Golden Assisted Living

Allegation investigated: Staff are financially abusing residents

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegation. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:08 AM, requested copies of facility documents relevant to the investigation at 9:54 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed residents between 11:00 AM to 1:30 PM. Regarding the allegation that staff are financially abusing residents, it was alleged that a possible elder financial abuse and identity exploitation by the staff of the facility. Reporting Party (RP) stated that RP overheard a conversation in the parking lot involving a staff member responsible for handling resident finances, where sensitive financial and personal identifying information (including social security numbers credit card information and IDs) also the use of EBT food cards that belong to residents appeared to be discussed. (continued on LIC 90909-C) Unsubstantiated (continued from LIC 9099) LPA's record review today between 10:00 AM to 11:00 AM revealed that the RP did not provide any name of any resident that is a recipient of Electronic Benefit Transfer (EBT) card and any staff who discussed sensitive information and allegedly use residents' EBT cards. RP also did not provide any other information or contact number, email or physical address to CCL for the LPA to communicate or to correspond, so no follow up communication was done with the RP to clarify and/or obtain further details. Further record review also revealed that only twenty-six (26) residents of the current census are receiving Social Security Supplemental Income (SSI) benefit wherein the facility is the payee and therefore receiving Personal and Incidental Allowance (P & I) through SSI. LPA's interview with five (5) residents receiving P & I revealed that they received their money on time every month. LPA's interview with the Administrator today at 12:07 PM revealed that the Administrator is not aware of any resident that is a recipient of EBT card or any governmental financial assistance program. Further interview also revealed that the Los Angeles County Department of Social Services (LAC DPSS) also calls the facility whenever a resident applies for food stamp or cash allowance to confirm if the applying resident is living at the facility and provided three (3) meals a day and basic services and was told that any resident living at the facility is not eligible to receive benefits because they are not homeless and being provided meals and services at the facility. The Administrator also denied discussing any resident's financial or personal information to anyone at the facility outside of the office.. Based on the information gathered during this and prior visit, this allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 30, 2026 · control 31-AS-20260325092014

Allegation investigated: Staff did not prevent resident from physically abusing another resident in care. Staff mismanaged resident's medications. Staff threatened resident. Staff did not assist resident with relocation to a new facility.

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with staff Amourfino Cruz and explained the reason for the visit. LPA conducted a physical plant tour at 9:05 AM, requested copies of facility documents relevant to the investigation at 10:02 AM, reviewed records between 10:15 AM to 11:15 AM and interviewed staff and residents between 11:15 AM to 1:30 PM. Regarding the allegation that Staff did not prevent resident from physically abusing another resident in care, it was alleged that Resident #1 (R1) was being abused by another resident at the facility. LPA's interview with Resident #2 (R2) who is the long-time roommate of R1 while living at the facility today at 11:43 AM revealed that R2 did not witness anyone abusing R1 and denied abusing R1 at any time, R2 did not have any argument or any kind of altercation with R1 while they were roommates. Further interview with R2 also revealed that R1 was nice to everyone and had no enemy while living at the living at the facility. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with staff on 03/13/26 at 1:00 PM and today between 11:15 AM to 1:30 PM revealed that four (4) out of four (4) staff interviewed did not receive any information about R1 being abused by anyone. Regarding the allegation that Staff mismanaged resident's medications, it was alleged that R1 may have been over medicated. LPA's record review revealed that R1 was given medication as prescribed for the months of February 2026 and March 2026. Further, laboratory results for R1's medication at that time did not cause R1 acute decline in motor function. LPA's interview with staff on 03/13/26 at 1:00 PM revealed while they were aware of R1's condition and upon the request of R1's third party provider, they couldn’t just stop the medication without the physician's order so they did request and eventually stopped the medication that may have caused R1 to limit motor functions. Regarding the allegation that Staff threatened resident, it was alleged that the Administrator threatened R1 with eviction. LPA's interview with the Administrator on 03/13/26 at 1:00 PM revealed that the Administrator is well aware that R1 was a client of Department of Mental Health (DMH)-Enriched Residential Care (ERC) and they were the ones who can and may move R1 at any time. The administrator also stated that it was R1 who was requesting to move out to live on R1's own and denied threatening evicting R1 at any time. Regarding the allegation that Staff did not assist resident with relocation to a new facility, it was alleged that R1 frequently requested assistance with relocation with the staff. LPA's interview with the Administrator on 03/13/26 at 1:00 PM revealed that R1 was a DMH-ERC and told R1 that the Administrator informed R1's Social Worker and would work with them so R1 could move to a place where R1 would like to live because they can't move R1 by themselves without the knowledge of DMH-ERC. R1 was successfully moved out of the facility on 04/02/26 by the DMH-ERC staff. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 27, 2026 · control 31-AS-20260304202236

Allegation investigated: Staff are not providing adequate supervision to a resident Staff are not meeting the hygienic needs of residents Staff do not ensure resident is properly clothed

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:02 AM, reviewed records between 10:15 to 11:15 AM and interviewed staff and residents between 11:15 to 1:00 PM. Regarding the allegation that Staff are not providing adequate supervision to a resident, it was alleged that Resident #1 (R1) is “constantly outside, struggling to move own self. LPA's record review today and on prior visit revealed that there is no resident by the name that the reporting party (RP) reported is residing at the facility. LPA called the RP multiple times to clarify the report and if the RP could provide any physical description of the reported resident to no avail. LPA was not able to communicate with the RP as the Voicemail Messaging system on RP's phone was not set up nor replied to LPA's text messages. (continued on LIC 9099) Unsubstantiated (continued from LIC 9099) LPA's interview with staff and Administrator on prior visit on 02/10/26 also confirmed that there is no resident by the name that the RP provided. LPA however found that there is a resident with almost similar name as the RP provided but was observed to be always at the facility on own room otherwise goes out with friend/family and not lingering outside of the facility. LPA's interview with the facility resident with almost similar name RP provided today at 11:49 AM, confirmed that the resident always goes out with friend/family almost every day and just stay at own room when at the facility. LPA's interview with the Administrator at 12:10 PM confirmed what the facility resident stated. Regarding the allegation that Staff are not meeting the hygienic needs of residents, it was alleged that R1' feet have black discoloration, toenails are overgrown and curving inward. LPA's observation on the resident with almost similar name during this and prior visit revealed that the resident is very well kept and clean from head to toe. LPA observed the toenails had no discoloration, not overgrown and/or had ingrown but was polished with dark pink color instead. LPA's interview with the facility resident with almost similar name revealed that the resident is very independent and able to do own self-care including but not limited to showering, toileting and grooming. Regarding the allegation that Staff do not ensure resident is properly clothed, it was alleged that R1's pants were halfway down and no shoes. LPA's observation on the resident with almost similar name during this and prior visit revealed that the resident is very well kept and clean from head to toe. Further, the resident is an amputee and had only one foot and fully clothed with leggings and shoe during visits. LPA's interview with the facility resident with almost similar name revealed that the resident is very independent and able to do own self-care including but not limited to showering, toileting and grooming. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 14, 2026 · control 31-AS-20260202101633

