money. On 03/13/23 LPA Mario Leon interviewed Executive Director, Michael Mendoza about the allegation. LPA asked if there was any current issues with the relationship between staff and residents, in that it was alleged that a staff member is stealing resident's money. Continued on LIC9099-C Unsubstantiated He stated, that as far as he knows there is not any issues surrounding that allegation. He has just begun working here and has not witnessed nor heard of any staff member doing anything like that. On 03/13/23 LPA interviewed residents R1-R8 about the allegation, five (5) of which names are listed on the ledger whom the above named facility is handling their money, and 8 of 8 denied the allegation and R3 stated, "I haven't heard anything about it.". On 03/13/23, LPA interviewed staff S1-S6 about the allegation; and 5 of 6 denied the allegation. The staff stated, by a majority, that all staff do not steal their residents' money. Based on interviews and records reviewed there was insufficient evidence to support the allegation. Although the allegations 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. An exit interview was conducted with Michael Mendoza, Executive Director, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 13, 2023 · control 11-AS-20230307120033

Allegation investigated: Staff do not treat residents with dignity or respect.

On 03/01/23 Licensing Program Analyst (LPA) Perry Scott conducted an initial 10-day visit regarding the allegation above. LPA was met by Executive Director, Michael Mendoza. The purpose of the visit was explained. Investigation Consisted of the following: LPA toured the facility. The following documents were requested and obtained: resident and staff roster. LPA conducted interviews with staff and residents. The investigation revealed the following: Allegation- Staff do not treat residents with dignity or respect. On 03/01/23 LPA interviewed Executive Director, Michael Mendoza about the allegation. LPA asked if there was an issue with the staff and residents. In that it was alleged that the staff do not treat residents with dignity and respect. He stated, that as far as he knows there is not any issues with the staff treating the residents in a disrespectful manner. And there are no records of staff being disciplined prior to his being here. He has not witnessed nor heard of any staff member doing anything like that. Continued on LIC9099-C Unsubstantiated On 03/01/23 LPA interviewed residents R1-R5 about the allegations and 5 of 5 denied the allegation and stated they were not treated with disrespect and a lack of dignity. All of the residents stated that they feel safe in the facility and get along with all of the staff. And were not aware of any issues of this nature. On 03/01/23, LPA interviewed staff S1-S6 about the allegation, staff do not treat residents with dignity and respect; and 5 of 6 denied the allegation. The staff stated by a majority that everyone speaks to all the residents in a respectful and dignified way. Based on interviews and records reviewed there was insufficient evidence to support the allegation. Although the allegations 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. An exit interview was conducted with Michael Mendoza, Executive Director, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 1, 2023 · control 11-AS-20230227123409

Allegation investigated: Staff did not inform responsible party of change in resident's condition Staff did not assist resident with obtaining medical care Staff did not safeguard resident's personal belongings

On 1/31/2023 Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced subsequent complaint investigation at the facility listed above. LPA arrived at facility and was greeted by Administrator Camille Crenshaw. LPA explained the purposed of the visit is to deliver findings on the allegations listed above. The investigation consisted of the following: LPA Randle toured facility grounds, LPA requested pertinent documents pertaining to the investigation. The following documents were gathered: Staff and Client Rosters, entire file for resident (R1) including MARS and any other pertinent documentation regarding R1 such as special incident reports. LPA reviewed facility files and interviewed staff (S1-S8), Resident (R1) was not interviewed R1 never returned to the facility from hospitalization, further R1’s medical condition would likely not yield comprehensible information. Unsubstantiated Con't On 1/31/2023 LPA Randle interviewed or attempted interviews with residents (R2-R9). LPA requested, received, and reviewed the following information: entire file of R1, Staff roster, Resident roster, and other documents relevant to the investigation. Investigation Revealed the following. Allegation: Staff did not inform responsible party of change in resident's condition The complainant alleges Staff did not inform responsible party of change in resident's condition. LPA interviewed Administrator Camille Crenshaw (S1) denied the allegation. Administrator S1 added that R1’s responsible party has a POA and all medical decisions are approved by POA. Per Assistant Administrator (S8) POA in fact was involved directly in decisions regarding resident’s R1 condition. Per S8 R1’s POA was involved in medical decision regarding R1’s change in condition along with PCP. LPA interviewed residents (R2-R7) regarding the allegation Staff did not inform responsible party of change in resident's condition. Residents interviewed all stated (R2-R9) they had no problem with staff communicating their change of condition to their responsible party. LPA interviewed staff (S1-S8) regarding allegation all stated there were no delays in communicating to staff that informs responsible parties of changes to residents. Based on information gathered, the department did not find sufficient evidence to support allegation " Staff did not inform responsible party of change in resident's condition Allegation: Staff did not assist resident with obtaining medical care The complainant alleges Staff did not assist resident with obtaining medical care. LPA interviewed Administrator Camille Crenshaw (S1) denied the allegation, S1 stated that facility staff and (S1) noticed R1’s gait therefore S1 provided a 1 on 1 to R1 for safety of fall risk. R1 was transported to the hospital for evaluation. LPA interviewed staff (S1-S8) all staff stated, residents are assisted with obtaining medical care when needed or asked, no one is denied. Residents (R1-R9) that were interviewed by LPA residents stated staff attends to residents in a timely manner when they call for any reason. Of the residents interviewed by LPA all had no complaints and affirmed they like living at the facility Based on information gathered, the department did not find sufficient evidence to support allegation " Staff did not assist resident with obtaining medical care Allegation: Licensee did not safeguard resident personal belongings. The complainant alleges facility did not safeguard resident’s personal belongings. LPA interviewed Administrator Camille Crenshaw (S1) denied the allegation. LPA reviewed the property list of resident (R1) regarding the allegation. LPA observed the signature of R1's POA confirming all of R1’s property was returned. LPA interviewed (R2-R7) and asked if they had any property stolen or missing items those interviewed R2-R9 stated in the facility they feel safe and the facility keeps their property safe. LPA interviewed staff (S1-S8) regarding allegation, S1-S8 had not been made aware of any personal property or items missing and not found. Based on information gathered, the department did not find sufficient evidence to support allegation " Licensee did not safeguard resident personal possessions. The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found No evidence to support the allegations: Staff did not inform responsible party of change in resident's condition Staff did not assist resident with obtaining medical care Licensee did not safeguard resident personal belongings. 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. An exit interview was conducted with Administrator Camille Crenshaw and a hard copy was provided.the state’s words, verbatim · CDSS document, Jan 31, 2023 · control 11-AS-20220915094537

