Golden Living Health Management

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA Domingo was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Rocio Granda. According to the facility’s license, The facility serves one hundred and thirteen (113) elderly residents age 60 and above; all of whom may be non-ambulatory. Approved hospice waiver for eight (8) hospice residents. During today’s inspection, there were a total of seventy two (72) clients in care. LPA, accompanied by licensee’s staff, toured the interior and exterior of the facility, and inspected rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Call box was available in each resident unit and were tested for functionality. Resident's room temperatures were within a comfortable range. The facility’s ambient internal temperature was 75 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 119 F, Bathroom #1 sink was 119 F, and Bathroom #2 sink was 119 F. Refrigerator temperature was 35 F and freezer temperature was 0 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. [CONTINUED ON LIC 809C] [CONTINUED FROM LIC 809] No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. The last disaster drill was conducted in January 2026, quarterly. LPAs interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance and surety bond. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Administrator Rocio Granda, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Mar 23, 2026

Allegation investigated: Delayed medical care resulting in serious harm Medications not given as prescribed

Licensing Program Analyst (LPA) Sarah Hurt to deliver findings on the allegations listed above. LPA met with Administrator, Rocio Granda (by phone), and Business Manager, Monica Garcia. Regarding the allegation delayed medical care resulting in serious harm, it was alleged that the facility failed to ensure timely medical care for Resident 1, resulting in serious harm. During the investigation, it was determined that Resident 1, who had a known diagnosis of Type II Diabetes, hypothyroidism, and dementia, was not provided with proper medical oversight after exhibiting symptoms of decline. On 01/14/2025, Resident 1 was sent to Scripps Hospital and treated for hyperglycemia, dehydration, and diabetic ketoacidosis (DKA). Hospital records confirmed the resident’s blood sugar was critically elevated, and she presented with altered mental status and dehydration. Facility records and staff interviews revealed that Resident 1 had been eating minimally, was lethargic, and her blood sugar had been checked two days prior with elevated results; however, no immediate medical intervention or 911 activation occurred. Staff confirmed that the Wellness Director and Administrator were aware of the resident’s condition and ongoing lack of medication but failed to ensure prompt medical attention or reassessment of her care needs. Based on record review and interviews with staff, this allegation is substantiated. Continued... Substantiated Regarding the allegation medications not given as prescribed, it was alleged that the facility failed to administer medications as prescribed to Resident 1. During the investigation, it was discovered that Resident 1, who was dependent on insulin to manage Type II Diabetes, did not receive her prescribed insulin for approximately one month while residing at the facility. Staff interviews revealed that facility management was aware of the lapse in medication but failed to take action to ensure medication orders were refilled or that appropriate care arrangements were made. The facility Wellness Director stated the resident’s insulin was not being administered due to insurance issues and admitted the facility did not have documentation of a physician’s order for insulin administration. Caregivers confirmed Resident 1’s condition declined over several days, and she became lethargic and weak before being hospitalized. The facility’s failure to maintain accurate medication records, provide the required insulin, and reassess the resident’s medical needs resulted in a severe health decline requiring hospitalization for diabetic ketoacidosis (DKA) and dehydration. Based on record review and interviews with staff, this allegation is substantiated. The following deficiencies are being cited (see LIC 9099D) from the California Code of Regulations, Title 22, and the California Health and Safety Code. This incident is currently under review and a future civil penalty may apply based on H&S Code section 1569.49(f). Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted with Administrator, Rocio Granda (by phone), and Business Manager, Monica Garcia, and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 21, 2026 · control 08-AS-20250115091722

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Feb 22, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.The following requirement has not beem met as evidenced by: Resident 1 was not provided timely medical care resulting in serious harm, which poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 21, 2026

Plan of correction: The licensee will retrain staff on • Retrain all staff, including management, on, recognizing signs and symptoms of diabetic complications (hyperglycemia, DKA, lethargy, altered mental status), hen to contact a physician, when to contact 911 for emergency medical care, provide a written plan requiring immediate physician notification and emergency response when a resident misses critical medications such as insulin and submit to LPA by POC date of 02/22/2026.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Feb 22, 2026

87465 Incidental Medical and Dental Care (a)A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(4)The licensee shall assist residents with self-administered medications as needed. The following requirement has not been met as evidenced by: Resident 1's medications were not given as prescribed, which poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 21, 2026

Plan of correction: The licensee will ensure all staff responsible for medication assistance will receive retraining on medication administration procedures, including: Administering medications strictly according to physician orders Accurate documentation on the MAR Identifying and reporting missed or refused doses immediately, and submi proof to LPA by POC date of 02/22/2026.

Allegation investigated: Resident was touched inappropriately by staff while in care Staff did not safeguard resident's personal items

Licensing Program Analyst (LPA), Natsha Persaud conducted an unannounced visit to conclude the complaint investigation regarding the above mentioned allegations. LPA met with Administrator, Rocio Granda. It was alleged that Resident #1 (R1) was touched inappropriately by staff while in care. It was reported Staff #1 (S1) touched R1 in an inappropriate sexual manner by fondling their breast and private area. R1 resided in the facility’s secured memory care unit, where S1 was an assigned caregiver. R1’s Physician’s Report dated 10/17/24, indicated R1 was independent with bathing, dressing/grooming, feeding, toileting, and medication management. However, R1’s Resident Appraisal dated 11/23/24 noted assistance was required with Activities of Daily Living (ADLs) except for toileting and needed redirection but could follow directions and communicate their needs. R1’s Individual Service Plan (ISP) with Assisted Living Waiver Program dated 07/25/24 indicated R1 had severe cognitive impairment which almost always impaired R1’s judgement. It also stated R1 required supervision and prompting with dressing, toileting, hygiene and bathing due to high risk of self-neglect. Continued on LIC 9099C. Unsubstantiated Interviews were conducted with multiple staff members and all corroborated R1’s medical assessment. Staff agreed R1 could manage washing their own body parts including their hair. Although R1 may need some assistance by staff with prompting and redirecting, R1 was able to follow through and clean themselves. Further staff interviews revealed that they assisted R1 by giving them soap and shampoo and stood-by to ensure safety. Some of the staff also reported that they assisted with washing R1 only in areas they could not reach such as R1’s back or legs. Furthermore, R1 affirmed they had the capacity to clean/wash their own body parts. R1 was last showered by S1 on 01/27/25. However, it was alleged the incident occurred on 02/05/25. R1 reported the incident occurred one time, as S1 has only showered R1 one time. However, the facility’s shower scheduled reflected S1 was noted on the schedule three times from December 2024 through January 2025. Additional staff interviews revealed that R1 was inclined to make a complaint when the staff does not bring R1 down to smoke a cigarette immediately upon their request. Staff denied witnessing S1 behave or interact inappropriately towards residents nor have they witnessed S1 touch them in a sexual manner. Furthermore, staff indicated that none of the residents disclosed experiencing sexual abuse from S1. Residents in the secured memory care unit were interviewed. However, due to the residents Major Neurocognitive Disorder condition, they could not provide relevant details. S1 was interviewed and refuted touching R1 inappropriately. S1 reported that when they assisted R1 with showers, they were only on stand-by assist to supervise for safety reasons and to hand over R1’s clothes, shampoo and soap. Further staff interviews confirmed that staff R1 received assistance from staff by scrubbing R1’s body, especially in places R1 could not reach and shampooing R1’s hair. Lastly, the San Diego Police Department conducted interviews but was unable to establish evidence of a crime. It was also alleged that staff did not safeguard resident's personal items. It was reported that R1’s personal items, a diamond & sapphire broach, wallet, money and passport were stolen. A review of facility records, Resident Personal Property and Valuable form reflected “No valuable items.” However, it was not signed by R1. The form was only signed by the administrator and dated 10/21/24. Outside Source (OS) interviews confirmed R1 has possession of their passport. The OS explained being involved with R1’s care for years and explained R1 was homeless prior to living in residential facilities. OS never witnessed R1 with those valuable items mentioned. In addition, R1 was not capable of handling their finances or valuable possessions due to their Major Neurocognitive Disorder. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 08-AS-20250213104754

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced Case Management - Deficiencies visit. LPA met with Administrator, Rocio Granda and discussed the purpose of the visit. During a complaint investigation, it was discovered the facility allowed Staff #1 (S1) to work at the facility prior to obtaining a fingerprint clearance and an association to the facility. A review of the facility's Personnel Roster dated 05/02/25 indicated S1 did not have a fingerprint clearance and was not associated to the facility. S1 cannot work or be present in the facility, until they obtain an approved fingerprint clearance and an association to the facility as required per Title Regulations. The administrator explained S1 was immediately removed from the schedule once they were made aware of the allegation. S1's last day worked was 10/05/25 and S1 was terminated on 10/06/25. A deficiency was issued. A civil penalty was assessed. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1 and Staff #1]the state’s words, verbatim · CDSS document, Feb 3, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Feb 4, 2026

Criminal Record Clearance. Obtain a California clearance or a criminal record exemption as required by the Department or. This requirement is not met as evidenced by: Based on record review, the licensee did not ensure 1 out of XX [S1] staff were fingerprint cleared and/or associated with the facility, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Administrator terminated S1 on 10/06/25. POC corrected. A civil penalty was assessed.

Allegation investigated: Staff did not ensure safe environment for resident.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Administrator Rocio Granda. On 01/21/2026 it was alleged that staff Staff did not ensure safe environment for resident. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, residents, outside sources, and records review. It was alleged that staff did not attempt to keep Resident 2 (R2) from entering Resident 1 (R1)'s room, tampering with their possessions, and acting aggressively toward R1. Staff informed that R2 was not known to be aggressive and no reports had been made from residents regarding this. Staff informed that while they had received reports of R2 entering rooms without permission, staff reminded R2 to respect boundaries, which R2 has subsequently done. Staff additionally informed that R2 had a cognition issue which resulted in abnormal behaviors and statements, however none of R2's behaviors were reported or observed to be aggressive. (Continued on LIC9099 p.2) Unsubstantiated (Continued from LIC9099 p.1) Staff informed that all residents had locks on their doors with their own personal key and residents were aware of their right to lock their doors. R2 was interviewed during the visit. R2 informed hearing that someone had been going gone into resident rooms. R2 stated that they had been accused of it, but they did not recall entering other resident rooms. R2 stated that they get along with other residents at the facility and have not had altercations with other residents. Attempts were made to interview R1, however R1 was not able to be interviewed. Outside source interview from an advocacy agency representative did not corroborate the allegation. The outside source informed that staff cared for residents well and intervened regarding resident dynamics. The outside source did not express concerns regarding resident care at the facility. Records review did not give evidence that the event occurred. No incident reports were found to show that any notable altercation had occurred between R1 and R2. The facility's House Rules showed that residents sign, upon admission, regarding respectful behavior expectations at the facility. During an unannounced facility visit LPA directly observed resident rooms on both floors of the facility. LPA observed resident rooms in various states of their doors being opened, closed, occupied, and unoccupied. LPA did not observe any residents entering rooms or any residents who were unhappy with the positioning of their doors. LPA directly observed R2 during the facility visit. LPA observed R2 sitting solitary at different locations at the facility without issue or aggression. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Rocio Granda, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 08-AS-20260121140350

Allegation investigated: Facility staff financially abused resident

Licensing Program Analyst (LPA), Natasha Persaud conducted a telephone visit to conclude the complaint investigation regarding the above mentioned allegation. LPA discussed the allegation with Administrator, Rocio Granda. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged that staff financially abused Resident #1 (R1). R1 reported there was a discrepancy with their bank account and $3400.00 missing. R1’s interview revealed they were under the impression that the Assisted Living Waiver (ALW) Program was going to handle all facility costs. R1 was made aware by facility that ALW covers a portion of the rent and R1 was responsible for the other portion. Staff interviews and facility documentation stated R1 moved into the facility in December 2024. R1 had outstanding rent balances for January and February 2025, totaling $2840.14. A review of facility records indicated on 02/18/25, the facility withdrew two (2) payments from R1 totaling the balance due for rent for both months. Continued on LIC 9099C. Unsubstantiated Further record review indicated the facility had a credit card authorization form on file for R1, but it was not signed by R1. Therefore, R1 had to provide verbal authorizations along with their physical bank card for the facility to withdraw funds. R1 confirmed they provided verbal authorization along with their physical bank card to staff to pay their rent electronically. However, R1 was under the impression that only one month’s rent would be withdrawn, even though two (2) months were passed due. Staff interviews confirmed R1 were aware they needed to pay their full rent balance in order to reside in the facility. R1 stated they wanted to remain in the facility and were willing to pay their rent balance. A review of R1’s Admission Agreement reflected R1 signed the document, as their own responsible party. R1 also confirmed they independently go to the bank to handle their banking needs. R1 didn’t pay their rent for March, and a balance was due. Staff and R1’s interview confirmed they discussed the outstanding balance and R1 was willing to pay. R1 admitted they provided verbal authorization along with their physical bank card. When staff attempted to collect payment for March by running R1’s credit card, it was declined. R1 contacted their financial institute and was made aware of a withdrawal made on 03/03/25 in the amounts of $1300.00 and $500.00. The facility withdrew the rent funds with R1’s authorization and physical bank card, totaling $2840.14, on 02/18/25. The facility did not make any withdrawals on 03/03/25. The facility conducted the financial transaction, while R1 was present and handed R1 back their bank card, once the payment was processed. The facility doesn’t have authorization to withdraw funds without R1’s authorization and physical bank card. An outside Source was interviewed and reported they were under the impression that ALW covered the entire rent balance. Therefore, it was a misunderstanding of the balances withdrawn from R1’s bank account. R1 provided their verbal authorization and bank card to staff to make withdrawal. R1 admitted they wanted to pay their rent so they could remain at the facility. Once R1 was made aware payment was required for rent, the amount R1 thought was stolen was accounted for. However, R1 was not able to account for the $1800 missing on 03/03/25 but will follow up with their financial institution for resolution. R1 no longer resides at the facility. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda. [See LIC 811 Confidential Names List to identify Resident #1]the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 08-AS-20250314120720