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Jose Tan and Michael Cava conducted an unannounced Required One (1) year inspection to this facility. LPAs met with Administrator Monique Lopez and explained the purpose of the visit. At 9:55 AM LPAs conducted a tour of the facility inside and out with the Administrator. The following were observed: There is one main entrance being utilized at the facility. Screening area is located in the reception area. Sign in log book, hand sanitizer and masks are available. The facility had submitted and approved Mitigation Plan and Infection Control Plan. The facility has a designated visitor's area in the front of the main building. The facility has sufficient stock of PPE in the storage room The facility is a two (2) storey building and a basement. The facility is fire cleared for 128 ambulatory residents, sixty (60) of which maybe non-ambulatory. Hospice waiver for twenty five (25) residents. The basement has the Kitchen, Cafeteria, Activity room, Laundry Area, Staff break room and Storage rooms. There are sixty four (64) shared bedrooms with own bathroom and eight (8) public bathrooms. There were two (2) shaded smoking area in the surrounding backyard equipped with outdoor furniture. There is no body of water in the facility. Common Areas: The facility has two (2) elevators, both of which are working properly. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and interconnected and back up and tests are done in house on 04/03/24 and valid until 08/31/26 The facility is equipped with sprinkler system which was last tested on 04/20/24 and valid until 04/30/26. Fire extinguishers are located all throughout the facility and were last serviced on 10/14/25. Fire Drill was last conducted on 12/18/25. (continued from LIC 809) Personal accommodations in resident bedrooms and bathrooms were observed for safety, privacy, and comfort. Random resident rooms were inspected and observed with all required furnishings, working signal system, grab bars and nonskid surfaces in the bathrooms. Hot water temperature in random resident bathrooms were checked and measured a range of 108.7°F to 116.2°F. There were enough clean linen available. Basement: Kitchen and Cafeteria are located in the basement area the kitchen appeared clean, odorless and free from insects. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable foods. Frozen foods are wrapped and stored appropriately. Kitchen was observed to be inaccessible to residents. Activity calendars are posted on the elevators, boards and Activity room. Laundry room is located in the basement and was observed to be locked during visit At 2:20 PM, LPA reviewed records of six (6) random residents and six (6) staff. Resident and staff records appeared to be complete and updated. Medications were observed to be locked in the medication room and inaccessible to residents. There were two ( 2) complete first aid kits in the medication room. There is no health and safety hazard observed during this visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 7, 2026

Allegation investigated: Staff do not intervene when residents engage in verbal altercations Staff did not ensure that residents are provided a safe environment Staff did follow reporting requirements

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted a physical plant tour at 9:23 AM, requested copies of facility documents relevant to the investigation at 10:32 AM and interviewed staff and residents between 10:45 AM and 1:00 PM. Regarding the allegation that Staff do not intervene when residents engage in verbal altercations, it was alleged that the reporting party (RP) heard a verbal altercation coming from a room. RP overheard a male voice yelling and possibly throwing items in the room with the door closed. RP also heard a female voice yelling. LPA's interview with Resident #1 (R1) today at 11:40 AM, the resident who was heard yelling revealed that there was no altercation happened and R1 was just talking on the phone and having an argument with someone on the phone. Further interview also revealed that R1 was alone in the room when the incident occurred. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with Staff #1 (S1) today at 12:03 PM, who was requested by RP to go to R1's room when the incident occurred, confirmed that R1 was alone in the room and R1 was talking on the phone when S1 arrived at R1's room. Regarding the allegation that Staff did not ensure that residents are provided a safe environment, it was alleged that per Resident #3 (R3), residents in that room (R1's room) argue all the time and it is unclear if the altercations get physical and R1 yelled at R3 and informed the staff of the verbal abuse against R3 by R1. LPA's interview with R1 today at 11:40 AM revealed that there was no physical or verbal altercation happened in R1's room as R1 was alone in the room, R1 had no one to argue or to physically fight with. R1 admitted to having yelled at R3 only because R3 had been in "everyone's business" and kept on bugging R1 and not leaving R1 alone. Regarding the allegation that Staff did follow reporting requirements, it was alleged that as a mandated reporter the altercation should have been reported to the required agencies. LPA's record review today at 12:30 PM and interview with staff and residents, there was no verbal abuse or any altercation occurred and therefore there was nothing serious that needs to be reported to any agency. Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Dec 17, 2025 · control 31-AS-20251209142255

Allegation investigated: Staff did not ensure resident was seen by physician

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted a physical plant tour at 12:33 PM, requested copies of facility documents relevant to the investigation at 1:00 PM, reviewed records between 1:00 PM to 1:35 PM and interviewed staff between 1:35 PM to 2:45 PM. Regarding the allegation that Staff did not ensure resident was seen by physician, it was alleged that a doctor was trying to speak with Resident #1 (R1) but Resident #2 (R2) told the doctor to get out of their room. LPA's interview with the administrator today at 1:40 PM revealed that R1 & R2 are in a relationship and living in one room, the visiting Social Worker (SW) of R2 upset R2 and became agitated so when the physician came to their room for a monthly routine checkup of R1, R2 yelled at the doctor to get out of their room and prevented R1 to see the physician. (contiued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) Further interview also revealed that the physician went on to see other residents and went back and eventually saw R1 for the monthly routine checkup. LPA's record review at 1:00 PM confirmed that R1 was seen by the physician on the same day of the incident. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 22, 2025 · control 31-AS-20250627120455