Allegation investigated: Personal Rights - Failure to follow Mitigation Plan.

On 12/21/22 at 9:15 am, Licensing Program Analyst (LPA) Perry Scott and Licensing Program Manager Janae Hammond conducted a complaint visit to the above facility. We were met by administrator, Camille Crenshaw, and the purpose of the visit was explained. The investigation consisted of the following: On 12/21/22 LPA and LPM interviewed administrator, Camille Crenshaw staff 1 (S1) and Staff 2-7 and residents 1-6. LPA and LPM obtained copies of resident/staff rosters, staff timecard, in service training logs for confidential information training, and COVID-19 training. LPA and LPM conducted a tour of the physical plant, which consisted of common areas, resident rooms, and storage areas. The investigation revealed the following: Allegation: Personal Rights - Failure to follow Mitigation Plan. It is alleged that the facility staff did not have access to personal protection equipment (PPE) during a COVID outbreak, and the facility allowed COVID positive staff to work during an outbreak. On 12/21/22 between 9:40 and 11:15am, LPA Scott and LPM Hammond interviewed facility staff 1-7. Unsubstantiated The interviewed revealed 6 of 7 staff interviewed denied the allegation. And 1of 7 staff confirmed the allegation. The interview with staff #6 revealed that staff #6 tested positive for COVID-19 on 01/15/2022. And reported to work on 01/17/2022. And staff #6 retested on 01/17/2022 and received a negative result. During the interview S6 stated S6 was not asked to return home to isolate but rather S6 continued to work. On 12/21/2022 between 12:15-1:00pm, LPA Scott and LPM Hammond interviewed residents 1-6. The interview revealed 6 of 6 residents denied the allegation. On 12/21/2022 at 1:05pm a record review was conducted and revealed the following: Facility staff has completed in service training related to COVID-19. A tour of the physical plant was conducted, and supplies of personal protection equipment were stored in the front office, med room, administrator’s office, and supply room adjacent to the front office. PPEs are accessible to staff in the storage room and the front office. LPA Scott conducted an in-office file review of the facility file, provider information notices (PINS), and approved facility mitigation plan, facility COVID-19 line-list, and guidance from Long Beach Department of Public Health (DPH). Based on interviews, observations, and records review there was in sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was given to administrator, Camille Crenshaw.the state’s words, verbatim · CDSS document, Dec 21, 2022 · control 11-AS-20220109123431

Type of visit: Required - 1 Year

On October 26, 2022, Licensing Program Analyst (LPA) Wendy Gibbs and Licensing Program Manager (LPM) Janae Hammond, conducted an unannounced Annual inspection, to ensure infection control measures. LPA and LPM met with Camille Crenshaw, Executive Administrator and explained the purpose of the visit. Facility currently has 68 clients. The structure is two story building which consist of the following: The first floor consists of resident rooms, storage rooms, laundry room, living room, art room, visitor restrooms, kitchen, dining room. The second floor consist of an activity room, resident rooms, and storage rooms. Bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew, a non-skid mat was in place and some residents had chairs as well. Temperature in the bathrooms measured 109.8-110.1 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Kitchen Food supply was checked. Refrigerator was stocked with perishables. Freezer was stocked with frozen meats, vegetables, and fruits. Pantry had ample food supply stocked. Appliances were all in working order. Common areas were clean and for the most part clear of hazards; doorways were free of obstructions. Linens & Hygiene Supplies: In the storage closet there were an ample supply of pillowcases, mattress pads, fitted sheet, blankets, bedspreads, hand towels, bath towels and wash cloths were observed. The outdoor perimeter of the building consists of an outdoor two (2) shaded area, outdoor garden, and a designated smoking area. There were three (3) storage sheds by the garden. Emergency Phone Numbers, Exit Plan & Menu: The telephone land line is operational. Emergency Disaster Plan and "See something, Say something, Let Us Know" posted. Multiple fully charged fire extinguisher were observed on both floors. The facility conducted a fire inspection on August 31,2022. The facility had a fire drill in August 2022. Clients & Staff Files: Records of staff and clients were reviewed. Records are stored in front staff office. Medications, First-Aid Kit & Book: Medication is stored in locked medication room. Reviewed MARs for residents. First aid kit was inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze. They did not have the first aid manual. First aid and medications are available for staff use but inaccessible to clients. LPA reviewed the Surety Bond and Liability Insurance. LPA observed staff wearing masks, Visitor Log /Symptom screening Log, Designated isolation room, required Covid-19 Postings, 30 day supply of PPE and other required documents, including phone numbers are posting as mandated by the DPH and CCLD. LPA informed Administrator that facility fees are overdue. Deficiencies to be cited LPA observed: In room 220 fan cover was missing in the bathroom. In activity room there was an accessible paper cutter. In room 140 resident uses oxygen and there is no sign posted outside of the room. In the garden there was a shovel and pick ax accessible to residents and two (2) storage sheds were unlocked. Storage shed 1 (one) contained hazardous chemicals and storage shed 2 (two) contained gardening tools. Deficiencies cited under California Code of Regulations Title 22 Division 6, Chapter 8. Exit interview conducted with Camile Crenshaw and provided with Appeals Rights.the state’s words, verbatim · CDSS document, Oct 26, 2022