Allegation investigated: Staff did not ensure resident was accorded dignity with other residents

Licensing Program Analyst (LPA), Natasha Persaud conducted a telephone visit to conclude the complaint investigation regarding the above mentioned allegation. LPA discussed the allegation with Administrator, Rocio Granda. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged that staff did not ensure resident was accorded dignity with other residents. It was reported Resident #1 (R1) was being harassed by their roommate, Resident #2 (R2). R1 reported R2 insulted and prohibited R1 to speak Spanish on the phone with their family. R1 has a cell phone and calls their family daily. R1 speaks English and Spanish but prefers Spanish. R1 confirmed they speak Spanish when using their cell phone due to their family members only speaking Spanish. R2’s interview revealed they did not like when R1 speaks in Spanish because R2 assumed R1 was talking badly about R2. Continued on LIC 9099C. Unsubstantiated R2 did not have confirmation the discussion in Spanish were about R2, as R2 does not speak Spanish. R2 also reported staff speak Spanish to R1 when assisting R1, which offends R2. R1 and R2 confirmed there were no physical altercations and neither resident was worried about their safety. R2 denied insulting R1 or interrupting R1 when they are on the phone speaking Spanish. Facility records indicated R1 has moved rooms three (3) times within a four (4) year period due to roommate issues. The administrator’s interview revealed they were not aware of the incident between R1 and R2, as it was not reported. Administrator explained if they were aware of an incident, it would have been addressed with both residents. The administrator offered to relocate R1 to another room once it’s available. In addition, the administrator required staff to speak English only to R1. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda. [See LIC 811 Confidential Names List to identify Resident #1 and #2]the state’s words, verbatim · CDSS document, Jan 20, 2026 · control 08-AS-20250401111807

Allegation investigated: Neglect resulting in serious bodily injury Staff did not assist resident with showering needs Licensee did not address residents change in condition

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the complaint investigation. LPA met with Administrator, Rocio Granda and discussed the above mentioned allegations. During the investigation, the Department reviewed records, conducted interviews with staff, residents, and outside sources, and briefly toured the facility. It was reported that R1 was neglected resulting in serious bodily injury. R1 arrived at the hospital on 7/26/2022 with maggots surrounding a left leg wound with a foot infection. It was also reported that R1 was not receiving shower assistance. R1 confirmed they could not recall the last time they received a shower at the facility. Lastly, it was reported the licensee did not address R1’s change in condition. The administrator stated they were not aware of the wound or change in condition and the facility does not offer wound care. However, the Wellness Director’s (WD) interview confirmed they had knowledge that R1 had an infection on their left foot, which started with R1’s toe and got worse. The WD explained that R1’s physician came to the facility every Tuesday to check on R1. WD also stated the caregivers were not qualified to treat or care for the wound; they could only wrap the wound. Continued on LIC 9099C. Substantiated R1’s Physician’s Report dated 11/29/2021 indicated R1’s had motor impairment/paralysis, and was unable to bathe, dress/groom, and transfer to and from bed. R1’s Resident Appraisal dated 09/27/2021 indicated R1’s overall health appears fair and required a dialysis diet. It also showed that R1 required assistance with the following: transferring in and out of bed; toileting; dressing; bathing; hair care; personal hygiene; help with moving about the facility; medication management; and help in participating in activities. Also, R1 was receiving dialysis three times a week. The administrator’s interview confirmed that R1 was receiving full service for activities of daily living. The facility’s Body Check form for R1 dated 09/27/2021 indicated R1 had scars on their left arm from dialysis and a small ulcer on left side ankle/dryness in both feet and toes. R1 was supposed to receive a shower once per week. However, staff were not providing a shower to R1 as the wound had been observed by staff. R1’s Admission Agreement (AA) dated 09/27/21 indicated R1 was a Level 4. Level 4 identified on the AA which reflected the following services: escort AM/PM; bathing; dressing; grooming; and 2hr checks. R1’s medical records indicated R1 was evaluated by their Primary Care Physician (PCP) on 7/15/2022. At that time R1 had a 1x1.5cm ulcer at the base of their left fourth toe with discharge present. One-week history of blister of left foot with progressed pain, at a high level, not relieved by pain medication. Skilled nursing was ordered for wound care. R1 skipped dialysis twice in one week due to left foot pain. R1 had shaking chills and had not been receiving would care at their facility. There was a vast increase in size of the wound of left foot from 5cm ulcer at base of left toes, dorsal surface, induration/discharge/foul odor/soiled dressing present. Concerns of sepsis with high risk for amputation, PCP called 911 and transferred care to Emergency Medical Services. A further review of R1’s medical records indicated the chief complaint for the hospitalization on 07/25/2022 was for leg pain with bacterial skin infection on left foot. The wound on R1’s left foot was classified as Class IV wound- dirty or infected is a classification for surgical wounds that are significantly contaminated. The report also stated the large, infected wound on the left foot extended from the plantar to the dorsal aspect. In addition, the report indicated that the foot is swollen, there is a foul-smelling oozing open wound over the MTP joints from T2-T5, there are some maggots seen on the lateral aspect of the wound. A left below-knee amputation surgery was performed due to nonhealing infected left foot wound, peripheral vascular disease. Staff interviews confirmed R1 had a change in condition. Staff stated when R1 first moved in, they were “half-independent”. R1 used both wheelchair and walker at the facility, was active and able to propel themselves in their wheelchair. R1 was also able to use the bathroom independently. Once R1 became less independent, diaper changes were provided. However, the facility did not conduct the required reappraisal when R1 had a change in condition and/or obtained a current Physician’s Report. The Care Coordinator’s (CC) interview confirmed there was a change in condition when the CC went to a nursing home to assess R1 after the leg amputation and bring R1 back to the facility. The CC stated R1 needed help with transferring from bed to wheelchair and became a two-caregiver assist. The reappraisal was not conducted for R1. Resident interviews confirmed they observed maggots on R1’s leg due to a leg infection, along with a bad odor, and reported it to staff. The administrator confirmed R1 was not receiving home health services prior to 7/26/2022. The administrator explained R1 was being treated for the wound by their PCP, and it was up to the PCP to determine and order home health for wound care. Administrator further stated that if home health was pending/resident waiting, then they can get involved and assist. Also, if a resident’s situation got worse fast, staff would send the resident out to the hospital for treatment. PCP’s interview stated they attempted to get R1 skilled nursing services, as it’s the PCP’s responsibility. However, R1’s medical insurance was very limited and difficult, it never went through. PCP also suggested many times to R1, to transfer to a skilled nursing facility where their needs would be better met. However, R1 declined to move and stated they liked it at the facility. In addition, the PCP said they asked R1 many times to send R1 out to the hospital as they could not get home health or other care needed, but R1 declined offers. PCP explained they did not provide any instructions to staff once the infection was identified due to staff not having any nurses or staff that were trained or qualified to change and care for the wound. The facility staff failed to provide adequate care for R1 which resulted in a serious medical condition. Based on LPA’s observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8, are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1] A civil penalty in the amount of $500 was assessed per Health and Safety Code 1569.49(c)(1), for a violation that the Department determined resulted in an injury of R1. Determination of Civil Penalties under Health and Safety Code Section 1569.49 are pending and under review by the Program Administrator of the Community Care Licensing Division. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jan 16, 2026 · control 08-AS-20220729155959

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jan 17, 2026

Additional Personal Rights ... (a)…residents… shall have... the following personal rights: (4) To care, supervision, and services that meet their... needs and are delivered by staff that are sufficient in...qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on interviews and records review the licensee did not provide care and supervision to 1 out of 84 [R1] residents, which posed an immediate health, safety, and personal rights risk residents in care.the state’s words, verbatim · CDSS document, Jan 16, 2026

Plan of correction: The administrator agreed to attend training along with staff regarding topics of care and supervision. A $500 immediate civil penalty was assessed and will be ongoing until corrected.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Jan 17, 2026

Observation of the Resident. The licensee shall ensure that residents...observed for changes in physical, mental...assistance is provided when such observation reveals unmet needs. When changes...shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any This requirement was not met as evidenced by: Based on interviews and records, the licensee did not observe a change in condition for 1 out of 84 [R1[ residents, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 16, 2026

Plan of correction: The administrator agreed to schedule an in-service training on observation of the resident and send proof of scheduling by POC due date. The administrator agreed to send proof of training within 2 weeks.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Feb 13, 2026

Basic Services. Basic services shall at a minimum include: Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal... and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement was not met as evidenced by: Based on interviews and records, the licensee did not ensure 1 out of 84 [R1] residents received assistance with bathing as documented, which posed a potential health, safety, and personal rights risk residents in care.the state’s words, verbatim · CDSS document, Jan 16, 2026

Plan of correction: The administrator agreed to attend in-service training on Basic Services and submit proof of training by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced Case Management - Deficiencies visit. LPA met with Administrator, Rocio Granda and discussed the purpose of the visit. During a complaint investigation, it was discovered the facility did not report an incident. Resident #1 (R1) went to the hospital and the facility didn't report the hospitalization as required per Title Regulations. A deficiency was issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jan 16, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Feb 13, 2026

Reporting Requirements. A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not report an incident involving 1 out of 84 [R1] residents, which posed a potential health and safety risk to residents.the state’s words, verbatim · CDSS document, Jan 16, 2026

Plan of correction: Administrator agreed to attend training on reporting requirements and submit proof of training by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit to conduct an unannounced health and safety check for residents in care. LPA identified herself and was granted entry by Julio Garcia, Activities Coordinator, and Guillermina Ramirez, Care Coordinator. LPA met with Rocio Granda, Administrator, and disclosed the purpose of the visit. On January 13, 2026, an Incident Report (IR) was received by Community Care Licensing (CCL) notifying the Department that resident #1 (R1) and resident #2 (R2) (licensee was provided an LIC 811 that identifies the residents) had reported to staff that staff #1 (S1) had inappropriate encounters with them. During today's visit, LPA toured the facility to conduct a health and safety check of residents in care and requested and obtained records pertinent to this incident. No deficiencies were cited during today’s visit, but LPA notified Administrator that additional phone calls or visits may be necessary. An exit interview was conducted with Rocio Granda, Administrator, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Administrator at the conclusion of the visit. The signature below confirms that the documents were received.the state’s words, verbatim · CDSS document, Jan 14, 2026

Allegation investigated: Lack of supervision resulting in resident altercation injury.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Administrator Rocio Granda. On 09/22/25 it was alleged that lack of supervision resulted in a resident altercation injury when Resident 2 (R2) was accused of bruising Resident 1's (R1) hand. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Staff interviews were consistent regarding the facility conducting an internal investigation when the incident was brought to their attention. Staff informed that both R1 and R2 lived in the Assisted Living section of the facility and spent much of their time together. While R1 and R2 required assistance with Activities of Daily Living (ADLs), they were able to ambulate on their own without staff assistance. Staff interviews additionally informed that the residents received regular checks from staff approximately every two (2) hours along with the other assisted living residents. (Continued on LIC9099 p.2) Unsubstantiated (Continued from LIC9099 p.1) While the internal investigation confirmed that a bruise did exist for R1, the origin and timing of when the bruise occurred came in to question. The internal investigation did not confirm that R2 caused the bruise, as information provided by R1 was inconsistent and they could not recall details surrounding the incident. Staff consistently stated that R2 was not a problematic resident and had never been accused of physically harming another resident before this incident. While the internal incident was inconclusive regarding what caused R1's bruise, both residents were counseled to be respectful of each other's personal space. Resident interviews did not corroborate the allegation. Three (3) attempts were made to interview R2 among two (2) facility visits, without success. R1 confirmed that they were friends with R2; R1 could not recall the details of the situation that resulted in the bruise. R1 stated that staff were helpful at the facility when they needed assistance, and did not express concern regarding supervision at the facility. An outside source from an advocacy organization who was familiar with the facility and the incident was interviewed. The outside source confirmed that they checked on both residents involved in this incident and did not have concerns regarding staff supervision at the facility. The outside source informed that many residents at this facility dealt with psychiatric issues, and verbal conflict regularly occurred. This outside source informed that they attended all Resident Council meetings and no supervision issues have been brought up. Facility records showed that staff completed an internal incident report regarding the situation, and that the administrator conducted an internal investigation. The documents showed that staff took action when made aware of the possible physical abuse, and elevated the situation. Records additionally showed that staff were aware of residents' baseline conditions, as staff noticed the bruise on R1's hand, inquired about it, and elevated it for follow-up. This evidences that the staff were monitoring residents during the timeframe of the incident. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Rocio Granda, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 17, 2025 · control 08-AS-20250922133100

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit. LPA was greeted by and met with Administrator Rocio Granda, to discuss the purpose of the visit. Today's visit was regarding the facility's bedridden clearance. LPA conducted a health and safety check, interviewed staff and residents, and collected facility records. No deficiencies were cited during the facility visit. An exit interview was conducted with Administrator Rocio Granda, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22). Their signature confirms receipt of these documentsthe state’s words, verbatim · CDSS document, Nov 13, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted a case management visit regarding an incident report that was received by Community Care Licensing (CCL) on 11-3-2025, involving a resident and staff. LPA identified herself and discussed the purpose of the visit with Administrator, Rocio Granda. The purpose of this visit was to conduct a health and safety visit. During the visit, LPA toured the facility and obtained relevant records. No deficiencies cited during today's visit. An exit interview was conducted with Administrator, Rocio Granda. A copy of this report was provided to the administrator as well as a copy of the Licensee Appeal Rights (LIC9058 03/2022) at the conclusion of the visit.the state’s words, verbatim · CDSS document, Nov 5, 2025