Allegation investigated: Staff are not providing the meals listed on the menu to residents Staff are not providing adequate food service to residents

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:48 AM, requested copies of facility documents relevant to the investigation at 10:32 AM and interviewed staff and residents between 10:45 AM to 1:00 PM. Regarding the allegation that Staff are not providing the meals listed on the menu to residents, it was alleged that the new menu has 80% of the old menu items. LPA's record review and observation revealed that the facility hired a new chef on 04/17/25 and has since developed a new menu with a nutritionist. LPA's interview with the new chef revealed that since the chef took over, they always make sure that they serve whatever is on the menu and they plan ahead to ensure that they have all the meat, vegetables and all the ingredients in stock so they don't have to substitute. LPA's observation during today's visit and prior visit revealed that the meal they are serving on the day of the visit is what exactly was written on the menu. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with four (4) residents on 04/02/25 between 10:21 AM to 1:00 PM and eight (8) residents today between 10:45 AM to 1:00 PM, revealed that twelve (12) out of twelve (12) residents stated that the food is okay to good and they serve on what is in the published menu. Regarding the allegation that Staff are not providing adequate food service to residents, it was alleged that residents were served rotten roasted turkey that made some residents sick and that the fridge and freezers don’t work well because the meat has been defrosted and refrozen again with ice on them. LPA observed during physical plant tour today and prior visit on 04/02/25 that all the refrigerators and walk in freezers are working properly and all the foods were wrapped and labeled accordingly. LPA's interview with four (4) residents on 04/02/25 between 10:21 AM to 1:00 PM and eight (8) residents today between 10:45 AM to 1:00 PM, revealed that twelve (12) out of twelve (12) residents stated that they did not see nor remember eating a roasted turkey. LPA's interview with the reporting party (RP) today revealed that the RP was unable to name the resident who got sick while eating the rotten roasted turkey nor able to tell the date and time the alleged rotten turkey was served. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 19, 2025 · control 31-AS-20250401102141

Allegation investigated: Staff did not treat residents with respect

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent visit at this facility to further investigate the above allegation. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:51 AM, requested copies of facility documents relevant to the investigation at 10:33 AM and interviewed staff and residents between 10:50 AM to 1:00 AM. Regarding the allegation that Staff did not treat residents with respect, it was alleged that staff laughed at residents when residents expressed their concern/complaint. LPA's interview with twelve (12) residents on 01/22/25 between 10:00 AM to 1:00 PM and additional four (4) residents today revealed that sixteen (16) out of sixteen (16) residents interviewed stated that the staff are respectful and did not experience being laughed at nor witnessed any other residents being laughed at by the staff when they complain at the office or to any staff at the facility. Based on the information gathered during visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 8, 2025 · control 31-AS-20250116134118

Allegation investigated: Staff do not ensure that resident rooms are free of bed bugs

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:43 AM, requested copies of facility documents relevant to the investigations at 10:28 AM and interviewed staff and residents between 10:45 AM to 1:00 PM. Regarding the allegation that Staff do not ensure that resident rooms are free of bed bugs, it was alleged that there is a bed bug infestation on the room of Resident #1 (R1). LPA's observation during the physical plant tour at R1's room revealed that R1's mattress was encased in a bed bugs protector fitted sheet. LPA's interview with R1 today at 11:05 AM revealed that the mattress protector has been in R1s bed for months now and denied having a bed bug in own bed. R1 confirmed that the pest control came today and treated their room and did not find any trace of bed bugs. LPA's visit to eight (8) random residents' bedrooms also confirmed that the residents' mattresses are encase in a bed bug protector sheet (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with twelve (12) residents today between 10:45 AM to 1:00 PM revealed that twelve (12) out of twelve (12) residents did not have bed bugs infestation in their bed/room. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, May 1, 2025 · control 31-AS-20250430082433

Allegation investigated: Illegal eviction Staff withheld resident's funds

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:22 AM, requested copies of facility documents relevant to the investigation at 9:54 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that Resident #1 (R1) was illegally evicted, it was alleged that R1 was told to pack personal belongings to move out of the facility and was not given or issued an eviction letter. LPA's record review today revealed that R1 was a client of Los Angeles County Department of Health Services (LA DHS) through LA County Department of Mental Health Enriched Residential Care Housing (LA DMH ERC) and was the agency who transferred R1 to a six (6) bed facility. LPA's interview with the Administrator today revealed that R1 was the one who requested to be transferred to another facility. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with R1's roommate today at 2:20 PM confirmed that it was R1 who wanted to leave ever since R1 came at the facility. Regarding the allegation that Staff withheld resident's funds, it was alleged that R1 asked staff for own Personal and Incidental (P & I) monthly allowance of $177 but staff refused to provide it to R1. LPA's record review today revealed that R1 regularly get P & I allowance and signed for it every month, the last allowance R1 was given and signed for by R1 was on 03/06/25. LPA's record review of nine (9) other residents revealed that the facility always distributes on the 2nd or 3rd day of every month but R1 was hospitalized during these dates but was issued P & I money on the next Thursday upon R1's return to the facility on 03/03/25. LPA's interview with the Administrator revealed that if any resident missed the distribution of P & I on the 2nd or 3rd day of the month, the next distribution day is Tuesday or Thursday of the month following the original distribution dates. LPA's interview with nine (9) residents receiving P & I allowance at the facility, between 11:00 AM to 1:00 PM revealed that nine (9) out of nine (9) residents interviewed stated that they received their PNI on time and no staff withheld their P & I allowance. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 10, 2025 · control 31-AS-20250303145417