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Resident sustained a fall resulting in injuries.

On 05/27/22 Licensing Program Analyst (LPA) Jade Jordan conducted a subsequent visit; continuing the investigation of allegation(s) above. LPA was met by Facility Director, and the purpose of visit was explained. Investigation Consisted of: Physical Tour, Interviews With Reporting Party, Administrator, Resident 1 (R1), Roommate of Resident1, Record Review of R1’s Facility Medical History, Medical Records, and Incident Reports. Regarding Allegation: Resident sustained a fall resulting in injuries. Investigation Revealed that on 04/05/22, R1 had an Unwitnessed Fall at the facility in their room. Facility Administrator was notified by R1, of the fall and was sent to Norwalk Community Hospital, same day. R1 sustained injury; of right arm abrasion, low back pain, hematoma on left face lateral to left eye. CT scan showed “Mildly displaced fracture of lumbar vertebra”. Reporting Party (RP) stated due to be a Mandated Reporter, they had to make a report based on severity of injury, and that they were unable to get enough information due to confusion from R1. Rp stated that “R1 did not have a history of being seen in the hospital for falls. Unsubstantiated Record Review, and Interviews with Administrator revealed that R1 did not have a history of falls and is ambulatory, R1 did not have a fall plan. Interviews were conducted with R1’s Roommate. They stated that “they had only moved in with R1 for about a month but had never witnessed them fall.” Interviews with R1 stated that no one saw the fall, hadn’t fallen before, and did not feel neglected by the facility, R1 stated they did not remember how they fell. Based on Interviews Conducted, and Record Review the Department finds that this was an isolated incident, Therefore : “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Exit Interview Conducted, A copy of this report provided. No citations issuedthe state’s words, verbatim · CDSS document, May 27, 2022 · control 11-AS-20220405101505