Allegation investigated: Facility staff financially abuse resident

On 10/17/2025 at 3:30PM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger meet virtually via Teams to deliver findings for the above allegations. LPA explained the purpose of the visit with Administrator Rocio Granda. During the course of investigation, the Department conducted interviews with staff, the residents’ family, and the reporting party. Records were reviewed and obtained, including an audit report. A Report of Suspected Dependent Adult/Elder Abuse (SOC 341) on 8/22/2024 reporting fraudulent transactions on R1 bank account. On the allegation: Facility staff financially abused a resident 8/22/2024 it was reported that there were fraudulent transactions on R1 bank account. R1 was accompanied to a branch by four social workers, and they requested a Debit Card for R1’s account. Since this required R1’s consent, this was discussed with R1 and he stated that he only wanted to make a balance inquiry, not obtain a debit card. Continued on LIC 9099C... Unsubstantiated ...Continued from LIC 9099 Excessive transactions were made on R1’s account from March 2024 to April 2024 that appeared suspicious. A letter dated 12/21/2022 was a product stating there were issues with R1’s finances due to his memory and confusion with transactions. According to R1’s physician’s report dated 4/26/2023, R1 was exhibiting mild cognitive impairment and was unable to manage his own cash resources. Additionally, R1 was non-ambulatory and could not leave the facility unassisted. In interviews with S1 they state the facility did not handle resident finances. Residents handled their own finances with assistance from companies like Telecare or through conservators. In video surveillance from a bank visit to BluPeak Credit Union on 12/5/2023., an individual escorted R1 to the bank. Based on interviews with the facility staff, this individual was not identified as a facility staff. Additionally, R1 did not recognize the individual, nor did he know her name. The activity appears suspicious, and the auditor could not identify where the cash was deposited. Video surveillance from a bank visit to BluPeak Credit Union on 8/22/2024, Showed R1 entering the branch by four individuals. W1 was interviewed and she stated that the one of the Case Managers (identified as a Caucasian female with short hair), was described as “overpowering” during this visit and was asked to walk away from the counter so that W1 could speak to R1 alone. W1 stated that the Case Manager was answering questions for R1. R1 told W1 that the Case Managers went through his belongings in his room and told him to be quiet. S1 was able to identify one individual as a Telecare Case Manager in the video on 8/22/2024. However, S1 could not identify the other individuals, and S1 stated they were not facility staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Oct 17, 2025 · control 08-AS-20240826155025

Allegation investigated: Staff did not accord resident dignity in their relationship with staff or residents

Licensing Program Analyst (LPA), Natasha Persaud conducted a telephone visit to conclude complaint investigation regarding the above-mentioned allegation. LPA spoke with Administrator, Rocio Granda. During the investigation, a brief tour of the facility was conducted, record review, and interviews conducted with staff, residents, and outside sources. It was alleged that staff did not accord resident dignity in their relationship with staff or residents. It was reported Resident #1 (R1) and Resident #2 (R2) had a quarrel about the bedroom door being opened. R1 wanted the door open due to an odor caused by R1’s medical condition. R2 preferred to keep the door closed at all times. On 06/19/25, LPA observed a sign on R1 & R2’s door that stated to keep the door closed. Resident interviews revealed on 06/06/25, R1 and R2 were yelling at one another, and R2 was in their wheelchair and kicked R1’s hand. R1 did not sustain any injuries and the altercation was unwitnessed. Continued on LIC 9099C. Unsubstantiated R2 is paralyzed on one side of their body, R2 admitted they were flailing their one operational hand and leg at R1 but uncertain if they made contact. Staff stated they entered the room and R1 and R2 were having a disagreement about the door being opened or closed. R2 has a history of wanting the door to remain closed all day. Staff confirmed they did not witness R2 hit or kick R1. Staff explained they would have intervened if there was any physical altercation. The facility does not provide one on one supervision. Staff addressed the ongoing concern between the two residents not agreeing with the status of the door. Therefore, the facility took action by relocating R1 to a private room to avoid further conflict. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted via telephone and a copy of this report along with Licensee Rights (LIC 9058 03/22) were emailed to Administrator, Rocio Granda. [See LIC 811 Confidential Names List to identify Resident #1 and Resident #2]the state’s words, verbatim · CDSS document, Oct 1, 2025 · control 08-AS-20250611162354

Allegation investigated: Staff caused bruising to resident.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced 10-day visit to initiate a complaint investigation and deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Administrator Rocio Granda. On 09/10/2025 it was alleged that staff caused bruising to Resident 1 (R1). The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, residents, outside sources, and records review. Staff interview revealed that R1 was frequently agitated and resisted care. Staff stated that during episodes of agitation R1 thrashed in their bed, hit their body on their bed rails, and has attempted to get out of their bed although they cannot walk, resulting in falling out of the bed. Staff additionally informed that fall mitigations were in place for R1 such as a low bed, fall mats, and half-rail padding to prevent R1 from injury. Staff informed that R1's hospice agency was contacted during each fall, and requests were made to evaluate R1's prescription due to their change in condition of increased agitation. (Continued on LIC9099 p.2) Unsubstantiated (Continued from LIC9099 p.1) Staff informed that the hospice agency assessed R1 and a care conference was held regarding R1's change in condition, prescription update, and self-induced injuries that were occurring during the episodes of agitation. During an unannounced facility visit LPA interviewed R1. LPA observed R1 to have bruises along their left arm and one bruise on their left leg during the facility visit. R1's explanations for these bruises were implausible due to R1 stating the left leg bruise was due to a pole on the wall that did not exist per LPA's observation, and that the arm bruises were due to an unknown person coming into R1's room years ago and hitting them. R1 resided in the facility's Memory Care unit and was not able to be qualified as a valid historian. LPA attempted to contact three (3) outside sources for interview. LPA spoke with a hospice worker familiar with R1 who verified staff statements regarding R1 having frequent outbursts and attempting to climb out of their bed, resulting in falls. Additional requests for interviews from R1's hospice agency and an outside advocacy agency familiar with R1 were not returned. Review of facility records during the timeframe of complaint showed staff documentation and communication to R1's hospice agency regarding bruising, frequent falls out of bed, agitation, and hallucinations by R1 that someone came into their room in the night and hit them. These records corroborated staff statements, outside source interview statements, and LPA direct observations during interview with R1. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Kitchen Supervisor Andres Barragan, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Sep 17, 2025 · control 08-AS-20250910111033

Allegation investigated: Staff did not provided a safe environment for a resident.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced 10-day visit to initiate a complaint investigation and deliver findings regarding the above complaint allegations. LPA introduced themselves and disclosed the purpose of the visit to Administrator Rocio Granda. On 09/09/2025 it was alleged that Staff did not provide a safe environment for Resident 1 (R1). The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, residents, and records review. It was reported that staff allowed Resident 2 (R2) to create a hostile environment for other residents by threatening R1. Staff members familiar with both residents informed that R1 and R2 have had verbal altercations in the past, all of which were initiated by R1. Staff informed that while R2 did have behaviors of yelling, cursing, and saying inappropriate words, R2 kept to themselves and ate their meals in their room. Staff informed that R2 only became upset if someone got into their personal space, and that R1 and R2 have never had a physical altercation. (Continued on LIC9099 p.2) Unsubstantiated (Continued from LIC 9099 p.1) A staff witness to the incident of concern denied that R2 threatened R1 during the interaction. Staff additionally stated that since admission, R1 had a longstanding pattern of misinterpreting interactions and conversations with other people, and then making accusations against that person. Staff members denied that R2 caused a hostile environment for other residents. During an unannounced facility visit LPA separately and privately interviewed R1 and R2. Both residents acknowledged that they did not get along and had agreed to stay away from each other and not interact. Both residents denied that they had ever had a physical altercation. R2 stated that all prior verbal altercations with R1 were instigated by R1. R1 informed that the verbal altercation caused R1 to feel threatened by natural and inanimate objects. R1 stated that they felt safe living at the facility. An attempt was made to contact an outside advocacy agency familiar with the facility; requests for interview were not returned. Records review revealed that the facility conducted an internal investigation regarding the verbal altercation between R1 and R2. The documentation showed that R2 denied threatening R1, informing that R1 initiated the altercation. The document further showed that the residents were advised to keep apart from each other and notify a staff member immediately if a future incident were to occur. No records were found to show that the residents had a physical altercation or that any injuries had occurred during the incident. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Kitchen Supervisor Andres Barragan, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Sep 17, 2025 · control 08-AS-20250909225542

Allegation investigated: Licensee failed to secure a resident's medication; Facility staff is not properly cleaning a resident's bathroom

On 03/29/21 the Department received a complaint alleging the licensee failed to secure a resident's medication and facility staff is not properly cleaning a resident's bathroom. The Department reviewed complaint information gathered from client/staff interviews conducted. R1 states a bottle of syrup was left on the dresser by staff the contents of the bottle were not verified but believed by R1 to be medication – facility staff deny medication left on dresser because the medication is maintained on a medication cart. In addition, based on interviews and the facility’s housekeeping schedule there is insufficient evidence to support that facility staff are not properly cleaning the restrooms. Based on interviews conducted and records reviewed, information obtained does not present a preponderance of evidence to support or corroborate the referenced allegations. The allegations are deemed unsubstantiated. A copy of this report along with Licensee Rights was emailed to Administrator, Rocio Granda. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 5, 2025 · control 08-AS-20210329163620

Allegation investigated: Medication not given as prescribed; Licensee did not arrange for medical care appropriate to meet the needs of a resident; Facility is not adequately staffed at night to handle facility responsiblities

On 04/06/21 the Department received a complaint alleging medication not given as prescribed; the licensee did not arrange for appropriate medical care to meet the needs of a resident; and the facility is not adequately staffed at night to handle facility responsibilities. The Department reviewed complaint information gathered from R1, staff interviews and facility records. The Administrator was contacted for additional follow-up information. R1 requests and is taken to the emergency room for medical attention. The Administrator has contacted R1’s Primary Care Physician to address R1’s medical needs and make any medical referrals as needed. R1 interviewed and admits to refusing PRN medication prescribed. There is insufficient evidence provided to support the facility is not adequately staffed at night. Based on interviews conducted and records reviewed, information obtained does not present a preponderance of evidence to support or corroborate the referenced allegations. The allegations are deemed unsubstantiated. A copy of this report along with Licensee Rights was emailed to Administrator, Rocio Granda. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 5, 2025 · control 08-AS-20210406114823

Allegation investigated: Licensee is not following proper evicition protocols regarding resident in care.

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced visit to the facility to deliver investigative findings regarding the above mentioned allegation. LPA identified herself, explained the purpose of the visit and nature of the complaint to Administrator, Rocio Granda. On February 28, 2025 the Department received this complaint which alleged licensee is not following proper eviction protocols regarding Resident #1 (R1) [See LIC811 Confidential Name List for a description of select person identifiers used in this report]. The Department’s investigation included a facility tour, record reviews, as well as interviews of staff and outside sources. (Continued on LIC9099-C) Unsubstantiated (Continued from LIC9099) A record review revealed that proper 60 day notice was given to R1. The reason for the notice was nonpayment of rent over a period of eight months. An interview with an outside source who is familiar with the facility did not report any concerns regarding facility not following eviction protocols for R1 or any other resident. The Department has investigated the allegations that licensee is not following proper eviction protocols regarding resident in care. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed unsubstantiated. An exit interview was conducted with Administrator Rocio Granda, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.the state’s words, verbatim · CDSS document, May 23, 2025 · control 08-AS-20250228115144

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Other visit. LPA met with Administrator, Rocio Granda. The facility is licensed to care for 113 Non-ambulatory elderly residents. The facility applied for a bedridden fire clearance for one (1) resident. The Fire Marshall approved the fire clearance for one (1) bedridden resident on 06/27/24. During today’s visit, LPA toured the interior and exterior of the facility and observed no immediate health or safety issues. The facility sketches/floor plans remained consistent with the current layout of the facility. This portion of the application process has been completed. The Licensee will be sent an updated license to reflect the new fire clearance after CCLD management’s final review and approval. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Mar 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA conducted the visit was Administrator, Rocio Granda. LPA, accompanied by administrator, toured the interior and exterior of the facility, and inspected each room. The facility was clean, and sanitary. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperature at taps accessible to residents were all compliant and measured at 112 F.. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, and/or toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per the administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. No deficiencies were observed or cited during today's annual inspection. A Technical Advisory was issued. Annual Continuation will be conducted due to time restraints. An exit interview was conducted with Administrator, Rocio Granda to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Mar 21, 2025

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

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to conclude the complaint investigation. LPA identified herself and discussed the allegation mentioned above with Administrator, Rocio Granda. During the investigation, LPA briefly toured the facility, requested records, and interviewed staff, residents, and outside sources. It was alleged staff did not safeguard resident's personal belongings. It was reported Resident #1's (R1) money and clothing was missing. R1’s Physician's Report dated 08/18/22 indicated R1 was able to manage their own cash resources, and independently dress/groom, feed self, and toilet. R1 was interviewed and provided conflicting information by stating no money or clothing was missing, then stated money was missing. R1 expressed money was missing but couldn’t determine the amount. R1 does not have a bank account due to financial issues. R1 cashes their checks and keeps money at the facility hidden in their room. Continued on LIC 9099C. Unsubstantiated The administrator was interviewed and confirmed not having knowledge R1 was storing cash in their room. A review of R1’s records indicated the Resident Personal Property And Valuables form dated 04/27/21 was blank and signed by the resident, indicating there was nothing for the facility to safeguard for R1. R1’s interview also revealed they’ve become forgetful, as they provided different amounts of cash missing. The administrator explained providing facility transportation and escort to obtain money orders for R1’s rent. R1 was three months delinquent in rent. Therefore, the administrator, staff and R1 went to obtain payment for the overdue rent balance. R1 cashed their own checks and obtained the money orders on their own. The administrator explained after assisting with obtaining money orders, R1 had cash left over and requested a ride to the bank the deposit the remainder. However, it was revealed R1 did not deposit the cash at the bank, as they do not have an active bank account. R1 then stored the cash in their room in a book. R1 was unable to locate the cash or determine the amount. R1 admitted they wanted to pay their rent and not be delinquent but fell behind due to bank issues. R1 also confirmed they were not forced to pay their rent but aware they could be served an eviction notice for non-payment. Therefore, they paid their past due balance once provided transportation to obtain money orders to pay their rent. The facility provides transportation for residents to conduct their personal affairs. R1 has transportation for medical appointments and day program were provided through their insurance. However, R1 does not have family or friend involvement and relies on the facility for assistance unrelated to medical appointments. Resident interviews confirmed their belongings are not missing or stolen. Staff interviews revealed R1 will report missing items. Staff will assist in the search with R1 to locate missing items, usually the items are retrieved in R1’s room. Staff also revealed R1 has become forgetful but does not qualify for the secured memory care unit. R1 is their own responsibly party and handles all their own appointments/affairs. However, the facility has involved an outside agency to assist R1 with their finances. During the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]the state’s words, verbatim · CDSS document, Feb 6, 2025 · control 08-AS-20240709163518