Allegation investigated: Staff are not properly managing residents' medications

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 10:43 AM, requested copies of facility documents relevant to the investigation at 11:12 AM, interviewed staff and residents between 11:15 AM to 1:30 PM and reviewed random residents' record between 1:30 PM to 2:30 PM. Regarding the allegation that Staff are not properly managing residents' medications, it was alleged that the Medication Office was found in disastrous conditions and was filled with unlocked medications. LPA's observation during physical plant tour revealed that the Medication Room itself was locked during visit, organized and in proper order. LPA's interview with the Lead medication technician and Administrator at around 11:30 AM, confirmed that the Medication Room is always locked and inaccessible to all residents. Medication pass is done in the dining room during meals (breakfast, lunch, and dinner). (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Further interview revealed that if a resident is not present at the dining room, resident knocked on the medication room to get their medication. Moreover, if a resident has not taken own medication within the medication pass window, medication technician goes to the resident's room and administer the medication. LPA's record review of twelve (12) random residents Medication Administration Record (MAR) revealed that twelve (12) out of twelve (12) residents MAR shows that all medication of each resident were given as prescribed. LPA's interview with twelve (12) residents or 10% of current census between 11:15 AM to 1:30 PM, revealed that twelve (12) out of twelve (12) residents were given their medication correctly and on time. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Mar 28, 2025 · control 31-AS-20250324100753

Allegation investigated: Staff did not provide comfortable accommodations to residents in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:22 AM, requested copy of facility documents relevant to the investigation at 9:49 AM and interviewed residents and staff between 10:00 AM to 1:00 PM. Regarding the allegation that Staff did not provide comfortable accommodations to residents in care, it was alleged that only cold air was coming out of the heating unit. LPA's observation during physical plant tour at 9:22 AM revealed that the facility has the heater on and LPA could feel the heater along the hallway and all the random rooms visited on both floors. Further, all the thermostats were set in between 72°F to 78°F during visit. LPA's interview with the administrator at 11:30 AM revealed that each thermostat covers four (4) rooms and they adjust it based on their residents' need. Further, the administrator admitted that they got a complaint yesterday (01/21/25) from a resident that the heater was not working. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Administrator checked the rooms and already placed a work order for that cluster of rooms. LPA observed that the technician arrived today at around 12:10 PM and proceeded to the roof to diagnose and do the repair. LPA's interview with Resident #1 (R1) who complained to the administrator confirmed that R1 only noticed the heater the day before and reported it immediately to the administrator. It was also alleged that the television in the lobby has been broken for several months and the facility's WI FI has been turned off or not working. LPA's records review between 1:00 PM to 1:45 PM revealed that the service provider for both TV and internet are the same and there were outages during the wildfire. LPA's interview with the administrator revealed that the TV in the lobby has never been broken and had only outages due to severe weather. LPA's interview with twelve (12) residents between 10:00 AM to 1:00 PM today revealed that twelve (12) out of twelve (12) residents stated that there were times that the television and internet were not working but only for about a week or so about two (2) weeks ago, which coincide with the wildfire timeline. Based on the information gathered during this visit, this allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 22, 2025 · control 31-AS-20250116134118

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 developed a stage 4 pressure injury while in care Resident sustained an unexplained fracture while in care Staff did not seek medical attention to resident in a timely manner.

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to deliver the findings for the above allegations. LPA met with the Administrator Monique Lopez and explained the reason for today’s visit. During the initial visit on 05/17/2024 at 12:16 PM, LPA obtained copies of the facility records, relevant to the investigation and interviewed the Administrator. This case was referred to and accepted by the Investigation Bureau (IB) and was assigned to IB Investigator Edward Hector, who conducted a separate investigation regarding the same allegations. During the course of the investigation, Investigator Hector interviewed a nurse from the Hospice services agency, facility staff, hospital staff, Resident #1 (R1) and R1’s family member and obtained medical records from the hospital and skilled nursing facility where R1 was discharged after hospitalization. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099-C) Regarding the allegation that a resident developed a Stage 4 pressure injury while in care, it was alleged that Resident #1 (R1) had multiple pressure wounds including a stage 4 pressure wound when admitted to the hospital on 05/12/24. IB Investigator, Hector’s record review on 06/23/24 revealed that R1 was admitted to hospice on 11/30/22 and had been treating R1’s wound since then and the last visit for wound care was on 05/10/24. Investigator Hector’s interview with the hospice nurse on 07/23/24 at 4:32 PM, revealed that the nurse had been treating R1 since November 2022. When R1 presented with wounds, more frequent visits were implemented to care for R1’s wounds and an additional visit from Omni Wounds doctor was implemented to care for R1’s wounds. Further interview with the nurse also revealed that the facility communicated with the hospice agency regarding R1’s wound progress and overall health condition and kept R1 “dry” at all times. Additionally, the nurse and IB Investigator’s interview with the facility Administrator on 07/23/24 at 2:30 PM, R1 on 07/31/24 at 11:46 AM confirmed that R1, though wheelchair bound, was able to ambulate on R1’s own. Regarding the allegation that Resident sustained an unexplained fracture while in care, it was alleged that R1 had a rib fracture when admitted to the hospital on 05/12/24. IB investigator Hector’s interview with hospital staff on 07/30/24 at 9:10 AM, revealed that the doctor who initially saw R1 did not report of chest/rib pain. Investigator Hector’s interview with the hospice nurse on 07/23/24 at 4:32 PM revealed that R1 never complained of any chest/rib pain while treating R1 therefore the hospice agency was not aware of R1’s rib fracture. Investigator Hector’s interview with the facility Administrator on 07/23/24 at 2:30 PM also revealed that they were not aware of R1’s rib fracture as R1 never complained of pain on the rib/chest area. Investigator Hector’s interview with R1 on 07/31/24 at 11:46 AM confirmed that even R1 was not aware of any rib fracture as R1 “didn’t feel it”. Regarding the allegation that Staff did not seek medical attention to resident in a timely manner, it was alleged that R1 was admitted to the hospital for failure to thrive, declining mental and physical status. LPA’s record review on 05/17/24 revealed that R1 was admitted at the facility on 10/05/22 and was admitted to hospice care on 11/30/22 and was able to communicate their needs to the facility. Investigator Hector’s interview with the facility Administrator on 07/23/24 at 2:30 PM, revealed that R1 was declining since February 2024 but was still alert, oriented and still went outside the facility to smoke. (continued to LIC 9099-C) (continued from LIC 9099-C) LPA’s interview with the administrator on 05/17/24 at around 1:30 PM revealed that on 05/10/24, R1 complained of not being well but refused to go to the hospital and instead requested a family visit. Family members who regularly visit R1 came on 05/11/24 but another family member, a first-time visitor, came on 05/12/24 and called 911 for R1. R1 initially refused to go to the hospital but eventually agreed. Investigator Hector’s interview with R1 on 07/31/24 at 11:46 AM revealed that the facility provided assistance when R1 needed it and whenever R1 asked for it. Based on the information gathered during the course of the investigation, including interviews, and record reviews, these allegations are deemed unsubstantiated at this time Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Jan 16, 2025 · control 31-AS-20240515161345