Allegation investigated: Resident aquired scabies while in care

Licensing Program Analyst (LPA) Jey Cardenas conducted a subsequent complaint visit to the above facility to deliver findings into the above allegation. Upon arrival at the facility LPA meet with administrator Melissa Flores and explained the reason for today’s visit. The investigation consisted of the following: Initial visit was conducted on 10/06/21 LPA interviewed administrator, Melissa Flores, Staff#1-3 (S1-S3) and obtained Resident#1 (R1) Physician report, appraisal, and functioning capabilities. On 3/28/22 LPA conducted subsequent visit and interviewed seven (7) residents and one (1) staff. Regarding allegation: Resident acquired scabies while in care. On 10/06/2021 LPA Cardenas interviewed administrator Melissa Flores who indicates that R1 had not been confirmed to have scabies. R1 was on hospice and nurses were using scabies medication on R1 but there was never confirmation that resident indeed have scabies. Flores states that resident has not had scabies in the past. Unsubstantiated On 10/07/2021 LPA Cardenas spoke with Hospice registered nurse, John Chen who indicates that R1 has a skin rash, it has not been confirmed that it is scabies. He states that there was no burrowing. Per the hospice instructions Dr. prescribed permethrin cream as a preventative measure, and he is only follow hospice protocol. On 4/22/22 LPA Cardenas spoke with Norwalk Community Hospital who indicates that resident was brought in with scabies treatment, however there is no confirmation that resident had scabies at time of admission. “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Exit interview conducted and a copy of this report was provided to Melissa Flores. (cont pg 2) is ambulatory but has difficulty walking upstairs, R1 can get out of bed unassisted and is not a fall risk, resident has had two falls since being at facility. Per interview with S1, staff stated that she was getting residents ready to take them to the dinning room. S1 fixed R1s hair and left resident sitting on the bed; staff walked out of the room for five minutes and when she returned, she saw R1 on the floor by the door. R1 couldn’t communicate what happened. LPA Cardenas reviewed medical records from Norwalk Community Hospital, On 09/29/2021 R1 arrived to Norwalk Community hospital with left hip pain due to unwitnessed fall at the facility. X-ray hip and pelvis 2 views showed left femoral neck fracture, there are also nondisplaced fractures of the left superior and interior pubic rami. On 12/08/2020 R1 was admitted to Emergency room Chief complaint: Left arm pain, “patient apparently fell from bed at the facility 10 days ago.” On arrival the left arm is swollen. X-ray on the left humerus shows a fracture dislocation of the proximal humerus. LPA Cardenas reviewed R1’s facility records: Per Physician report dated 10/27/20 R1 primary diagnosis is Dementia, resident is confused, disoriented and non-ambulatory. Per most recent Appraisal on file is dated 4/18/19: R1 is Active but has difficulty climbing/ descending stairs, uses walker, Needs no special observation. Per Unusual incident report (UIR) on 9/28/21 S1 found R1 inside the resident’s bedroom on the floor. R1 was admitted to the hospital with a confirmed left hip fracture. Per UIR on 08/14/21 R1 fell out of chair while eating breakfast. R1 didn’t not have re-appraisal, it was not completed after residents’ hospitalization's for fall. Initial physicians report was completed 04/09/2019 and second physician report was completed 10/27/2020, Dementia residents should have a physician report completed every year. LPA Cardenas reviewed Steward Hospice Plan of care, R1 is recertified due to declining condition, R1 is diagnosed with Senile Degeneration of Brain. Continues to have a slow and steady decline in condition. R1 is very confused and is a fall risk (ongoing problem.) POA is notified regarding unusual gait. Recommended use of wheelchair during mealtime. Based on LPA’s interviews, and record review(s), the preponderance of evidence standard has been met, therefore the allegation, is found to be SUBSTANTIATED. California Code of Regulations, Title 22 are being cited on the attached LIC9099-D. Exit interview conducted and a copy of this report and appeal rights provided to Melissa Flores. An immediate civil penalty of $500 is warranted in accordance with California Health and Safety Code Section 1569.49(c)(1)the state’s words, verbatim · CDSS document, Apr 25, 2022 · control 11-AS-20210930152624

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.49(c)(1) · Plan of correction due date: Apr 26, 2022

Any violation that the department determines resulted in the injury or illness of a resident. This requirement not met as evidenced by: On 09/28/2021 R1 had a fall and sustanined left femoral neck fracture. This poses an immediate health and safety risk to residents.the state’s words, verbatim · CDSS document, Apr 25, 2022

Plan of correction: Submit written plan on how facility plans to ensure residents are provided with the services required, needs and serivces plan will be completed and updated as needed. (immediate civil penalty issued on today 4/25/2022.)

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Apr 29, 2022

Reappraisals The pre-admission appraisal shall be updated, in writing... This requirement not met as evidenced by: LPA reviewed R1s file and found facility failed to reappraise resident after inital fall.the state’s words, verbatim · CDSS document, Apr 25, 2022

Plan of correction: Facility will ensure that resident is reappriased to ensure facility can meet residents needs and provides adequate care and supervision.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5) · Plan of correction due date: Apr 29, 2022

Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs...This requirement not met as evidenced by: Durin record review LPA observed inital Physician report dated 4/9/19, second report was dated 10/27/2020 which doesnt comply with required annual medical assessment.the state’s words, verbatim · CDSS document, Apr 25, 2022

Plan of correction: Facility will ensure all dementia residents have updated mediacal assessement annually. Submit self certification indicating this requirment will be met.

Allegation investigated: Staff are under the influence of an illegal substance while providing care and supervision Residents do not have planned activities while in care Residents have access to toxic items while in care Residents pull cords are not accessible while in care Facility has inadequate record keeping for medication Residents medications are being mishandled while in care Staff are stealing from residents while in care