Type of visit: POC

Licensing Program Analyst (LPA), Natasha Persaud conducted a Plan of Correction visit. LPA met with Administrator, Rocio Granda. Administrator contacted LPA via email stating the deficiency has been corrected and completed prior to the due date. On 01/08/25, the facility was issued a deficiency regarding a resident not having a written order on file for multivitamins. For the plan of correction, the administrator decided to conduct In-Service training on medications. The deficiency had a due date of 02/05/25. However, the administrator had the training conducted and completed on 01/14/25. The deficiency has been corrected and cleared. No deficiencies were issued today. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jan 17, 2025

Allegation investigated: Staff did not ensure resident was treated with dignity in their relationships with others

Licensing Program Analyst (LPA), Natasha Persaud conducted a visit to conclude the complaint investigation regarding the above mentioned allegation. LPA met with Administrator, Rocio Granda and Office Assistant, Yahaira Garduno During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged staff did not ensure resident was treated with dignity in their relationships with others. It was reported Resident #1 (R1) wasn’t treated with dignity by Resident #2 (R2) when R2 made inappropriate comments towards R1. The inappropriate comments made were ugly, paranoid freak, mentally ill, and crazy. It was also reported those inappropriate comments led to R1 isolating in their room, not wanting to eat, change their briefs/colostomy bag, and/or take care of their personal appearance. R1’s interview confirmed the inappropriate comments did not result in neglectful actions. R2 denied making those inappropriate comments towards R1. R1 and R2 confirmed they were friends, but it was an on and off relationship due to conflict. One conflict that occurred between R1 and R2 included R1 accusing R2 of stealing their shirt. Continued on an LIC 9099C. Unsubstantiated R1 found their identical shirt and apologized to R2. Another conflict was R2 requested R1 dye R2’s hair and R2 was not pleased with the outcome, and it created conflict between the two residents. Evidence obtained through interviews revealed R1 continued to engage in the friendship, as if there were no issues with the relationship and the way they were being treated. R1’s interview revealed when there’s conflict with another resident, they feel less than and has difficulty coping. However, R1 continues to return to the conflicted relationships. Resident interviews confirmed R1 starts conflict with others and complains to staff before R1 is held accountable for their role in the conflict. Staff confirmed this is a known behavior for R1 to report incidents when they believe they are the one at fault. Staff interviews revealed R1 has conflict with many residents in the facility. Staff also explained if they walk past R1 and do not say hello then R1 becomes offended, and conflict begins. Staff confirmed they have not witnessed R2 make inappropriate comments towards R1. R2 confirmed making one statement in private towards R1 and admitted they did not mean the comment. After the comment was made R1 and R2 were friends again. Residents also stated one day R1 is nice and then the next day, R1 is not nice. The residents have a choice of who they engage with. R1 has conflict with residents but continues those friendships that lead to more conflict. Staff are not able to tell residents who they can communicate with and become the mediator when conflict arises, which is often. Resident interviews also confirmed staff stick up for R1. Therefore, staff try to ensure R1 is treated with dignity in their relationships with others. Other residents involved in conflict with R1 did not report their rights were violated. During the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Office Assistant, Yahaira Garduno whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1 and #2]the state’s words, verbatim · CDSS document, Jan 8, 2025 · control 08-AS-20241021145523

Allegation investigated: Staff did not repair wall allowing rodents into the facility

Licensing Program Analyst (LPA), Natasha Persaud conducted a visit to conclude the complaint investigation regarding the above mentioned allegation. LPA met with Administrator, Rocio Granda and Office Assistant, Yahaira Garduno. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged staff did not repair a wall in a resident’s room allowing rodents into the facility. It was reported rodents were entering a resident’s room through a hole in the wall located under the bathroom sink. Staff interviews revealed the hole was patched by maintenance. However, LPA observed the hole on 12/05/24 and it was not completely repaired, allowing rodents access. Resident interview confirmed observing a rodent in their room. The facility was made aware of the rodent issue and did not resolve the issue. The wall was not patched completely, and a pest control company was not contacted for inspection once the facility had knowledge. After LPA’s visit on 12/05/24, the facility contacted a pest control company, and the facility was inspected on 12/06/24 and treated as a precautionary measure, as no live rodents were discovered. Continued on an LIC 9099C. Substantiated A review of the pest control invoices indicated on 08/09/24, the facility’s rooms were last inspected for pests/rodents by the same pest control company, no pests/rodents were observed. On 08/09/24, the pest control company recommended the walls be patched. There was a prior inspection conducted on the same room having the hole in the wall on 05/25/23, the facility was instructed to repair wall damage and penetrations to exclude pests. As of today, 01/08/25 there have been no reports of pests/rodents and the hole in the wall was repaired. The administrator explained they have a contract with the pest control company and will contact them if there are any further reports. The facility was aware of the rodent issue and attempted to patch the hole in the wall but was unsuccessful. Also, the facility did not contact the pest control once receiving the notification of rodents in resident’s room. Based on observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Office Assistant, Yahaira Garduno whose signature below confirms receipt of these rights. R1’s Resident Appraisal dated 04/07/23 indicated R1 required assistance with bathing, dressing/grooming, toileting. The appraisal also indicated the facility will provide medication administration. The facility also has documentation on file dated 8/29/24 indicating R1 was allowed to manage and store their own multivitamins but the facility will manage all other medications. The administrator’s interview revealed R1 was independent and there were no concerns for R1 having access to cleaning supplies or medication. Administrator added R1’s physician deemed R1 safe by allowing R1 to manage and store their own multivitamins. The facility provided R1 with a locked drawer to store medications. Administrator also stated they were not aware R1 was had cleaning supplies in their room. Staff interviews revealed there were no concerns for R1’s safety and they had no knowledge R1 had access to cleaning supplies. Staff explained they observe items in resident’s room but do not look through their belongings. R1’s interview revealed they purchased Lysol and was storing it in their room in closed box that was identified in writing as “activities.” There was no way to determine what was in the box without searching through R1’s belongings. Staff confirmed they did not observe the closed box, as they are not allowed to look through the resident’s belongings. Resident #2 (R2) was R1’s roommate at the time of the incident. R2 confirmed they had no knowledge R1 was storing cleaning supplies and never observed it in their room. The facility staff confirmed they did not have knowledge R1 was purchasing items and storing them in their room the facility. On 12/19/24, the facility provided documentation to R1 explaining only residents with orders from their physician can store and manage medications and cleaning supplies. However, those items must be locked to protect other residents, R1 signed the document in agreement. Also, the facility has confiscated all R1’s cleaning supplies and has them locked. R1 was reassessed by their physician and the facility but there was documentation regarding R1’s safety around cleaning supplies. Due to the incident, the administrator believed R1 should no longer have access to cleaning supplies. The physician’s report and/or resident’s appraisal for Residential Care Facility for the Elderly does not have a question indicating if a resident can have access to cleaning supplies. Administrator explained if the resident is deemed safe to leave the facility unassisted and manage their own medications, that was an indication to the administrator that R1 was safe around cleaning supplies. During the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Office Assistant, Yahaira Garduno whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1 and #2]the state’s words, verbatim · CDSS document, Jan 8, 2025 · control 08-AS-20241126122416

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 15, 2025

Maintenance and Operation. 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 observations and interviews the licensee did not ensure the facility was in good repair for 1 out 87 [R1] residents, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Administrator had the hole in the wall repaired and pest control inspect the resident rooms, which were treated as precautionary measurement. POC corrected.

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

Allegation investigated: Staff are unable to communicate with residents due to a language barrier

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the complaint investigation regarding the above mentioned allegation. LPA met with Administrator, Rocio Granda and Office Assistant, Yahaira Garduno. During the investigation, a brief tour of the facility was conducted along with interviews with staff and residents. It was alleged staff are unable to communicate with residents due to a language barrier. It was reported that one evening on or about 11:00pm, an outside source was unable to communicate with staff. The facility’s NOC shift is from 10:00pm-6:00am. The outside source indicated none of the staff working the night/NOC shift could speak any English, which included both the night manager and the medication technician. LPA confirmed both the night manager and the medication technician staff speak English. There are some staff/caregivers on the NOC shift, which Spanish is their primary language. However, they can communicate with the residents to meet the resident’s needs. Some staff interviewed were unable to communicate in English with complex questions, but it does not affect their ability to provide care. Continued on LIC 9099C. Unsubstantiated The staff assigned, provide direct care to the residents daily and are aware of the resident’s individual needs. The Manager’s Assistant (MA) confirmed there are English speaking staff on each shift. The MA also stated staff can radio one another for assistance if a resident is unable to understand staff. The Administrator confirmed the night manager and medication technician speak English. The Administrator explained the facility requires the medication technicians to speak English. Administrator also stated the night manager handles issues with residents directly, completes internal incident reports in English and contacts 911, which was an indication they speak English. LPA reviewed internal incident reports completed in English by the night manager. Resident interviews confirmed their needs are met and they can communicate their needs to staff. The language barrier does not affect the staff’s ability to provide care and supervision to residents. In addition, the facility has staff available to communicate in English on each shift. Therefore, staff are also available to communicate with outside agencies in English. During the investigation, interviews were conducted. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Office Assistant, Yahaira Garduno whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jan 8, 2025 · control 08-AS-20241112094804

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Deficiencies visit. LPA met with Administrator, Rocio Granda and Office Assistant, Yahaira Garduno. LPA explained the purpose of the visit was to issue deficiencies identified during a complaint investigation that concluded on 01/08/25. A review of records indicated Resident #1 (R1) did not have current documentation on file. R1's Resident Appraisal was dated 04/07/23 and due by April 2024. Once made aware the appraisal was not current, the facility conducted a reappraisal for R1 on 12/10/24. R1 also didn't have an written order for an over the counter (OTC) medication. R1's records reflected a correspondence dated 08/09/24 from the facility addressing R1's physician regarding R1 being able to store and manage their own multivitamins. The physician responded stating R1 can store and manage their own multivitamins. However, the facility did not have a written order on file for R1's multivitamins. Deficiencies are being cited on the attached LIC 809D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Office Assistant, Yahaira Garduno whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1]the state’s words, verbatim · CDSS document, Jan 8, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e) · Plan of correction due date: Feb 5, 2025

Incidental Medical and Dental Care. For every prescription and nonprescription PRN medication...shall be a signed, dated written order from a physician...and a label on the medication. Both the physician's order and the label...of the following information. This requirement is not met as evidenced by: Based on record review the licensee did not ensure 1 out of 87 [R1] residents have current written orders on file, which posed a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Administrator stated R1 no longer takes the multivitamin, therefore, they will not need to request an order. Administrator stated they will conduct In-Service training on obtaining written orders for every prescription and nonprescription PRN medication. Administrator will provide proof of training by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(i) · Plan of correction due date: Feb 5, 2025

Reappraisals. When there is significant change in condition...or once every 12 months, whichever occurs first... share the reappraisal with the resident...and appropriate facility staff, as specified in Section 87467, Resident Participation in Decision Making. Based on record review the licensee did not ensure 1 out of 87 [R1] residents was assessed every 12 months, which posed a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jan 8, 2025

Plan of correction: Administrator submitted an updated appraisal for R1, POC corrected.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Incident visit. LPA met Wellness Director, Diana Rodriguez and Administrator, Rocio Granda. The facility self reported an incident that occurred on 12/10/24 involving Resident #1(R). The report indicated R1 was at dialysis center receiving treatment and began to have medical symptoms, including cardiac arrest. The dialysis center began CPR and contacted 911. R1 was transported to the hospital for evaluation and admitted to the intensive care unit. R1's Physician's Report dated 09/28/23 indicated R1 had acute respiratory failure and diabetes and required assistance with bathing, dressing/grooming, toileting and medication management. The administrator stated R1 was not admitted to the facility receiving dialysis treatment. Wellness Director explained R1 began dialysis on 11/20/24. R1 goes to dialysis center three times a week and is transported by a transportation company. On 12/10/24, the Wellness Director observed R1 as they were leaving for their dialysis appointment. R1 did not exhibit any symptoms or signs for concern. The Wellness Director also reported they touched R1's hand prior to entering the transportation vehicle, as they were assisting R1 and R1's skin was a normal temperature and not hot to the touch. There was no indication of a possible fever or other symptoms. The Wellness Director spoke with R1' social worker and discovered R1 passed away at the hospital on 12/17/24. No deficiencies were issued today. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Dec 18, 2024

Allegation investigated: Neglect/Lack of Supervision resulting in use of illegal drugs