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced Required One () year inspection to this facility. LPA initially met with Administrator Monique Lopez and explained the purpose of the visit. At 10:25 AM, with the Administrator, LPA conducted a tour of the facility inside and out. The following were observed: There is one main entrance being utilized at the facility. Screening area is located in the reception area. Sign in log book, hand sanitizer and masks are available. The facility had submitted and approved Mitigation Plan and Infection Control Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted indoors. Hand washing, coughing etiquette, physical distancing and other necessary signage were posted in the bathroom and all over the facility. The facility has a designated visitor's area in the front of the main building. The facility has sufficient stock of PPE in the storage room The facility consists two (2) storey building and a basement. The facility is fire cleared for 128 ambulatory residents, sixty (60) of which maybe non-ambulatory. Hospice waiver for twenty five (25) residents. The basement has the Kitchen, Cafeteria, Activity room, Laundry Area, Staff break room and Storage rooms. There are sixty four (64) shared bedrooms with own bathroom and eight (8) public bathrooms. There were two (2) shaded smoking area in the surrounding backyard equipped with outdoor furniture. There is no body of water in the facility. (continued to LIC 809-C) (continued from LIC 809) Common Areas: The facility has two (2) elevators, both of which are working properly. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and interconnected and back up and tests are done in house on April 2024. The facility is equipped with sprinkler system which was last tested on 04/20/24 and valid until 04/30/26. Fire extinguishers are located all throughout the facility and were last serviced on 10/18/24. Fire Drill was last conducted on 01/03/25. Personal accommodations in resident bedrooms and bathrooms were observed for safety, privacy, and comfort. Random resident rooms were inspected and observed with all required furnishings, working signal system, grab bars and nonskid surfaces in the bathrooms. Hot water temperature in random resident bathrooms were checked and measured a range of 109.2°F to 114.4°F. There were enough clean linen available. Basement: Kitchen and Cafeteria are located in the basement area the kitchen appeared clean, odorless and free from insects. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable foods. Frozen foods are wrapped and stored appropriately. Kitchen was observed to be inaccessible to residents. LPA observed however that the lunch being served is not the one on the menu for the day and there is no activity calendar posted anywhere in the facility. Laundry room is located in the basement and was observed to be locked during visit. At 2:35 PM, LPA reviewed records of six (6) random residents and six (6) staff. Resident and staff records appeared to be complete and updated. Medications were observed to be locked in the medication room and inaccessible to residents. There were two ( 2) complete first aid kits in the medication room. Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 16, 2025

Allegation investigated: Staff did not seek medical attention to resident in a timely manner

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:34 AM, requested copies of facility documents relevant to the investigation at 10:00 AM, reviewed records between 10:00 AM to 11:00 AM and interviewed resident and staff between 11:00 AM to 1:00 PM. It was alleged that Resident #1 (R1) had an infected abscess on the arm and was not sent to see medical attention. LPA's record review revealed that R1 did not have a skin condition upon admission on 08/13/24 and was ambulatory, able to bathe, care for own toileting needs, groom and dress and even manage own cash resources. R1 was not incontinent both bladder and bowel. LPA's interview with staff on 10/25/24 between 1:30 PM to 2:30 PM revealed that R1 was independent and able to go out alone to run own errand and/or meet with love partner outside of the facility. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with the same staff and the administrator today at 12:31 PM, revealed that when R1 showed the infected part of R1's body to them on 10/21/24, both the staff and the administrator told R1 to go to the hospital to have the skin condition be medically evaluated. R1 was sent to the hospital and was admitted on that same day. Further interview with the administrator today also revealed that R1 did not come back to the facility after that hospitalization but was officially discharged at the facility on 11/22/24. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Dec 11, 2024 · control 31-AS-20241022101541

Allegation investigated: Staff took away resident's television use Staff took away resident's internet use Staff did not provide adequate dining assistance to resident in care

This report is being amended to rectify typographical and grammatical errors. No change in findings. Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:03 AM, reviewed records between 10:30 AM to 11:30 AM and interviewed staff and residents between 11:30 AM to 1:00 PM. Regarding the allegation that Staff took away resident's television use, it was alleged that the TV on Resident #1 (R1)'s room stopped working. LPA's observation during today's visit revealed that the TV set in R1's room had no antenna nor connected to a TV cable provider and only connected to the internet and has own internet service provider (ISP)'s modem and wi-fi router which belongs to R1’s roommate and R1 admitted that R1’s roommate was not paying the internet provider that is why there is no internet connection. (continued on LIC 9099-C) Unsubstantiated LPA's record review today between 10:30 AM to 11:30 AM revealed that nothing on R1's admission agreement states that the facility will provide a television or cable connection in R1's or any room at the facility. LPA's interview with the administrator on 10/25/24 at 11:30 AM confirmed that the facility only provides Cable TV services on the TV room and everyone is welcome to watch but not on individual rooms. Further interview also revealed that the facility staff would assist any resident who would like to get a cable/internet service on their room at their expense. Regarding the allegation that Staff took away resident's internet use, it was alleged that the staff stopped R1’s internet connection. LPA's interview with the administrator at 12:00 PM, confirmed that the facility has internet connection and provide the password to the residents when they asked and denied stopping the connection of any resident at any time. LPA tested and connected to the facility's internet and observed to be working. LPA's interview with three (3) residents in the living area by the lobby revealed that they are connected to the facility's internet and the password were given by the administrator. LPA's observation during today's visit also revealed that the facility is expanding the internet coverage by adding wireless router on the far end area of the facility to enable any resident to connect to their internet connection. Regarding the allegation that Staff did not provide adequate dining assistance to resident in care, it was alleged that staff are late on picking up R1 for lunch in the dining area. LPA's interview with the administrator on 10/25/24 at 11:30 AM and today at 12:17 PM, revealed that R1 is being served trays every day for breakfast and eat at the dining room for lunch and dinner. LPA's interview with R1 on 10/25/24 at 11:50 AM revealed that sometime the staff are late about ten (10) minutes but it is okay now and the staff now comes on time to pick up R1 for lunch. LPA's interview with two (2) staff today between 11:30 AM to 1:30 PM revealed that they usually pick up R1 ten (10) to twenty (20) minutes before lunch time but there are times that R1 was not ready so they had to go around and help other residents and come back which would cause their delay but they always try to come on time. Further interview also revealed that the only thing they do for R1 was to transfer R1 from bed to wheelchair which R1 could do alone at times. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 31, 2024 · control 31-AS-20241018144046