On 03/24/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced subsequent visit to continue investigation regarding allegation(s) above. LPA was met by Facility Administrator Susan Phan, and Quality Assurance Director Melissa Flores, the purpose of the visit was explained. Investigation consisted of : Resident Interviews, Staff Interviews,Physical tour, Observation Of Med room, Medical Administration Records, Resident Rooms. Copies of the following were requested: Company Substance Abuse Policy, Staff Roster, and Resident Roster. Regarding Allegation: “Staff are under the influence of an illegal substance while providing care and supervision” Interviews conducted with Quality Assurance Director revealed that the company has a substance abuse policy. The policy prohibits the sale, use, or possession of drugs or alcohol while in the workplace, or while on the company property, or business. If the company has a reasonable suspicion, based on physical, psychological or other behavioral signs an investigation will be conducted, and the employer may request the employee to submit to a drug or alcohol test. Unsubstantiated Q/A Director, who was the former administrator during the time of allegations were received, stated that they do not witness any employees whom they have a suspicion of alcohol or drug use. Interviews with residents generally stated that they did not witness any staff being under the influence of any drugs while providing care and supervision. During the visit LPA did not observe any suspicion of staff members being under the influence. Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Regarding Allegation: “Residents do not have planned activities while in care.” Interviews with Activity’s Director revealed that in March of 2020 the facility shut down communal activities, including dining due to the situation surrounding Corona Virus disease. Normal Activities were put on hold, and other activities such as coloring packets, virtual visits, and room visit were replaced to keep residents in care safe and allow for social distancing. Actvities Director stated that Tv’s are not turned off, if residents do not want to participate in planned activities. Interviews with residents generally stated that they had not witnessed Televisions being turned off, if residents did not want to participate in planned activities. Residents stated that in 2022, they had resumed normal activities such as Karaoke, Current Events, Exercise Chair, and Gardening. LPA observed residents in the activity room interacting, and observed a monthly activities calendar, with planned activities. Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” ******************************Continued on 9099 C************************************ Regarding Allegation: “Residents have access to toxic items while in care” LPA observed a dining hall called “Pinks café” that is open to residents during mealtimes. Inside the dining is a half door that is locked, with a latch in front of a full door, that also locks. LPA observed a locked storage in the kitchen, that contains kitchen toxins. During the tour of the kitchen, LPA did not observe any toxic chemicals out of the locked storage. LPA confirmed with Administrator that the kitchen is a restricted area to staff, and residents are not allowed. Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Regarding Allegation: “Residents pull cords are not accessible while in care” LPA Sampled 7 resident rooms in the facility. All rooms were observed to have 4 pull chords. Two chords were observed on the wall next to the bed, freely accessible to pull and in good conditions, and two chords were observed next to the toilet stall in resident bathrooms. All were in working condition. Interviews with residents in care all generally stated that” they have no obstructions preventing them from using the pull chord.” Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” *****Continued on 9099C*********************************** Regarding Allegation(s): “Facility has inadequate record keeping for medication”, “Residents medications are being mishandled while in care” Interview with Med Tech revealed that A Medical Administration Record (MAR) is kept for every resident in care who takes medications at the facility. One Binder is used for all residents for the month, and has the listed medications the resident takes in the book. The MAR’s is signed at the time medication is administered. The facility passes out meds, using a roll cart, medications are not pre-prepped. Medication are stored in the locked cart, which is in a locked Medication room. Generally medications are administered during mealtimes. If a resident is unavailable for a meal, the med tech will go to the resident’s room to provide. Interviews with residents in care all generally stated that their medication is provided accurately, and that they have no issues receiving the correct medications. LPA observed the Medical Administration Records for the month of March. Sampled Pages were signed for all medication that was issued.” Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Regarding Allegation: “Staff are stealing from residents while in care” Interviews with Quality Assurance Director revealed that they are not receiving complaints About any individual staff stealing from residents. Interviews with residents in care generally stated that staff are not stealing from them. LPA did not observe any theft taking place while touring the facility. Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” An Exit interview was conducted, and a copy of this report was provided. No citations were issued during this vist. Regarding Allegation: “Residents have access to toxic items while in care” LPA observed a dining hall called “Pinks café” that is open to residents during mealtimes. Inside the dining is a half door that is locked, with a latch in front of a full door, that also locks. LPA observed a locked storage in the kitchen, that contains kitchen toxins. During the tour of the kitchen, LPA did not observe any toxic chemicals out of the locked storage. LPA confirmed with Administrator that the kitchen is a restricted area to staff, and residents are not allowed. Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Regarding Allegation: “Residents pull cords are not accessible while in care” LPA Sampled 7 resident rooms in the facility. All rooms were observed to have 4 pull chords. Two chords were observed on the wall next to the bed, freely accessible to pull and in good conditions, and two chords were observed next to the toilet stall in resident bathrooms. All were in working condition. Interviews with residents in care all generally stated that” they have no obstructions preventing them from using the pull chord.” Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” An Exit interview was conducted, and a copy of this report was provided. No citations were issued during this vist.the state’s words, verbatim · CDSS document, Mar 24, 2022 · control 11-AS-20200406150644