Licensing Program Analyst (LPA), Natasha Persaud conducted a visit to conclude the complaint investigation regarding the above mentioned allegation. LPA met with Office Manager Assistant, Yahaira Garduno. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and residents. It was alleged Neglect/Lack of Supervision resulting in use of illegal drugs. Evidence obtained revealed there were multiple residents using illegal drugs inside the facility and it has been going on for a period of time. There were reports of staff’s observations involving residents possessing and using illegal drugs in their room, which were photographed by staff. Staff stated that the reports, photographs, video, and drugs that they confiscated were turned over to the facility’s administrator. The administrator’s interview revealed there were a lot of rumors from staff and residents of drug use on facility property, but they lacked evidence to prove those allegations. The administrator also stated once the illegal drugs were confiscated by staff and turned into her, she disposed of them in the trash. Continued on an LIC 9099C. Substantiated Administrator also revealed she has spoken to some of the residents about drug usage at the facility and advised them they would be evicted if it continued. However, none of the residents involved have ever received an eviction notice despite their continued drug usage. The facility’s House Rules reflected “smoking is prohibited within the facility, except in designated areas, smoking within the community or vicinity of community may result in eviction.” Illegal drugs that were confiscated, were not reported to the police department, according to the administrator. In addition, the police records reviewed confirmed illegal drug use was not reported to local law enforcement. There were two incidents involving Resident #1 (R1). On 1/06/2024, a caregiver was in R1’s room changing their briefs when the caregiver found a clear plastic baggie containing a crystal substance between R1’s legs. On 2/2/2024, the same caregiver was in R1’s room and observed a clear plastic baggie containing marijuana on R1’s nightstand. R1 does not have a prescription for marijuana and the substance is prohibited on facility property without one. Both incidents were reported to the administrator. R1’s interview revealed that R1 was warned both times, but no other action was taken. There was another incident on 6/27/2024, involving Resident #2 (R2), which indicated that two staff members entered the room of R2, and the room was filled with smoke. R2 was in the room with another resident and R2’s roommate who was confined to their bed. The staff told R2 they could not smoke in the room, and they opened the doors and windows to let the room air out. The staff stated the smoke smelled “weird” and both felt sick after being exposed to the smoke. Of the interviews conducted, two (2) of the residents admitted to smoking methamphetamine and marijuana in their rooms. Further observations revealed on 07/18/24 Resident #3 (R3) had a plate with marijuana on a table in their room in plain view. Next to the plate was a glass pipe and four cigarette lighters. Resident interviews confirmed witnessing resident’s using illegal drugs inside the facility. Further resident interviews revealed residents were admonished about smoking marijuana at the facility. However, they were told to be discrete about it. Continued on a LIC 9099C. Additional evidence confirmed on 06/27/24, an observation of a clear glass pipe with a bulbous end from which was recognized as a pipe/device used to smoke illegal substances such as methamphetamine. Also, the same day was observed a square piece of aluminum foil with black burnt residue in a trash can on the patio area where residents admitted other residents smoke illegal drugs. The foil was recognized as a device used to smoke illegal drugs and the black substance was residue of the product that was smoked. On 07/18/24, a glass marijuana pipe, four lighters, and a rectangle plate with marijuana on it was observed in R3’s room. Facility records reflected on 1/23/2024 Resident #4 (R4) admitted R3 was the person who sold drugs to other residents, and they bought from R3, and everyone knew. On 02/06/XX, year unknown, revealed a photograph of clear plastic bag containing white crystal substance believed to be Crystal Methamphetamine, which was taken in R2’s room. On 08/18/XX, year unknown, revealed a photograph of a glass pipe with a bulbous end and burnt residue in the bowl, which was confiscated by staff, and also found in R2’s room. Staff indicated the photographs with unknown years were taken on or about 2023. In addition, a photograph of laptop and glass pipe with black burnt residue inside, was confiscated by staff from R4’s room. Based on observations, record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Office Manager Assistant, Yahaira Garduno whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Residents #1, #2, #3, and #4] Facility records reflected on 1/23/2024 a resident admitted another resident was the person who sold drugs to other residents. However, the resident accused of selling drugs denied the allegation. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Office Manager Assistant, Yahaira Garduno whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Nov 7, 2024 · control 08-AS-20240621170515

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(b) · Plan of correction due date: Nov 8, 2024

Administrator – Qualifications and Duties. The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. This requirement is not met as evidenced by: Based on interviews, the licensee did not ensure the administrator carried out the policies of the licensee for 4 out of 90 [R1-R4] residents, regarding illegal drug use in the facility, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 7, 2024

Plan of correction: Administrator agreed to attend vendor training regarding Administrator duties and responsibilities. Administrator will schedule the training by POC due date and provide proof of scheduled training. In addition, the administrator will submit proof of training within 2 weeks.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Incident visit. LPA met with Administrator, Rocio Granda. The facility self reported an incident that occurred on 10/09/24 involving Resident #1(R) and Staff #1(S1). The incident report indicated S1 was rough with R1 when changing their brief. S1 was placed on suspension but has returned. S1 was removed from providing care to R1. Interviews were conducted with residents and staff. Staff interviews confirmed S1 is a good caregiver and there have been no issues with S1 providing care to residents. Resident interviews confirmed S1 was not rough with them and there have been no issues with S1. S1's interview revealed they have not been rough with residents. Facility's administrator acted appropriately with resident care and concerns. Based on interviews conducted conflicting statements were made. No deficiencies were cited for the incident. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Oct 17, 2024

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Annual Continuation. LPA met with Administrator Rocio Granda. LPA, accompanied by Administrator, toured the interior and exterior of the facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. Hot water temperature at taps accessible to residents were all compliant and measured at 113 degrees F.. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, and/or toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per the administrator, no firearms or ammunition are kept at the facility. Facility telephones were all working. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Administrator Rocio Granda to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 17, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management-Other visit. LPA met with Office Assistant, Yahaira Garduno and discussed the purpose of the visit was to issue an amended report. No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to the Office Assistant whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Sep 26, 2024

Allegation investigated: Licensee did not address resident's change in condition. Licensee is not meeting resident's incontinent care needs. Licensee is not meeting resident care needs. Licensee does not have sufficient staffing. Licensee is not meeting resident's dietary needs.

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Assistant Office Manager Yahaira Garduno. Administrator Rocio Granda arrived shortly after. On March 1, 2021, Community Care Licensing (CCL) received a complaint alleging licensee did not address resident's change in condition, licensee is not meeting resident's incontinent care needs, licensee is not meeting resident care needs, licensee does not have sufficient staffing, and licensee is not meeting resident's dietary needs. During the investigation, the Department collected facility documentation and conducted interviews. According to the first allegations the licensee did not address an unnamed or undescribed resident's changed in condition as that resident did not receive medical care to a wound on their feet. The Department received a picture of the unknown resident’s feet but there was no identifying information to the image. Unsubstantiated Additionally, the image only showed two legs and feet that were wrapped in bandages with no visible wound. Interview with staff present between February 2021 and March 2021 did not reveal any resident with a wound that was not being treated by an outside source. Additionally, outside source interview could not corroborate that licensee is not addressing residents change in conditions. It was also alleged that licensee was not meeting Resident 1, Resident 2 and Resident 3’s incontinence care. According to interviews with staff present R1, R2, and R3’s incontinence needs were met. Interview with current residents corroborated that they are currently receiving incontinence care timely and appropriately. Lastly, LPA Strong reviewed records that confirmed R1 was being provided incontinence care regularly. It was also alleged that licensee is not meeting resident’s care needs in that they are not providing residents with showers. Interview with residents did not corroborate that they are not receiving showers regularly. Records reviewed revealed residents have scheduled shower days and are allowed to decline showers. Interview without outside source could not corroborate that residents do not receive regular showers. Additionally, it was alleged that facility did not have sufficient staffing between February 2021 and March of 2021. Records reviewed revealed that there were, on average, 3.75 staff present within the Assisted Living area. Interviews with outside source revealed there is staff turnover, but they have not witnessed short staffing within the last three years. Interview with staff revealed though there are times staff may be limited, managers and supervisors assist in resident care. Lastly it was alleged that licensee is not meeting R3’s dietary needs as they required chopped or pureed food. Interview with residents revealed that if they need a special diet the facility would accommodate their needs or special requests. Interview with staff established that R3 was provided with their specific dietary need but would purchase own food that was not part of their specialized diet. Interview with outside source established that there have been no issues observed with resident’s food accommodations. Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Administrator Rocio Granda, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.the state’s words, verbatim · CDSS document, Aug 23, 2024 · control 08-AS-20210301103537

Allegation investigated: -Staff handles residents in a rough manner. -Staff does not treat residents with dignity and respect.

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegations mentioned above with Medication Technician, Andrea Rodriguez. During the investigation, LPA briefly toured the facility, reviewed records, and interviewed staff and residents. It was alleged staff handles residents in a rough manner. It was reported Staff #1 (S1) handled Resident #1 (R1) in a rough manner. R1 reported approximately 2.5 years ago, S1 was pushing and pulling R1’s wheelchair in a rough manner. R1 confirmed their body was not handled in a rough manner. However, they did not like the way S1 was moving them about in the wheelchair inside R1’s bedroom. R1 confirmed it was a one-time occasion and no injuries were sustained. Further resident interviews confirmed neither S1 nor other staff members have handled them in a rough manner. S1 denied the allegation. Staff interviews revealed they have not heard of or witnessed staff handling residents in a rough manner. Continued on an LIC 9099C. Unsubstantiated It was also alleged, staff does not treat residents with dignity and respect. It was reported S1 was rude to R1. R1 indicated S1 was not rude but loud when talking. R1 confirmed S1 did not use profanity and or say anything in particular. Resident #2 (R2)’s interview indicated S1 was condescending towards them. However, it was a long a time ago and it was addressed by facility staff. Once it was addressed, it no longer happened, and everything has been good with S1. Additional resident interviews confirmed S1 was treating them with dignity. S1 denied the allegation. Staff interviews revealed residents are treated with dignity. There have been some issues regarding language barriers between staff and residents. However, residents are not being mistreated, it’s possibly mis-communication. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Medication Technician, Andrea Rodriguez whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Aug 20, 2024 · control 08-AS-20240719173536

Allegation investigated: Staff did not ensure residents have access or assistance to required appointments

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegation mentioned above with Office Manager, Yahaira Garduno. During the investigation, LPA briefly toured the facility, reviewed records, and interviewed staff and resident. It was alleged staff did not ensure residents have access or assistance to required appointments. It was reported Resident #1 (R1) needed additional physical therapy (PT) and the facility would not assist with obtaining it for R1. The administrator’s interview revealed the facility requested additional PT but R1’s insurance declined the request. Interview with the Home Health agency that provided PT indicated R1 was discharged from PT on 05/20/24 due to reaching maximum potential. The Wellness Director’s interview revealed she asked the Physical Therapist and Registered Nurse for additional PT approximately one week later. Continued on an LIC 9099C. Unsubstantiated The Wellness Director explained she asked both individuals in person, while they were at the facility assisting other residents. On 06/26/24, the verbal request for additional PT was due to R1’s feet hurting, and difficulty ambulating was sent to the Home Health agency. The Home Health agency’s interview confirmed receiving the request and stated the following day on 06/27/24, the therapist responded to the request. The therapist stated R1 needed a higher level of care, reached maximum potential, with no current rehabilitation potential. Therefore, PT was not authorized. R1’s interview revealed they asked the facility for additional PT but did not receive it. However, the decision was up to the Home Health agency, not the facility. R1 is currently receiving PT through a different Home Health agency. The facility complied with Title 22 Regulations and assisted R1 with the request for additional PT. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights. This is an amended version of the original report created on 08/20/24.the state’s words, verbatim · CDSS document, Aug 20, 2024 · control 08-AS-20240709161340

Allegation investigated: Licensee did not provide a comfortable temperature for residents

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegation mentioned above with Office Manager/Supervisor, Yahaira Garduno and Med Tech, Johnny Laesch. During today's visit, LPA briefly toured the facility and interviewed staff and residents. It was alleged the licensee did not provide a comfortable temperature for residents. Today, LPA observed a comfortable temperature in the facility. Resident interviews revealed they were comfortable and some residents reported they were too hot and sweating. LPA observed some residents had two fans in their room and they were not in use. Per the residents, it was not hot enough to use the fans. Most rooms had the windows open, allowing in a cool breeze. Staff interviews confirmed residents are provided with fans and some residents were provided with multiple fans. Staff also stated the licensee ordered some portable air conditioning units and additional fans, which will be delivered soon. Continued on an LIC 9099C. Unsubstantiated The licensee is working on installing air conditioning for the entire facility. Staff reported some days the residents complain it's too hot and some days they are wearing sweaters and asking for their windows to be closed. Staff explained all residents are different with different body temperatures and they try to ensure all residents are comfortable. During the course of the investigation, interviews were conducted. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Med Tech, Johnny Laesch whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Jul 11, 2024 · control 08-AS-20240702095905