Allegation investigated: Staff allowed residents to smoke inside the facility Residents were not provided nutritious meals

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with Administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:22 AM, requested copies of facility documents relevant to the investigation at 10:11 AM and interviewed residents and staff between 10:30 AM to 1:15 PM. Regarding the allegation that Staff allowed residents to smoke inside the facility, it was alleged that residents were allowed to smoke inside the facility because R1 smoked in facility restroom at times. LPA's record review today at 10:14 AM today revealed that the on the admission agreement of the facility includes a copy of the house rules wherein all residents, upon admission was informed and sign the house rules wherein it specifically stated that smoking inside the facility is strictly prohibited. LPA's interview with three (3) residents on 04/05/24 between 10:30 AM to 1:00 PM and nine (9) residents today between 10:30 AM to 1:15 PM or 10% of the current census. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Revealed that twelve (12) out of twelve (12) residents interviewed did not witness or see any resident smoking inside the facility. LPA's interview with the administrator Regarding the allegation that Residents were not provided nutritious meals, it was alleged that Residents were fed mainly hot dogs and other unhealthy foods. LPA's observation during visit on 04/05/24, 05/17/24, 06/11/24 and today revealed that the facility served a variety of foods which almost always include soup, vegetable, meat and fruit on every meal. LPA's record review of facility menu confirmed that the facility served variety of foods with meat, fruit and vegetables on every meal. LPA's interview with three (3) residents on 04/05/24 between 10:30 AM to 1:00 PM and nine (9) residents today between 10:30 AM to 1:15 PM or 10% of the current census, revealed that eleven (11) out of twelve (12) residents interviewed believe that the food being served are nutritious and healthy. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 20, 2024 · control 31-AS-20240402133640

Allegation investigated: Staff did not prevent a resident from being hit while in care.

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with Administrator, Monique Lopez, and explained the reason for the visit. ---Staff did not prevent a resident from being hit while in care. It was alleged that Resident #2 (R2) hit Resident #1 (R1) on the face and R1 was unable to recall if it was left or right side of the face. R1 later referred to the alleged abuser as “visitor” and the reporting party reported no notable bruising or redness observed on R1's face. To investigate the allegation, on 06/11/2024, LPA conducted physical plant tour at around 2:00 PM, requested Staff Roster, Client Roster, Physician’s Report and Needs and Service Plan at 2:00 PM and interviewed the Administrator at 2:45 PM and six (06) residents between 2:45 PM to 03:30 PM. (CONT. LIC9099-C) Unsubstantiated On 09/11/2024, LPA interviewed an additional three (03) staff from 12:00 PM – 1:00 PM. During the physical plant tour, LPA did not observe any signs of abuse and all residents were clean and well groomed. The department’s incident report files did not indicate any prior incidents involving the alleged abuser R2 and the alleged victim R1. During interviews with staff, all staff stated they are unaware of R2 hitting R1 or any other resident or visitor hitting R1. During interviews with residents, R1 stated they were not hit by R2 or any other resident or visitor. All other residents stated they have never hit a resident and do not know of any residents being hit by anyone, including visitors. Based on observations, record reviews and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 11, 2024 · control 31-AS-20240606130224

Allegation investigated: . Staff had sexual relations with resident in care 2. Staff provided beer and marijuana to resident in care 3. Staff financially abused resident in care

Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Monique Lopez and informed her the purpose of the visit. On 01/31/2023, the Woodland Hills Regional South Adult and Senior Care Office received a complaint for the allegations mentioned above and referred it to the Community Care Licensing Division’s (CCLD’s) Investigations Branch (IB). It was assigned to Investigator Lorraine Patterson, to investigate and determine the finding for allegation # 1. LPA Tuesday Cabiness investigated allegations # 2 and # 3. The following was determined: Allegation # 1: It was alleged that staff had sexual relations with resident in care. On 02/01/2023, LPA Abeye Duguma, conducted a physical plant inspection, interviews, and obtained documents pertaining to the complaint. Investigator Patterson conducted additional interviews, obtained, and reviewed documents pertaining to allegation #1 on various dates, from approximately February 2023 through April 2023. The following was determined: Resident # 1 (R1) and staff # 1 (S1) both denied having a sexual relationship while at the facility. Interviews by staff denied witnessing or having any information of a relationship between R1 Unsubstantiated and S1. Further information revealed, R1 and S1 did have a personal relationship; but not until R1 relocated and moved from the facility and out of state and S1 was no longer working at the facility, and it was consensual from both. IB Patterson revealed there is no corroborating evidence to prove sexual abuse while in care, therefore based on interviews, the allegation is Unsubstantiated. Allegation # 2: It was alleged that staff provided beer and marijuana to resident in care. To investigate the allegation, on 02/01/2023 at 11am LPA Abeye Dugma, conducted a physical plant inspection, interviewed staff, and obtained documents pertaining to the allegation. On August 08, 2024, from 945am to 2pm, LPA Tuesday Cabiness conducted additional interviews with staff and residents, as well as obtained documents. It was revealed to LPA, that no one witnessed staff # 1 (S1) giving resident # 1 (R1) drugs or alcohol, and it was reported that residents do not use drugs while at the facility. Based on interviews, there is sufficient evidence to prove the allegation, therefore, the allegation is Unsubstantiated at this time. Allegation # 3: It is alleged that staff financially abused resident in care. To investigate the allegation, on 02/01/2023 at 11am LPA Abeye Dugma, conducted a physical plant inspection, interviewed staff, and obtained documents pertaining to the allegation. On August 08, 2024, from 945am to 2pm, LPA Tuesday Cabiness conducted additional interviews with staff and residents, as well as obtained documents. It was reported to LPA, that Brilliant Corners paid resident # 1 (R1’s) rent and sent the balance of (R1's) money to the facility for (R1). Administrator also reported to LPA, that she disbursed all residents’ funds twice a week, and (R1) was observed to be given their funds. LPA was not able to interview (R1) or (S1) who both are no longer living or working at the facility. Based on the information obtained this allegation is deemed Unsubstantiated at this time. An exit interview was conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 15, 2024 · control 31-AS-20230131095157