Allegation investigated: staff not following physicians orders for medication

Licensing Program Analyst (LPA) Jey Cardenas conducted an unannounced subsequent complaint visit to the above facility to deliver findings. Upon arrival at the facility LPA conducted a risk assessment over the telephone with staff Bonner; based on the assessment, the facility is clear of Covid-19 infection. LPA met with administrator Melissa Flores and the purpose of the visit was explained. The investigation consisted of the following: LPA interviewed administrator, Melissa Flores, staff and residents, toured physical plant, and obtained staff/ resident roaster and SIRS for incidents relating to Resident1 and Resident2. R1's Physician Report, MAR (July-August'21) Emergency ID sheet, Drs orders, Appraisal. Regarding allegation: staff not following physicians orders for medication, It is alleged that staff tried to administer Seroquel and Xanax at the same time trying to "kill” resident. LPA Cardenas interviewed R1 who indicates that residents on a pain management program and has to get pain medication every six Unsubstantiated hours. R1 states S2 teased and told resident that medication will be dispensed at the end after all the other residents gets their medication. Residents medication is never given on time. LPA asked if resident is still taking Seroquel and Xanax Resident states that S2 tried to give resident two (2) pain pill medications at the same time, LPA asked for that date of the incident, resident doesn’t remember, this was recently. LPA Cardenas interviewed Melisa Flores who indicates that recently R1 has been making accusations relating to medication, accusations are untrue, resident gets his medication per Dr orders. LPA Cardenas interviewed S2 who indicates that R1 takes psych medication and narcotics, R1 requests both medications be given at the same time. S2 reminds resident to wait before administering the other, because both medications can’t be taken at the same time. S2 indicates he has never threatened resident about medication. Medication is given per doctor’s orders. LPA Cardenas interviewed residents who indicate no issues with medication. LPA Cardenas reviewed incident report dated 8/19/21, “since 6:30am R1 has been harassing staff, making accusations that resident didn’t receive medication.” LPA Cardenas reviewed MAR and observed medication for R1 was logged when administered. Based on LPA’s interviews and record reviews, LPA did not find sufficient evidence to support the allegations, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report to be provided to facility representative wheelchair (unassisted/ unsupervised). Police was notified and R2 was later found at 10:10am. LPA Cardenas interviewed administrator Melissa Flores who indicates that facility staff did their morning rounds for breakfast and didn’t see R2. Resident went missing around the time when staff did their shift change. She states facility has 30 dementia residents varying from mild to severe. Residents reside through the facility and are mixed in with the assisted living residents. There are residents who can leave facility unassisted/ unsupervised, LPA asked how does the staff know who is able to exit the facility with/ without supervision? Melissa showed LPA the residents photos posted at the front office identifying who is unable to leave facility unassisted. LPA Cardenas reviewed facility video surveillance recording for date 08/14/21 at approximately 6:39am and observed R2 exit through the door that leads from the side of the facility into the garage area; R2 pushed a wheelchair and went around a parked van, resident walked around the van for few minutes until resident made way toward the second door from the garage leading to the outside of the facility. LPA toured the physical plant and observed the alert system that the facility has in place. There are cameras located at all exits/ entrance, in addition an alarm will sound when a door is opened. When someone exits or enters facility the person at the front desk will see a red light flash, the alarm will sound, and large monitors will expand picture of that assigned exit to show who is entering or exiting. Staff will see who it is and determine if resident leaving can go unassisted. Staff then push a button to stop the alarm sound. LPA Cardenas interviewed staff#7 (S7) who indicates that on that morning, there was a resident entering around the same time R2 exited. The alert system went off, unfortunately only one camera image will expand and project on the monitor, the other pictures will collapse. S7 didn't see R2 exiting. LPA inquired about the alert systems, (alarm, cameras) staff was unfamiliar with the alert/ camera systems. LPA asked who is not able to leave facility unassisted/ unsupervised, staff states this was second time working graveyard. Based on LPA’s observations, interviews, and record review(s), the preponderance of evidence standard has been met, therefore the allegations, are found to be SUBSTANTIATED. California Code of Regulations, Title 22 are being cited on the attached LIC9099-D. Appeal rights provided.the state’s words, verbatim · CDSS document, Oct 6, 2021 · control 11-AS-20210827103021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(b)(2) · Plan of correction due date: Oct 13, 2021

Care of Persons with Dementia. Safety measures to address behaviors such as wandering..This requirement not met as evidenced by: During interviews and observations R2 eloped from the facility. This poses a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Oct 6, 2021

Plan of correction: The licensee will submit a plan of correction outlying steps to take to ensure that Dementia residents do not elope from the facility in the future.

Allegation investigated: Staff made false accusations against resident

On 09/29/2021 around 11am Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Today’s complaint investigation was conducted face to face with Administrator Melissa Flores. The Investigation consisted of the following: On 09/23/2021 LPA Calderon interviewed reporting party. On 09/27/2021 LPA Calderon and Administrator Melissa Flores conducted a tour of the physical plant. LPA obtained copies of Staff and Resident rosters, Resident #1’s record (Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months), Copy of house rules and admission agreement. On 09/27/2021 LPA Calderon interviewed Administrator(S1). On 09/27/2021 LPA Calderon interviewed S2-S3 and on 09/27/2021 LPA Calderon interviewed R2 – R4. The investigation revealed the following: Unsubstantiated Allegation: Staff made false accusations against resident. It is alleged Staff made false accusations against resident. On 09/23/2021 LPA Calderon interviewed R1 for complaint. R1 states that he has been living in facility for 4 months and has never had any issues with staff, other residents or the facility. R1 states that he has been falsely accused of stealing towels, cursing at staff and other residents and stating he would harm himself or other residents. R1 states that the facility is retaliating towards him due to making complaints and wants him to move out. On 09/27/2021 LPA Calderon interviewed S1-S3 all state that R1 has been in violation of house rules, yelling and cursing at staff and other residents, destruction of facility property (kicking a hole in a wall), smoking cigarettes in the facility and smoke marjanuna on facility ground which is against their drug policy. On 09/27/2021 LPA Calderon interviewed R2-R4 all state to know what the house rules are, have seen R1 smoking cigarettes in the facility. R2-R4 do not have any issues with R1 and have not been harmed by R1 at this time. On 09/29/2021 LPA Calderon reviewed medical paperwork on R1. R1 per reports R1 has a hard time dealing with other people. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. A telephonic exit interview was conducted with Administrator Melissa Flores, and a hard copy was provided by hand for recordsthe state’s words, verbatim · CDSS document, Sep 29, 2021 · control 11-AS-20210922131751

Allegation investigated: Staff did not allow resident to have privacy during visit Staff spoke inappropriately to resident