Type of visit: Case Management - Other

Licensing Program Analyst, Natasha Persaud arrived on June 26, 2024 for an unannounced case management visit to follow-up on a substantiated case management investigation. LPA met with Rocio Granda, Administrator and reviewed the report. On November 12, 2020, the Department concluded a case management investigation into the questionable death of a resident in care. The licensee was found culpable of negligence for not providing needed care and supervision to R1 and was cited for a Type A deficiency under California Code of Regulations Title 22 (22 CCR), § 87705(c)(5)(A) Care of Persons with Dementia, which states in part, “When any medical assessment, appraisal, or observation indicates that the resident’s dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident." The investigation revealed that on April 6, 2020, a resident (R1) returned to the facility from a skilled nursing facility after hip surgery due to a fall. R1’s physician’s report dated March 9, 2019, evaluated R1 with a primary diagnosis of a major neurocognitive disorder characterized as “dementia with agitation.” Medical records dated April 6, 2020, documented R1 as a fall risk with a history of repeated falls, and indicated R1 now required a higher level of supervision and care. Multiple staff interview statements confirmed they were aware of R1’s increased weakness and nausea, and an unwitnessed fall that had occurred earlier the same day. Staff (S1) acknowledged they read a communication log that documented R1’s need for increased supervision and contact guard, touching and steadying assistance during toileting. However, S1 admitted that they left R1 alone and unattended on the toilet, then returned several minutes later and found R1 lying on the bathroom floor unresponsive and pale. R1’s head and upper body were in the shower area, while their legs were near the base of the toilet. Staff called 911 and paramedics pronounced R1’s death at the scene. The death certificate documented the immediate cause of death as traumatic brain injury due to R1 striking their head during a fall. Continued on an LIC 809C. At the time of the case management visit on November 12, 2020, the licensee was informed that a civil penalty might be assessed based on Health and Safety (HSC) §1569.49. The Department has concluded an analysis and has determined that a civil penalty per HSC §1569.49(e) in the amount of $15,000 is warranted for a violation that resulted in the death of R1 while under the care of this facility. This is evidenced by the facility’s neglect and lack of supervision which led to R1’s fall, directly resulting in the resident’s death. Today June, 26, 2024, the Department will be issuing a civil penalty per Health and Safety Code 1569.49(e) in the amount of $15,000 for a violation that resulted in the death of a resident. A copy of the LIC 421D form was given to Administrator, Rocio Granda and originals were signed. An exit interview was conducted, a copy of this report was issued, and appeal rights were provided. Administrator, Rocio Granda signature on this report acknowledges receipt of the appeal rights, found on page two of the LIC 421D.the state’s words, verbatim · CDSS document, Jun 26, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit to deliver enhanced civil penalties (ECP) and in conjunction conducted this case management visit for background clearance observed during the visit. LPA Lopez identified herself and was granted entry by Yahaira Garduno, Office Manager/Supervisor. LPA stated the purpose of the visit and reviewed the basic elements of the visit with Office Manager/Supervisor Garduno. During today’s visit, LPA Lopez provided the facility their ECP and checked the associations of the facility staff with the Licensing Information System’s, Facility’s Personnel Report Summary. Staff #1 (S1) was not on the list. According to the Gardian website, S1 is cleared but not associated to the facility. According to S1, they work at the facility Monday through Friday. Based on the evidenced obtained, a deficiency was cited and attached to the LIC809-D page of this report. An immediate civil penalty of $500 was also assessed during today's visit. An exit interview was conducted with Office Manager/Supervisor Yahaira Garduno and a copy of this report, along with the LIC811, LIC421 and the Licensee/Appeal Rights (LIC 9058 3/22) were provided to the Office Manager/Supervisor at the conclusion of the visit. The signature below confirms the documents were received.the state’s words, verbatim · CDSS document, Jun 19, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355 · Plan of correction due date: Jun 19, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or. This requirement was not met as evidenced by: Based on interviews and records reviewed the facility did not ensure Staff #1 (S1) had a transferred criminal record clearance or was associated to the facility which posed a potential health, safety and personal rights risk to 91 of 91 residents in care.the state’s words, verbatim · CDSS document, Jun 19, 2024

Plan of correction: Office Manager/Supervisor agreed to remove S1 from the facility until S1's background clearance was transferred and associated to the facility.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Carmen Lopez arrived on June 19, 2024, for an unannounced case management visit to follow-up on a substantiated complaint investigation. LPA met with Yahira Gardunio Ramirez, Office Manager/Supervisor and reviewed the report. On May 20, 2022, the Department concluded a complaint investigation which alleged the following allegation: licensee did not ensure needed medical care for a resident. The allegation was substantiated, and the licensee was cited for a violation as a Type A deficiency under California Code of Regulations Title 22 (22 CCR), § 87465(g) Incidental Medical and Dental Care, which states in part, “The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health…”. The investigation revealed that on May 29, 2020, a resident (R1) fell at the facility and complained of lower back pain. Staff interview statements admitted they observed R1 as being in “extreme pain,” but the facility did not contact 911 to have R1 medically evaluated for injury. A physician’s report dated May 29, 2020, diagnosed R1 with major neurocognitive impairment, characterized by frequent confusion and a history of wandering behavior. Resident appraisal records dated May 30, 2020, noted R1 as a fall risk and documented that R1 needed close supervision and monitoring. Facility records documented that R1 had two subsequent falls on May 30, 2020, and June 3, 2020. R1 verbally communicated additional back and leg pain to multiple staff; however, the facility failed to provide or arrange any medical evaluation. R1 continued to complain of pain up until their last day at the facility, June 6, 2020. While being transported to a new facility on June 6, 2020, R1 expressed hip pain to outside sources. R1 was immediately taken to the hospital and subsequently diagnosed with a hip fracture. An interview with an outside medical professional confirmed the fracture was an “acute fracture”, meaning it had occurred within a six-week timeframe while R1 resided at the facility. Medical records dated June 6, 2020, confirmed R1 underwent hip surgery, was hospitalized for two weeks, and then discharged into another licensed care facility on June 21, 2020. (Continuation on LIC809-C) At the time of the complaint visit on May 20, 2022, an immediate civil penalty of $500 was assessed and the licensee was informed that a civil penalty might be assessed based on Health and Safety section 1569.49. The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section 15610.67 defines serious bodily injury as "an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility’s neglect and lack of emergent care, after a fall that resulted in an untreated fracture led to R1’s pain and suffering. Today June 19, 2024, the Department is issuing a civil penalty per Health and Safety Code 1569.49(f) for a violation that the Department constitutes as serious bodily injury, in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on May 20, 2022, the amount of the civil penalty issued today will be $9,500. A copy of the LIC 421D form was given to Yahira Gardunio Ramirez, Office Manager/Supervisor and originals were signed. An exit interview was conducted, a copy of this report was issued, and appeal rights were provided. Yahira Gardunio Ramirez, Office Manager/Supervisor's signature on this report acknowledges receipt of the appeal rights, found on page two of the LIC 421D.the state’s words, verbatim · CDSS document, Jun 19, 2024

Allegation investigated: -Resident sustained multiple falls while in care, due to neglect -Staff gave resident wrong medication -Resident consumed facility food, resulting in food poisoning

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the complaint investigation regarding the above-mentioned allegations. LPA met with Administrator, Rocio Granda. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and residents. It was alleged Resident #1 (R1) sustained multiple falls while in care, due to neglect and staff gave R1 the wrong medications. R1’s Physician’s Report dated 10/07/20 indicated R1 was ambulatory, able to leave the facility unassisted, and was independent of activities of daily living to include medication management. R1’s interview revealed they were having falls and went to the hospital approximately nine (9) months ago. R1 stated while at the hospital they were told they were being given the wrong medications. A review of R1’s records did not indicate any hospital visits regarding falls or incorrect medications being given. However, R1 did go to the hospital multiple times for other medical issues. R1’s also stated they were falling because they were getting older and had some physical therapy which helped but it had nothing to do with the facility. Continued on an LIC 9099C. Unsubstantiated Staff interviews revealed not being aware of any falls for R1. A review of R1’s facility records did not indicate any falls. R1’s interview also confirmed they did not receive or require assistance from staff, as they were independent and ambulatory. Staff interviews confirmed R1 was independent and managing their own medications. The administrator confirmed R1 was provided with a lock for a drawer to store their medications. Further staff interviews revealed if any medications were incorrect, R1’s physician would have to make that determination. It was also alleged, R1 consumed facility food, resulting in food poisoning. On 09/16/21, LPA observed the kitchen and did not observe any cross contamination. All food was being stored and handled properly. Staff interviews revealed they also eat the facility food and have not gotten sick or food poisoning. Further staff interviews revealed R1 eats from fast food establishments and restaurants. Resident interviews revealed they were also eating the facility food and did not sustain food poisoning. R1 admitted they also eat outside food and was not able to confirm how they got food poisoning. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, May 2, 2024 · control 08-AS-20210907104633

Allegation investigated: Lack of supervision resulted in resident sustaining injury

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the investigation regarding the above-mentioned allegation. LPA met with Administrator, Rocio Granda. During the investigation, records were reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged lack of supervision resulted in Resident #1 (R1) sustaining injury. It was reported Resident #2 (R2) pushed R1 down resulting in a fractured hip. R1’s Physician’s Report dated 02/03/15 indicated R1 had a Major Neurocognitive Disorder, was ambulatory, able to handle their own activities of daily living, and did not have aggression. R2’s Physician’s Report dated 06/12/21 indicated R2 had a Major Neurocognitive Disorder with behavioral disturbances but was not aggressive and required assistance with all activities of daily living. R2’s Preplacement Appraisal dated 06/29/21 acknowledged R2 had a Major Neurocognitive Disorder with behavioral disturbances. Continued on an LIC 9099C. Unsubstantiated On 8/17/2021 during dinner time, two (2) staff members were present in the dining room along with other residents to include R1 and R2. Staff interviews confirmed R1 and R2 did not have any contact with each other during dinner time. While staff were assisting the residents, R1 went to use the restroom. R2 did not want to sit nor eat and started to walk around in the dining room area. Staff observed R2 pushed R1 from behind, R1 fell to the ground. R1 complained of leg pain, and R2 started banging their own head against the wall. Staff called for assistance, then the Police and Paramedics arrived. Both R1 and R2 were transported to the hospital for evaluation and treatment. At the hospital, R1 was diagnosed with a fractured hip and received surgery. R1 resided at the facility from 06/29/2021 to 8/17/2021. Facility records showed R2 started to show aggressive behavior towards other residents and staff as early as 7/4/2021. The administrator’s interview revealed they were looking for placement as R2 required a higher level of care. The administrator also indicated not being aware of the aggression upon admission and was not notified by R2’s responsible party there was any aggression to be addressed. Staff also reported they made accommodations to work and assist R2 while they were living at the facility. Facility records showed staff documented all incidents and the administrator attempted to find another placement for R2. The incident was observed by a staff member. Therefore, there was no lack of supervision resulting in the incident. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation is deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Residents 1-2]the state’s words, verbatim · CDSS document, May 2, 2024 · control 08-AS-20210818160505

Type of visit: POC

.Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced Plan of Correction visit. LPA met with Administrator, Rocio Granda. On 04/18/24, the facility was issued a deficiency regarding basic services requirements. Some residents are unable to leave the facility unassisted but will attempt to elope when staff are not present in the front office to observe or after hours. The administrator purchased and installed an alarm system to assist when staff are not present in the front office and/or after hours. The alarm system is operable and has deterred residents from leaving unassisted. The deficiency has been corrected and cleared. No deficiencies were observed today. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Rocio Granda whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, May 2, 2024

Allegation investigated: Staff did not assist resident with feeding Facility smells of mold

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the above-mentioned allegations. LPA met with Administrator, Rocio Granda and Staff, Adilene Ramirez. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged staff did not assist resident with feeding. It was reported Resident #1 (R1) was being served food by staff, but they were not assisting R1 with feeding. Outside source interviews revealed there were times staff would feed R1, while R1 was lying in bed causing R1 to choke. Outside sources also reported staff would bring R1 food and would take the full plate of food away if R1 didn’t eat. However, R1 didn’t eat because they were unable to feed themselves. R1’s Physician’s Report dated 03/29/24 indicated R1 was able to feed themselves. R1’s Preplacement Appraisal dated 04/01/24 indicated R1 was able to feed themselves with a modified diet. R1’s interview confirmed they were able to feed themselves and prefers to feed themselves. R1 was able to demonstrate feeding themselves. Continued on an LIC 9099C. Unsubstantiated R1 reported staff assist with all meals but they do not want assistance. R1 received a new hospital bed and is able to sit up to eat. R1 requested an across the bed table tray to allow for self-feeding. While at the facility, staff provided R1 with the table tray. Staff interviews confirmed they assist R1 with all meals and make the time to ensure they feed R1. It was also alleged the facility smells of mold. Outside source interviews revealed they smell mold when they are present in the facility. Outside source interviews also stated they feel sick when they are in the building with side effects. Today, LPA did not observe mold or smell mold. LPA made past multiple visits to the facility on 02/21/24, 3/19/24, and 04/02/24 and there was no evidence of mold. The administrator’s interview confirmed they had a professional mold abatement company inspect the facility for mold, and there was no evidence of mold. Staff interviews confirmed they have not observed or smelled mold in the facility. Resident interviews also confirmed they have not observed or smelled. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Adilene Ramirez whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Apr 18, 2024 · control 08-AS-20240415103954

Allegation investigated: Lack of supervision resulted in resident wandering out of facility

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the above-mentioned allegation. LPA met with Administrator, Rocio Granda and Staff, Adilene Ramirez. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, resident, and outside sources. It was alleged lack of supervision resulted in a resident wandering out the facility. On 04/07/24, Resident #1 (R1) left the facility and went to the McDonald’s located down the street. R1 sustained a fall and the paramedics responded and transported R1 to the hospital. R1 did not sustain any injuries. R1’s Physician’s Report dated 02/08/24 indicated R1 was confused and not allowed to leave the facility unassisted. Staff interviews revealed they were not aware R1 was left the facility unassisted as they were assisting other residents. R1 left the facility in the evening when office staff were not present to observe the elopement. The administrator’s interview revealed the doors lock from the outside at nighttime but not from the inside due to safety reasons and fire clearance. Continued on an LIC 9099C. Substantiated The facility provides 24-hour supervision. However, the caregivers are assisting residents at all times of the day, and they are unable to watch the front door after hours. Staff interviews confirmed they check on residents every two (2) hours or sooner. The administrator has relocated R1 to their secured memory unit. The administrator is going to purchase a security system to alert them when the doors are opened in the evening hours. The facility has an Absentee Notification Plan on file for R1. Based on interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Adilene Ramirez whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1].the state’s words, verbatim · CDSS document, Apr 18, 2024 · control 08-AS-20240411093448

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.312(d) · Plan of correction due date: May 16, 2024

Basic services requirements. Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not ensure supervision was provided to 1 out of 92 residents [R1], which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 18, 2024

Plan of correction: Administrator stated they will purchase door alarms for exits to alert staff when the doors are being opened after hours.