Allegation investigated: Staff did not safeguard resident's personal belongings

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:08 AM, requested copies of facility documents relevant to the investigation at 10:12 AM and interviewed staff between 10:30 AM to 12:30 PM. LPA also reviewed records between 12:30 PM to 1:30 PM. Regarding the allegation that Staff did not safeguard resident's personal belongings, it was alleged that Resident #1 (R1)'s belongings were thrown away by the while being away from the facility. LPA's record review today at 11:40 AM revealed that R1 was admitted at this facility on 04/20/2018 and was brought to the hospital on 11/20/23 due to R1's medical condition and has not been back at this facility since. Further review also revealed that R1 had a signed admission agreement and addendum specifically stating that if the resident leaves the facility for such reasons as hospital stay, skilled nursing care, or vacation. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) And if the resident is unable to or decided not to return to the facility, any belongings left behind at the facility will be held for 21 days and then be discarded. Since R1 left the facility and decided not to return to the facility since R1 left in 11/20/23, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 8, 2024 · control 31-AS-20240805162043

Allegation investigated: Staff left resident on the floor for an extended period of time

Licensing Program Analyst (LPA) conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:03 AM, reviewed records between 10:43 AM to 12:00 PM and interviewed residents and staff between 12:00 PM to 1:30 PM. It was alleged that Resident #1 (R1) fell on the floor for four (4) hours, and no one checked on R1. LPA interview with R1 today revealed that the incident happened on 06/16/24 but claimed that it happened at the facility and that two (2) female staff went by to R1's room at around 5:00 PM to deliver dinner and clean R1's bathroom but ignored R1 while lying on the floor. Reporting party (RP) who interviewed R1 reported that R1 fell two (2) days ago (07/16/24). LPA's record review today revealed that R1 was admitted only on 06/25/24. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's review of the Closed-Circuit Television (CCTV) footage from 07/12/24 to 07/17/24 review today between 10:43 AM to 12:00 PM revealed that there is only one (1) female staff that may have delivered dinner to R1 during the period the RP reported. Staff #1 (S1) denied seeing R1 on the floor since R1's admission during interview. LPA's interview with the administrator also revealed that there is housekeeper scheduled to clean the bathroom of any resident in the afternoon unless a resident reported an "accident". Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jul 18, 2024 · control 31-AS-20240715090557

Allegation investigated: Staff did not maintain resident's records Staff did not provide adequate transportation to resident in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit at this facility to investigate the above allegations. LPA met with staff Yesenia Acosta who called the administrator and explained the reason for the visit. The administrator designated Ms. Acosta to sign the report. LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and interviewed staff and residents between 10:30 AM to 1:00 PM. Regarding the allegation that Staff did not maintain resident's record, it was alleged that staff misplaced Resident #1 (R1)'s medical records and were not able to provide copies to RP. LPA's record review today at 1:05 PM revealed that the facility has no hospital record on file, only from the doctor's office. LPA's interview with staff today at 11:49 AM revealed that whenever a resident was hospitalized at any hospital, the hospital provides the discharge paper to the resident, and it was up to the resident to give or provide a copy to the facility. The facility is not directly provided any hospitalization record by any hospital. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff did not provide adequate transportation to resident in care, it was alleged that staff would transport R1 to doctor's appointments and drop R1 off at the entrance of the medical building and not go inside with R1. LPA's record review today at 1:05 PM revealed that the facility only provides arrangement of transportation to any resident if they need assistance. Further review also revealed that R1 was legally blind (one eye) and had the capacity for self-care and was ambulatory. LPA's interview with staff today between 10:30 AM to 1:00 PM revealed that when R1 was still living at this facility, R1 was independent and goes in and out of the facility to buy personal needs and meet with love partner at any time. Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 5, 2024 · control 31-AS-20240402133640

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: Staff did not seek timely medical attention for a resident Staff did not ensure resident was adequately fed

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:02 AM, requested copy of additional facility documents relevant to the investigation at 9:34 AM, reviewed records from 10:00 AM to 11:30 AM and interviewed residents and staff between 11:30 AM to 1:15 PM. Regarding the allegation that Staff did not seek timely medical attention for a resident, it was alleged that Resident #1 (R1)'s catheter had been in that condition for approximately two weeks prior and no action was taken by facility staff. LPA's record review on 08/18/23 at 1:30 PM and today at 10:00 AM revealed that the facility contracted Licensed Vocational Nurse (LVN) had visited R1 on a daily basis and check on R1's catheter including but not limited to irrigation, checking the bag and tubing and emptying and/or replacement of catheter. Further, the nurse last visited R1 on 08/13/23 and was the one who recommended R1 to be brought to the hospital on the same day. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff did not ensure resident was adequately fed, it was alleged that R1 had a high sodium level which indicates a possibility that R1 was not being properly fed. LPA's record review on 08/18/23 at 1:30 PM and today at 10:00 AM revealed that R1 had no dietary restriction. LPA's interview with three (3) care staff on 08/18/23 between 10:15 AM to 1:30 PM, revealed that all three (3) staff interviewed stated that R1 was on tray service and always eat regularly with no dietary restriction. LPA's interview with R1's roommate today at 1:15 PM today confirmed that R1 eats regularly, and staff brought R1's food to R1 everyday every meal. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 26, 2024 · control 31-AS-20230817165539