Licensing Program Analyst (LPA) Jey Cardenas conducted an unannounced subsequent visit at this facility to continue complaint investigation regarding allegations listed above. LPA conducted a risk assessment, based on the assessment, the facility is clear of Covid-19 infection. LPA Cardenas met with administrator, Melissa Flores and explained the purpose of today's visit. The investigation consisted of the following: LPA interviewed administrator, Melissa Flores, staff and residents, toured physical plant, and obtained staff/ resident roaster and SIRS for incidents relating to Resident#1 (R1) and Resident#2 (R2), R1's Physician Report, MAR (July-August'21) Emergency ID sheet, Drs orders, Appraisal. It is alleged that, R1’s Physician came to the facility to perform a monthly exam. S1 walked in and then sat down and "trash talked" R1 to the Physician. Unsubstantiated (continue page 2) Regarding allegation: Staff did not allow resident to have privacy during visit; LPA Cardenas interviewed R1 who indicates that physician came to the facility to perform an exam, they were both in the room and S1 came in and told physicians that resident leaves facility at night and doesn’t return and that S1 brought up the fact that residents ankle was bad. LPA Cardenas interviewed S1, staff said during morning meeting Melissa said that R1's Home Health nurse had concerns regarding residents wound. R1 was not allowing wound to heal by taking the dressing off and applying duct tape around, when the tape was removed there was a skin tear. That same day Physician came to see resident, R1 and physician were in the visitor’s room (106). S1 knocked on the door and asked the physicians if they could talk after, physicians asked S1 to come in, S1 appraised physician about R1s wound for approximately five minutes and then left. LPA interviewed administrator Melisa Flores who indicates that when physicians visit residents they meet in a separate room, the staff will appraise the physician about residents and then leave. Melissa indicates that none of the residents have complained about staff violating resident’s privacy. S2- S6 indicates residents haven’t complained about not getting privacy. During interviews with R2 resident was unable to answer question due to Dementia. R3-R8 indicates staff give them their privacy. Regarding allegation: Staff spoke inappropriately to resident; During interview with R1, resident indicated that S1 “trashed talked” resident to physician, LPA asked how was staff trash talking, or if any inappropriate language was used, resident didn’t report any. During interview with S1 staff indicated that no inappropriate language was used during that incident, or any other time with R1 or other residents. During interview with administrator Melisa Flores she indicates that staff is professional and conversation S1 had with physician was relevant to the visit. During interviews with staff S2, S3, S4 they indicated that staff do not speak inappropriately to the residents. S2 indicates that staff being stern can be misinterpreted but residents are not spoken to inappropriately. S5 and S6 indicated that some staff could be more professional. During interviews with R2 resident was unable to answer question due to Dementia. R3-R8 indicated that staff is nice, and staff have not spoken inappropriate to them. R8 indicates staff is friendly, and responsive to residents needs. Based on LPA’s interviews and record reviews, LPA did not find sufficient evidence to support the allegations, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report to be provided to facility representative Melissa Flores.the state’s words, verbatim · CDSS document, Sep 22, 2021 · control 11-AS-20210827103021

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Resident is not awarded privacy Staff are not safeguarding resident's property

On 09/16/21 Licensing Program Analysts (LPAS) Jade Jordan and Ana Soto conducted an unannounced visit to conduct an investigation regarding the allegations above. The LPA’s were met by Facility Administrator Melissa Flores, and the purpose of the visit was explained. The investigation consisted of : Resident / Staff interviews, Video Surveillance, Requested Pertinent documents regarding the allegation. Regarding Allegation: "Staff do not award resident Privacy." The investigation revealed based on resident interviews, that all residents generally stated that they feel they are awarded privacy by staff, and Staff do not invade their personal space. Based on LPAS observation, LPAS did observe any staff being intrusive to any resident in care. Therefore “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated Unsubstantiated Regarding Allegation: Staff are not safe guarding Residents Personal Property. The investigation revealed that the Personal Inventory of RP did not show a dollar amount listed over $150.00. According to admissions agreement Resident cash over $25 shall be held by the front office who will maintain an ink written transaction cash record. No Cash/Record was received or documented by the facility. LPAs Observed facility Video surveillance dated 09/11/21, where Rp appeared to pulled wallet out of pocket, placed wallet on a chair, and wheeled oneself away. LPA observed on the surveillance that after placing wallet on chair, RP Appeared to purposely stay within several feet away from the chair with wallet. Footage shows within the same hour other resident's arrived and spot the wallet, pointing it out, but not touching it. RP is then observed to wheel oneself back over to the chair, where residents where standing, and claimed the wallet. LPA interviews revealed that All Residents in care have the capability to lock their rooms. All residents interviewed generally stated that their personal items such as towels have not gone missing, and facility towels are made available upon request. Residents stated that they have not had other residents come to their room and take their personal property. Therefore based on LPAs Interviews, and observation LPA'S find that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 16, 2021 · control 11-AS-20210910125628

Allegation investigated: Facility staff dispensed medication to resident without a prescription Resident sustained a fall while in care