Allegation investigated: Medications not given as prescribed

Licensing Program Analysts (LPAs) Natasha Persaud and Ryan Fulton conducted an unannounced visit to commence a complaint investigation. LPAs met with Administrator, Rocio Granda and Business Office Manager, Monica Cordova. During today's visit, LPAs briefly toured the facility, requested records, interviewed staff and residents. It was alleged that medications were not given as prescribed for Resident #1 (R1). It was reported the facility stopped dispensing medications to R1. R1’s Physician Report dated 02/12/24 showed the facility store and manage R1’s medications. A review of R1’s Medication Administration Record (MAR) dated 03/14/24 to 04/12/24 indicated medications were being dispensed to R1. However, the MARs also had missing signatures, which was a sign the medications were not given as prescribed. R1 was transported to the hospital on 03/26/24 for a medical condition. At the hospital, R1 was diagnosed with an allergy to a specific medication and provided with discharge documentation that reflected R1 had the new allergy. Continued on an LIC 9099C. Substantiated Upon R1’s return, the facility received and reviewed the hospital documentation indicating the new allergic reaction to the exiting medication. Therefore, the facility should have discontinued the specific medication that caused the allergic reaction, removed the medication from the medication cart, and/or updated the MARs. Instead, the facility dispensed the medication causing the allergic reaction from 03/27/24 thru 04/01/24. Staff interviews confirmed they were aware the medication should have not been dispensed. However, staff stated R1 wanted the medication, therefore, it was dispensed to R1. Medications were not given as prescribed once the facility had knowledge to discontinue. Based on interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Business Office Manager, Monica Cordova whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names list to identify Resident #1] They discovered R1 on the floor and had R1 transported to the hospital. According to an internet search it takes approximately thirty (30) minutes for most medications to dissolve. Therefore, R1 would not have fallen within five (5) minutes of ingestion. R1’s interview revealed they took the medication and fell within minutes but did not believe it was a result of the medication. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Business Office Manager, Monica Cordova whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names list to identify Resident #1]the state’s words, verbatim · CDSS document, Apr 2, 2024 · control 08-AS-20240328101228

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Apr 3, 2024

Incidental Medical and Dental Care. The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not give medications as prescribed to 1 out of 91 residents [R1] in care, which posed an immediate Health and Safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 2, 2024

Plan of correction: Administrator stated she will schedule medication training by POC due and implement a new medication policy and procedure to ensure medications are given as prescribed. In addition, proof of training will be provided within 2 weeks.

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs), Natasha Persaud and Ryan Fulton conducted a Case Management - Incident visit. LPAs met with Administrator, Rocio Granda and Business Office Manager, Monica Cordova and discussed the purpose of the visit. During today's visit, LPAs briefly toured the facility, request records, and interviewed staff and residents. Community Care Licensing received a self reported incident involving Resident #1 (R1). The report stated on 03/26/24, R1 was transported to the hospital for chest pain. R1 refused to return to the facility once discharged and threatened harm to themselves and others. The administrator stated R1 was discharged back to the facility and was calm upon arrival. The administrator also implemented increased status checks, and had a meeting with R1, and staff to ensure R1's safety. No deficiencies were issued today. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Business Office Manager, Monica Cordova whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Apr 2, 2024

Allegation investigated: Lack of supervision resulted in resident altercation Staff verbally abused resident

Licensing Program Analyst (LPA) Natasha Persaud conducted a complaint investigation regarding the above-mentioned allegations. LPA met with Administrator, Rocio Granda, However, she had to tend to an urgent matter. Therefore, Medication Technician, Andrea Rodriguez completed he visit with LPA. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff and residents. It was alleged lack of supervision resulted in a resident altercation. It was reported Resident #1 (R1) was asleep in their room when Resident #2 (R2) came into R1’s room and hit R1, while they were asleep. R1’s interview revealed that R1 used to live in a shared room with R2 when the altercation occurred back in November 2023. Today, R1 expressed they were not concerned about the previous altercation because the facility acted appropriately, and the police were contacted. R1 did not press charges or sustain any injuries. LPA confirmed R1 has resided in a private room for over one year and there were no altercations in November 2023 between R1 and R2. R1 admitted there was no lack of supervision at the time of the altercation due to the residents being roommates. Continued on an LIC 9099C. Unsubstantiated The facility relocated R1 to a private room to ensure their safety. The previous altercation was addressed and resolved years ago. Staff interviews revealed there have been no recent altercations between R1 and R2, and R1 resides in a private room. It was also alleged staff verbally abused resident. It was reported Staff #1 (S1) called R1 a curse word on 03/10/24. It was reported R1 was waiting outside for a pizza delivery, when S1 verbally abused R1. S1 was sitting in their car when R1 approached the vehicle assuming it was the delivery person. However, once R1 approached the vehicle, it was S1. R1 stated S1 told them to leave as they’re not allowed in the street. S1 stated they told R1 they needed to leave as S1 couldn’t be around R1. S1 elaborated by stating there were previous issues between S1 and R1, which was also confirmed by R1. Staff interviews confirmed that R1 was waiting for a pizza delivery and mistook S1’s car but no curse words were exchanged. Resident interviews revealed there have been some issue between R1 and S1, but no curse words were witnessed on 03/10/24. Both staff and the resident that witnessed R1 and S1 on 03/10/24 denied S1 called R1 a curse word. The administrator explained the previous issues between R1 and S1 occur during the NOC shift when there are no other individuals to corroborate the concerns. The facility will be switching S1’s schedule from NOC shift to AM shift as a precautionary measure. The administrator expressed she wants to ensure all residents are treated with dignity and if there are any issues they can be observed and resolved. The administrator has not witnessed S1 curse at R1 and the incident was also not reported to her. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Medication Technician, Andrea Rodriguez whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1 and Staff #1]the state’s words, verbatim · CDSS document, Mar 19, 2024 · control 08-AS-20240312090659

Allegation investigated: Staff did not respond timely to assist resident. Illegal eviction.

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced complaint investigation visit. LPA Silveira introduced themselves, met with Administrator Rocio Granda and disclosed the purpose of the visit. The purpose of the visit was to deliver complaint findings for the above-mentioned allegations. The Department’s investigation consisted of interviews with staff, residents and outside sources, as well as a facility records review. It was alleged that the facility attempted to evict Resident #1 (R1) illegally. It was also alleged that staff did not respond timely to assist R1. In an interview conducted with an outside source on 10/21/2020, it was alleged that facility management illegally evicted R1. An interview conducted by the Department with the current Administrator revealed that R1 was never evicted and actually continued to reside in the facility up until 2023. [CONTINUED 9099-C] Unsubstantiated [CONTINUED FROM 9099] The interview also revealed that while the previous facility administration had initially attempted to evict the resident, all issues were resolved and the previous Administrator never followed through with the eviction. Interviews with staff corroborated that the resident was never evicted. It was also alleged that during October 2020 staff did not respond timely to assist R1 with their care needs. The Department made multiple attempts to contact R1, but the attempts were unsuccessful. The Department also attempted to interview other relevant witnesses to no avail. The Department conducted interviews with other residents who lived at the facility during October 2020. An interview with Resident #2 (R2) revealed that R2 had no complaints regarding staff responses to their care need requests. An interview with Resident #3 (R3) revealed that during this timeframe, they believed there was a loss of facility staff due to the COVID-19 pandemic. R2 believed that this caused a temporary strain on services due to a temporary change in staff and training issues. R3 stated that they are content with care services at the facility. Interviews with caregivers that worked at the facility during October 2020 also revealed that they believed R1’s care needs were addressed in a timely manner and they were not made aware of response time issues from other residents during that time. Due to a lack of corroborating evidence, the allegations that there was an illegal eviction and that staff did not respond timely to assist a resident are unsubstantiated. LPA Silveira conducted an exit interview with Administrator Rocio Granda. At the time of the exit interview Rocio was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016). The signature on this report acknowledges receipt of the rights.the state’s words, verbatim · CDSS document, Feb 29, 2024 · control 08-AS-20201016163901

Allegation investigated: Facility did not refill prescriptions in a timely manner Licensee did not arrange transportation services to meet resident's needs Facility staff was not able to communicate with residents and/or emergency service personnel

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow-up and deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Rocio Granda. During today's visit, LPA observed residents in care, reviewed and obtained copies of facility records, and interviewed staff. The Department’s investigation consisted of interviews with residents, staff, and outside sources, record review, and a tour of the facility. It was alleged that the facility did not refill prescriptions in a timely manner, the Licensee did not arrange transportation services to meet resident needs, and facility staff was not able to communicate with residents and/or emergency personnel. Continued on LIC9099-C page... Unsubstantiated Interviews with staff and review of assessment records revealed that Resident 1 (R1) was present at the facility for about one month between August and September 2020, was occasionally confused and disoriented, and received medication management by the facility. Additionally, R1 required staff assistance with transportation services and scheduling medical appointments. The Department was unable to interview R1 due to R1 leaving the facility in 2020 and a lack of R1’s contact information. Additionally, the Department was unable to review a majority of records regarding R1 due to the requirement that facilities are only required to maintain records for 3 years. Interviews with staff revealed that residents would occasionally ask staff to assist with scheduling medical appointments. Staff disclosed during interviews that medication technicians and the Wellness Director were able to assist residents with arranging medical appointments and would speak to scheduling personnel with the resident present to set up appointments. Interviews with staff revealed that during 2020, many medical appointments were either canceled or rescheduled as video call appointments. Additionally, staff stated in interviews that during 2020, residents’ doctors would approve additional medication refills without seeing the resident during an appointment after speaking with facility staff to ensure that the resident had not had any changes in condition. Interviews and review of facility communications revealed that in September 2020, R1 had a medical appointment to obtain medications that had to be rescheduled due to issues with transportation. Those interviews and records did not reveal any details regarding the specific reason for the rescheduled appointment. Interviews with staff revealed that R1 would have been running low on medications by the time that R1 left the facility in September 2020, however, staff denied that R1 had missed any medications. Staff interviews stated that residents would be admitted to the facility with either a 15- or 30-day supply of medications and that facility staff had been in the process of arranging for R1’s medications to be delivered to the facility. Residents and staff stated in interviews that the facility provided transportation services to residents via a facility van for medical appointments and errands. Residents and staff stated that residents were requested to schedule any transportation services a few days in advance due to demand. Additionally, staff stated that medication technicians would assist residents with obtaining outside transportation services such as MTS, the resident’s insurance, or hospital resources when needed. Staff interviewed stated that if the transportation log did not have any openings, staff would occasionally drive residents to medical appointments when staff were able to do so. Continued on LIC9099-C page... Interviews with residents and staff did not disclose evidence of residents missing or canceling medical appointments due to transportation issues. Interviews with staff and review of communication records revealed that staff attempted to arrange transportation for R1 to attend a medical appointment but due to short notice, the facility was unable to meet the request. R1’s medical appointment was rescheduled for a later date but R1 left the facility prior to the appointment. Interviews with residents and staff present at the facility during 2020 did not reveal difficulties with residents being able to understand staff due to language barriers. Those interviews revealed that while residents did have complaints regarding understanding staff, it was due to residents’ hearing impairments or staff accents or mumbling while speaking. Interviews with staff revealed that some residents would complain that staff did not speak English even when those staff were speaking English fluently. Interviews with staff did reveal that there were staff working at the facility in 2020 who did not speak English fluently, however, other staff were able to assist with translation services and did not voice any issues with meeting resident care. Staff interviewed disclosed that any staff who did not speak English fluently were not scheduled to be left alone at the facility and were not responsible for communicating with emergency personnel. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated. An exit interview was conducted with Administrator Rocio Granda, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Feb 28, 2024 · control 08-AS-20201007102549

Type of visit: Required - 1 Year

Licensing Program Analyst LPA Juliana Barfield conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Rocio Granda. Assistant Manager Yahaira joined LPA and Granda. During today’s visit, LPA toured the facility, reviewed staff and client records, and interviewed staff and clients. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection. An exit interview was conducted with the Administrator Rocio Granda, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Feb 28, 2024

Allegation investigated: Facility staff did not administer medications as prescribed

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to commence a complaint investigation and delivered findings. LPA identified herself and discussed the allegation mentioned above with Administrator, Rocio Granda. On February 20, 2024, Community Care Licensing (CCL) received a complaint alleging that facility staff did not administer medications to R1 as prescribed, [an LIC 811 Confidential Names List was provided to staff to identify the resident]. It was specifically alleged that staff did not administer the Nortriptyline, 50 ml according to the physician's orders. Per the physician's orders, R1 was to be administered one capsule for anxiety and depression daily before bedtime. A review of the physician's notes indicated that on February 18, 2024, when R1 was admitted to the hospital, (due to an unrelated condition), R1 had not been administered the medication. A review of the physician's notes indicated that the facility had run out of the Nortriptyline, and it was uncertain as to how long R1 had not been given the medication. (Continue at LIC9099C) Substantiated (Continue from LIC9099) According to the physician’s notes, on February 18, 2024, R1’s medical condition had been negatively affected due to the lack of medication. On February 26, 2024, during a visit to the facility, a review of R1’s medication administration records (MARs) confirmed that R1 had not been administered the medication as prescribed for nine (9) days from February 10th to February 18th, 2024. In addition, the MARs review disclosed that there was another medication that was not administered as prescribed from January 29, 2024, to February 18, 2024. According to the MAR’s notes, staff ordered a refill of the Nortriptyline on February 14, 2024. In addition, per the MARs review, there was no record if the medication refill was placed for the 2nd medication not administered. During interviews, staff indicated they did not know why the medication refills were not placed on a timely manner to meet R1’s needs. According to R1’s physician’s report, R1 needs assistance with medication management. No other explanation of why additional follow-up was not performed by staff to ensure medication refills for R1 were processed on time was obtained during the investigation. The Department has investigated the above-mentioned allegation and based on interviews with staff, outside sources, and records review, this allegation is deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D. A plan of correction was developed with Administrator, Rocio Granda. An exit interview was conducted with Administrator, Granda, to whom a copy of this report, LIC 9099D Deficiency form, the Licensee Appeal Rights (LIC9058 01/16), and the LIC 811 confidential name list were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 26, 2024 · control 08-AS-20240220113601

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(C)(2) · Plan of correction due date: Mar 26, 2024

87465 (C)(2) Incidental Medical and Dental Care … Once ordered by the physician the medication is given according to the physician's directions… this requirement was not met as evidenced by: Based on interviews and record review, facility staff did not administer R1 their medications as prescribed. This posed a potential health risk to 1 of 89 residents in care.the state’s words, verbatim · CDSS document, Feb 26, 2024

Plan of correction: Administrator agreed to conduct additional staff training on medication management by a 3rd party provider and submit documentation of training conducted by POC deadline, 3-26-2024.