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced Required 1-year infection control inspection to this facility. LPA initially met with staff Amourfino Cruz who called the licensee and arrived forty five (45) minutes later, LPA explained the purpose of the visit. At 9:35 AM, with the assistance of staff Marcelo Nogar, LPA conducted a tour of the facility inside and out. The following were observed: There is one main entrance being utilized at the facility. There are required poster posted at the entrance doors. Screening area is located in the reception area. Sign in log book, hand sanitizer and masks are available. The facility had submitted and approved Mitigation Plan and Infection Control Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the entrance door. Hand washing, coughing etiquette, physical distancing and other necessary signage were posted in the bathroom and all over the facility. The facility has a designated visitor's area in the front of the main building. The facility has sufficient stock of PPE in the storage room The facility consists two (2) storey building and a basement. The facility is fire cleared for 128 ambulatory residents, sixty (60) of which maybe non-ambulatory. Hospice waiver for twenty five (25) residents. The basement has the Kitchen, Cafeteria, Activity room, Laundry Area, Staff break room and Storage rooms. There are sixty four (64) shared bedrooms with own bathroom and eight (8) public bathrooms. There were two (2) shaded smoking area in the surrounding backyard equipped with outdoor furniture. There is no body of water in the facility. (continued to LIC 809-C) (continued from LIC 809) Common Areas: The Recreation rooms had chairs that were six (6) feet apart to promote social distancing. LPA observed four (4) signs posted alerting residents to wear masks maintain and two (2) signs for social distancing. The facility has two (2) elevators, both of which are working properly and had signs for masking requirements, coughing etiquette, and social distancing. There is a sign just outside of the elevator that only two (2) individuals should ride at a time. The facility maintains a comfortable temperature at 75°F. The facility's smoke alarms are hard wired and interconnected and back up and tests are done in house on a regular basis. The facility is equipped with sprinkler system which was last tested on 04/20/22 and valid until 04/30/24. Fire extinguishers are located all throughout the facility and were last serviced on 10/13/23. Fire Drill was last conducted on 10/09/23 Personal accommodations in resident bedrooms and bathrooms were observed for safety, privacy, and comfort. Random resident rooms were inspected and observed with all required furnishings, working signal system, grab bars and nonskid surfaces in the bathrooms. Hot water temperature in random resident bathrooms were checked and measured a range of 112.5°F to 118.9°F. There were enough clean linen available. There is no evacuation chair at both stairwell of the facility. Basement: Kitchen and Cafeteria are located in the basement area the kitchen appeared clean, odorless and free from insects. Kitchen is sufficiently stocked with at least two (2) days perishable and seven (7) days non-perishable foods. Frozen foods are wrapped and stored appropriately. Kitchen was observed to be inaccessible to residents. Laundry room is located in the basement and was observed to be locked during visit. At 1:25 PM, LPA reviewed records of ten (10) random residents and six (6) staff. Resident and staff records appeared to be complete and updated. Medications were observed to be locked in the medication room and inaccessible to residents. There were two ( 2) complete first aid kits in the medication room. Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 13, 2024

Allegation investigated: Staff do not allow resident to receive phone calls at the facility Staff do not provide resident with bed linen Staff do not meet resident's dietary needs Staff did not properly supervise resident, resulting in resident sustaining an injury

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with administrator Monique Lopez and explained the reason for the visit. LPA conducted physical plant tour at 9:43 AM, requested copies of facility documents relevant to the investigation at 10:12 AM and interviewed residents and staff between 10:30 AM to 1:25 PM. Regarding the allegation that Staff do not allow resident to receive phone calls at the facility, it was alleged that staff do not allow Resident #1 (R1)'s family member speak to R1. LPA's observation during visit on 07/24/23 at 9:30 AM revealed that R1 owned a cell phone and kept on R1's drawer. LPA's interview with Resident #2 (R2) on 07/24/23 at 10:30 AM revealed that R1 used own phone every now and then. LPA's interview with the administrator also revealed that whenever the office received a phone call for a resident, they page and locate the resident and bring to the office to use the phone, if unable to locate, they ensure to pass the message to the resident, if there is any. (continued on LIC 9099-C) Unsubstantiated Further, LPA's interview with twelve (12) residents or more than 10% of the current census revealed that eight (8) of the residents interviewed had their own cell phone and twelve (12) out of twelve (12) residents did not have any problem with the facility receiving their phone calls. Regarding the allegation that Staff do not provide resident with bed linen, it was alleged that R1 was not provided bed linen by the staff. On 07/24/23 at around 10:30 AM, LPA observed that the bed of R1 was made and had a clean linen. Also, during that visit, LPA's interview with R2 (R1's room mate) revealed that staff regularly change their linen once a week or if there is any accident, they change it immediately. LPA's interview with staff today revealed that they changed bed linens of every resident a minimum of once a week and immediately if there are "accidents" or if the linen is wet. LPA's interview with twelve (12) residents or more than 10% of the current census revealed that twelve (12) out of twelve (12) residents stated that their bed linens are changed at least once a week by the staff. Regarding the allegation that Staff do not meet resident's dietary needs, it was alleged that staff do not feed R1 three (3) meals a day. LPA’s interview with R2 (R1's room mate) revealed that R1 eats regularly in the dining room three (3) times a day. LPA's interview with care staff confirmed that R1 regularly went to the dining room to eat meals and never requested tray service. LPA's interview with twelve (12) residents or more than 10% of the current census revealed that twelve (12) out of twelve (12) residents stated that the facility serve meals three (3) times a day at the dining room. Regarding the allegation that Staff did not properly supervise resident resulting in resident sustaining an injury, it was alleged that R1 was attacked by a former roommate injuring R1's leg. LPA's record review today at 1:30 PM revealed that there was no record of R1 injuring own leg at any time while living at this facility. LPA's interview with the administrator today also revealed that she did not receive any report of R1 being attacked by a room mate during R1's stay at the facility. LPA's interview with R2, R1's last room mate, revealed that R2 gets along with R1 and there was no time that they had any altercation or argument. Further interview with the administrator also revealed that the former room mate of R1 prior to R2 left the facility on 03/24/2023. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 28, 2023 · control 31-AS-20230720082501