On 08/09/21 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced complaint visit regarding the allegations above. LPA was met by Facility Administrator Melissa Flores and the purpose of the visit was explained. The investigation consisted of: Resident Interviews, Staff interviews, Record Review, and requested Pertinent, and supplement documents regarding the investigation. Regarding Allegation: Facility staff dispensed medication to resident without a prescription. Reporting Party stated that Resident 1 (R1) was in the hospital due a fall. The toxicology report showed that (R1) had tested positive for Fentanyl. The facility was contacted and stated that they do not carry That type of controlled medication. The LPA conducted a record review of R1’s Medication Record and did not observe any prescription for fentanyl. LPA toured Medication room and did not observe any prescribed fentanyl medications in the facility. Unsubstantiated The Facility Administrator stated that that no resident in Care is prescribed that type of medication. The LPA conducted interviews with residents in care, some of which are on controlled medications. All resident, including R1 Generally stated that they receive their prescribed medications and have not received anything that was not prescribed to them. Based on LPA Record Review, Observation, and Interviews the LPA finds that : Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Regarding Allegation: Resident sustained a fall while in care. Reporting Party stated that the resident has had 3 documented falls dating back to 2020. R1’s last fall Was on 08/01/21. R1 was admitted to the hospital. Prior to the last fall, On 07/13/21 R1 was placed into hospice care. The facility conducted a Re-assessment /Needs and services plan on 07/29/21. The plan indicated R1 has a history of falls, and set a new plan in place, which included R1 being placed on Hospice, and bed rails being added to the bed, and discussed one on one care with family, or higher level of care to meet R1's needs. Family wants to keep R1 at the facility. . LPA conducted interviews with other residents in care, whom are both Ambulatory, and Non-Ambulatory. Residents 1-7 generally stated that they have not had any falls while in care. Based on LPA interview, and record review, the LPA finds that: Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and copy ot this report was given. No Citations were issued during this visit.the state’s words, verbatim · CDSS document, Aug 9, 2021 · control 11-AS-20210805101839

Allegation investigated: Staff are not checking on residents in a timely manner Staff are not meeting residents showering needs Staff are not ensuring resident eats Staff are not providing residents water

On 07/21/21 Licensing Program Analyst (LPA) Jade Jordan Conducted a 10 day complaint Visit, regarding the Allegations above. LPA Met with Assistant Administrator Ghea Guzman, And the purpose of the visit was explained. The Investigation Consisted of 3 staff interviews, and 7 Residents. LPA obtained other Documents pertinent to the investigation such as staff schedule/roster, Resident roster, some individual Physician reports, and needs and services. Continued On 9099C Unsubstantiated The investigation revealed based on allegation: Staff are not checking on residents in a timely manner. Resident interview (R) R 1-5 stated that staff are making sure their daily needs are met. Majority of the residents generally stated that staff are doing a good job with checking in with them. Staff 1-3 interviewed stated that they check on their assigned zoned residents within the hour or two. Sometimes Caregiving staff is assigned an extra zone to assist to meet staff coverage needs. LPA Reviewed caregiver zone logs, kept on a monthly basis, and observed caregivers initial documented every two hours of the Resident Zoned rooms that they checked. Based on LPA interviews, and record review Lpa finds that although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. The investigation revealed based on the allegation: Staff are not meeting residents showering needs. Staff interview's revealed that residents in care have showering schedules. 4 Residents concurred that they have a shower schedule, and out of the 4 some require assistance showering. 3 residents stated that they do not need assistance to shower and do so themselves. Based on LPA interviews, LPA finds that although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. The investigation revealed based on the allegation: Staff are not ensuring resident eats Residents 1-7 all stated that they receive meals and reminders of mealtimes to eat at the facility. Some residents Prefer to eat in their rooms, and some eat downstairs in the dinning room. Staff 1-3 stated that they remind residents of mealtimes and ensure sleeping residents are made aware that meals are being served. Residents have the option to receive meals in their rooms. Based on LPA interviews, LPA finds that although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. The investigation revealed based on the allegation: Staff are not providing residents water. Residents 1-7 all stated that they have access to drinking water in their rooms. 6 Residents indicated that they have water jugs that were provided by the facility. Residents in care generally stated that when they go to the dining hall for mealtime staff will assist them in filling up their water jugs. Assistant Administrator stated that residents can ask staff to fill them up upon entry of their room, Private cell phone use or Pull chords. All Resident have access to drinking water. LPA also observed drinking fountains within the facility. Based on LPA interviews, LPA finds that although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 21, 2021 · control 11-AS-20210712160809

Allegation investigated: Staff are not treating resident with respect

On 07/09/21 Licensing Program Analysts (LPAs) Jade Jordan, and Ana Soto conducted a subsequent complaint visit to continue Investigation regarding the above allegation(s) . LPA was met by Excuetive Director Melissa Flores, and the purpose of the visit was explained. Regarding Allegation: Staff are not treating resident with respect. LPA contacted RP several times and left a voicemail. No call was returned. The complaint received indicated that a med tech staff was being rude and was making noises outside of RP’s Door. No Details or description of what kind of noise was being made, was provided. Lpa conducted interviews with 10% of Residents in care, and interviewed staff as well. Based on Interviews with residents in care all generally stated that Staff are Respectful And have no issues with staff. Based on LPA Interviews, and Record Review the department finds that: Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit Interview conducted, copy of report provided. No citations issued during this visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 30, 2021 · control 11-AS-20210520114717