Allegation investigated: Facility staff failed to reposition resident. Facility did not maintain resident's room temperature within regulation.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to conduct interviews, collect records, and deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Mina Ramirez, Caregiving Supervisor. On 10/6/2020 it was alleged that facility staff failed to reposition a resident, and did not maintain a resident's room temperature within regulation. The Department’s investigation consisted of a virtual and unannounced facility visit, interviews with facility staff, outside sources, records review, and LPA direct observations. Regarding the allegation, "Facility staff failed to reposition resident", it was alleged that Resident 1 (R1) suffered pressure wounds due to staff not turning them in regular intervals. Staff interview revealed that R1's condition rose to a level of care that the Licensee could no longer provide; the issue was elevated to management for R1 to receive a higher level of care. Staff interview further revealed that staff attempted to reposition R1, but R1's Responsible Party refused to allow repositioning during the day, which further exacerbated the developing pressure wounds. (Continued on LIC9099 p.2) Unsubstantiated (Continued from LIC9099 p.1) Records review revealed that R1 had ongoing issues with their incontinence equipment, which resulted in R1's skin being exposed to moisture for extended periods of time, which was known to exacerbate skin breakdown. Records review showed that staff monitored R1's skin condition daily and elevated the issue to R1's physician, Responsible Party, and Home Health agency. Outside source interview did not corroborate the allegation, informing that they had no knowledge of the accusation or issue at the facility. R1 was unable to be interviewed for the investigation. Regarding the allegation, "Facility did not maintain resident's room temperature within regulation", it was alleged that the Licensee did not act when R1's room was observed to be of high temperature. Staff interview revealed that R1's Responsible Party would regularly increase the temperature of R1's room by turning on the room heater plus an additional personal heater, and place extra blankets on top of R1. Staff interview further revealed that staff attempted to turn off the heaters and remove the blankets, and open the windows in R1's room to cool it down. Staff interview further revealed that staff observed R1 to show signs of being too hot, such as visibly sweating, and communicated to R1's Responsible Party that R1 was too hot. Additional staff interviews revealed that on hot days staff would open windows and corridors throughout the facility for airflow, maintaining a comfortable temperature. Outside source interview revealed observations of staff placing a fan in R1's room to lower the temperature. Additional outside source interviews did not corroborate the allegation, informing no knowledge of the accusation or issue at the facility. Review of temperature records on the day in question produced varied results. Almanac.com showed that the temperature range on the day in question was between 66.9 and 97.0 degrees Fahrenheit; farmersalmanac.com showed a temperature range between 68.0 and 88.9 degrees Fahrenheit. No records were found to confirm the temperature of R1's room the day in question. As such, no evidence was found to corroborate that the Licensee did not maintain R1's room within regulation. No records were found to indicate that the facility exists in an extreme temperature area. (Continued on LIC9099 p.3) (Continued from LIC9099 p.2) During an unannounced facility visit, LPA directly observed R1's former room, which was on the first floor of the building. LPA's observations corroborated staff statements regarding the ability to individually heat the room via heater. LPA observed windows in the room that could be opened for airflow, and also observed other resident rooms with open screen doors and/or windows for temperature preference. R1 was unable to be interviewed for the investigation. Based on interviews, direct LPA observations and records review, The investigation did not yield a preponderance of evidence to conclude that facility staff failed to position resident, and facility did not maintain resident's room temperature within regulation. Based on the foregoing, the allegations are unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Mina Ramirez, Caregiving Supervisor, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 23, 2024 · control 08-AS-20201006111840

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an announced case management visit to cite deficiencies observed during a complaint visit that are unrelated to the complaint allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Wellness Director Diana Rodriguez. During the unrelated complaint visit, LPA observed Staff 1 (S1) working at the facility [Caregiver Supervisor was given an LIC811 Confidential Names List to identify S1]. Review of the Department's personnel record for individuals associated to the facility revealed that S1 was not associated to the facility. Interviews with S1 revealed that S1 has been working at the facility for more than 5 days. Therefore, a deficiency regarding staff association is being cited per California Code of Regulations Title 22 and noted on the attached LIC809-D page. Additionally, a civil penalty in the amount of $500 is being issued on an LIC421BG. An exit interview was conducted with Caregiver Supervisor Mina Ramirez, whose signature below confirms receipt of a copy of this report (LIC809), LIC811, LIC421BG, and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Feb 23, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Feb 23, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance. This requirement has not been met as evidenced by: Based on interviews and records review, the licensee did not ensure that S1's criminal background clearance was transferred to the facility prior to working. This poses an immediate safety risk to 97 of 97 residents.the state’s words, verbatim · CDSS document, Feb 23, 2024

Plan of correction: During the visit, LPA Ruiz confirmed that S1 left the facility. S1 must be background check cleared and associated to the facility prior to returning to work.

Allegation investigated: Residents were financially abused while in care

Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit regarding the above-mentioned allegations. LPA met with Medication Technician Supervisor, Yahaira Garduno. It was alleged residents were being financially abused while in care. Resident #1 (R1) and Resident #2 (R2) were the alleged victims. It was reported R1’s fanny pack, wallet, Identification card and $400 was stolen. R1 wears a key around their neck, which is for a lock to their drawer in their bedroom. R1 reported someone took the key off their neck and stole their items in the locked drawer. LPA observed R1’s fanny pack sitting on their table in their room. R1 opened their fanny pack, and their wallet was located inside the fanny pack. In addition, R1’s locked drawer also contained another wallet that R1 claimed was also stolen. R1 was unable to state having possession of the fanny pack and wallets, that were allegedly stolen. R1 was unable to locate the $400 or provide proof they had possession of the $400. R1 reported the theft occurred between 02/10/24 and 02/11/24. However, R1 reported today that the theft occurred back on 09/03/23, then also stated it occurred on 02/12/24, along with a credit card being stolen not cash. Conflicting statements were made. Continued on an LIC 9099C. Unsubstantiated Outside source interviews revealed R1 reported several months ago $400 cash was stolen and their wallet, then R1 found their wallet but not the cash. Outside source interviews confirmed R1 reports false accusations and may need to be reassessed. On 02/15/24, the facility met with R2 regarding their rent payment being due. R2 stated they were unable to make rent due to someone stealing their debit card while out in the community. R2 confirmed today being out at a hotel and being robbed of their debit/credit card back on 01/25/24. On 02/16/24 R2 reported their debit and credit card was stolen out of their room around 4am-5am. According to interviews, the debit card was reported as stolen by an outside source in the community prior to the report being made that the facility stole their debit and credit card. R2 was able to confirm no fraudulent activity was made on the accounts and the cards were cancelled. Both residents have a resident property and valuables form on file, which indicated nothing to report. Both residents also were provided a lock in their room on a drawer to store their personal items. Both residents’ physician’s reports indicated they are able to leave the facility unassisted. Facility’s Incident Report dated 02/16/24 confirmed the facility spoke with R2 on 02/15/24 trying to obtain a rent payment. However, R2’s card was stolen a few weeks ago, as they were assaulted and robbed out in the community. R2 was waiting for their new card to arrive, then reported it was stolen at the facility on 02/16/24. R2 denied receiving a new card then having it stolen again. Staff interviews confirmed they have not stolen any items from residents. Other resident interviews confirmed no items have been stolen from them. During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegations. The allegations are deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Medication Technician Supervisor, Yahaira Garduno whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Feb 21, 2024 · control 08-AS-20240214155043

Allegation investigated: Staff not providing adequate service to resident in care.

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out a complaint. LPA identified herself, was granted entry, and stated the purpose of the visit to Rocio Granda, Administrator. During the investigation, LPA toured the facility, conducted interviews and completed a records review. It was alleged that staff are not providing adequate service to resident in care. Interviews revealed staff provide several services to the residents. Services include cleaning the rooms, assisting residents when they need assistance and showering along with other duties as deemed necessary as requested by the residents. Interviews with staff denied not providing services to residents. Interviews revealed that the staff assist residents when the residents need help they let the staff know. Staff do rounds and check on the residents so they can meet their needs. Unsubstantiated Interviews revealed that about two years ago Resident 1 (R1) fell, and alleged they could not get staff to help. Interviews with staff revealed that R1 never mentioned that they fell and did not call to report the fall. Interviews with staff revealed that R1 is one of the most independent residents here and that R1 will let them know anytime there is a problem. Interviews revealed that R1 had medication stolen back (2020), Linens (2021) and recently their clorox wipes (2022). Interviews with staff revealed that R1 had surgery in 2020 and R1 had their friend pick up some of their belongings and that is when R1 noticed the medications were missing out of their room. R1 admitted that a friend did pick up the items and doesn't really know who took their medications. There was no report of missing linen from R1 to staff and although the facility provides linens, interviews revealed that R1 did not provide their own linens at any time. Interviews revealed R1's clorox wipes were missing and R1 reported it to the administrator. Interviews revealed that once R1 reported the wipes missing they were replaced. There were no witnesses that reported the staff are not providing adequate service to resident in care. The allegation is unsubstantiated. An exit interview was conducted with Rocio Granda, Administrator. A copy of this report and Licensee Appeal Rights (9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 8, 2024 · control 08-AS-20220728101558

Allegation investigated: Staff mishandles resident's medication. Staff did not provide a comfortable room temperature for resident. Facility is in disrepair. Facility is not free of insects. Facility does not provide adequate food service for resident. Resident's room does not have sufficient lighting.

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced complaint visit to deliver investigative findings. LPA identified herself and was invited into the facility. LPA met with Administrator, Rocio Granda and Yahaira Garduno Med Tech Supervisor and shared findings. The Department investigated the above-listed complaint allegations. The investigation consisted of an inspection of the facility, interviews with staff and outside sources, and a review of resident and facility records relevant to this investigation. On August 13, 2020 Community Care Licensing (CCL) received a complaint alleging that facility staff mishandles resident's medication. Resident 1 (R1) records were reviewed and there were no discrepancies or mishandling of medication. Resident 2 (R2) records were reviewed and there were no discrepancies or mishandling of medication. Resident 3 (R3) records were reviewed and there were no discrepancies or mishandling of medication. Outside Source 1 (OS1) was interviewed and there were no concerns regarding medication and was not aware of any mishandling of medications. (Continue on LIC9099C) Unsubstantiated (Continue from LIC9099) It was alleged that staff did not provide a comfortable room temperature for resident. LPA Domingo toured the facility and the ambient temperature was 68 to 70 degrees Fahrenheit. During the tour the residents that were observed were well groomed. The temperature outside of the main building was 73 degrees Fahrenheit and one resident had a light jacket and a hat. It was observed all residents in care were clean, well-groomed, and appropriately dressed. There was shade provided and all residents observed were comfortable. OS1 was interviewed and had no complaints regarding room temperature for the residents. It was alleged that the Facility is in disrepair. LPA Domingo toured the facility and observed no rooms or community areas that was in disrepair. The dinning room, activities room, resident rooms were observed to be clean, no odors, no dirty linens or clothes on the floor. The facility tour showed no disrepair. OS1 was interviewed and there have been no concerns regarding disrepair of the facility. It was alleged that the Facility is not free of insects. LPA Domingo toured the facility and observed no rooms or community areas with insects. The residents’ rooms and accommodations were observed to be clean, free from clutter, and malodor free. The dinning room, activities room, resident rooms were observed to be clean, no odors, no dirty linens or clothes on the floor and no insects. The facility tour showed no insects. OS1 was interviewed and there have been no concerns regarding insects in the facility. It was alleged that the Facility does not provide adequate food service for resident. According to management, they have never experienced a shortage of food as groceries are delivered every week and more often if needed. R1, R2 and R3 stated that they had no concerns with the quantity, availability and quality of food provided at the facility. During interviews, the residents indicated they liked the food and that the food portions were sufficient to meet their needs. OS1 was interviewed and had no concerns regarding the facility food service. Continued on LIC9099C Continued from LIC9099C It was also alleged that Resident's room does not have sufficient lighting. LPA Domingo toured the facility and observed no rooms or community areas that did not have sufficient lighting. The dinning room, activities room, resident rooms were observed to have sufficient lighting. The facility tour showed no disrepair or lights. OS1 was interviewed and there have been no concerns regarding insufficient lighting. The Department has investigated the above-mentioned allegations and has found that based upon interviews, record reviews, and observations, there was insufficient evidence to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, these allegations are deemed to be unsubstantiated. An exit interview was conducted with Med Tech Yahaira Garduno to whom a copy of this report, along with Licensee Rights (LIC 9058 03/22), were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 30, 2023 · control 08-AS-20200813143233