Golden Manor Retirement Center

Allegation investigated: Staff did not maintain a safe environment for residents. Facility is not in good repair. Facility has bedbugs. Facility does not provide meals and snacks for diabetic diet. Facility does not provide adequate food service. Resident is not receiving mail. Resident did not get 60-day notice of rent increase. Facility does not provide activities.

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation for the allegations listed above. LPA met with Administrator, Maria Jacobo, and explained the purpose of the visit. On 7/8/21, LPA Glenn Trueman conducted the initial visit and interviewed the administrator and a resident. On 10/30/23, LPA Chan toured the facility and randomly selected 8 rooms (rooms #4, #11, #23, #26, #36, #44, #51, and #68) to inspect. Interviews were held with the administrator, 5 Staff, and 8 Residents. LPA also reviewed 5 resident files. The investigation revealed the following: 1. Allegation - Staff did not maintain a safe environment for residents. It was alleged that the staff allow people to smoke inside their rooms, allow to sell marijuana, and have registered sex offenders at the facility. LPA interviewed administrator, staff, and residents. Unsubstantiated The administrator stated the residents could smoke outside in the patios or outdoors but not in their rooms. She had not heard of any residents selling marijuana in the facility nor do they hire staff or admit residents who are registered sex offenders. Staff stated they do not allow residents to smoke in their rooms. They have not witnessed any residents selling marijuana or other drugs either. 7 out of the 8 residents interviewed stated the residents do not smoke in their rooms. They go outside to the patio where it is allowed. They have not seen or heard of any residents selling marijuana at the facility. They stated they feel safe residing here. 2. Allegation - Facility is not in good repair. It was alleged that the air conditioner was not working for almost 2 years, the elevators are frequently breaking down, and the ceiling had leaks. Per the administrator and staff, when things are not working properly, the maintenance personnel will try to fix it immediately. She stated the facility is an older building and they are maintaining the physical plant as best as they could. When the elevator is in disrepair, she contacts the outside elevator technician and they come right away to repair it. During the tour today, LPA observed the elevator and air conditioners working properly. The rooms inspected did not have any water leaks from ceiling. 3 out of 8 residents stated the elevator breaks down at time but they will fix it right away. One reported the elevator has been down for 10 months. The rest did not have any issues with things in disrepair. 3. Allegation - Facility has bedbugs. Administrator and staff stated they have not seen or received any reports of bedbugs from residents. LPA obtained the pest control report which was last serviced on 6/6/23. Per administrator, the maintenance staff has been performing the pest inspections and spraying the facility. Staff stated the maintenance person conducts random room checks every week to observe for pests. 7 out of the 8 residents interviewed had not seen any bedbugs in their rooms. During the visit today, LPA inspected 8 rooms and found a dead bed bug with blood stain in room #36. Although a bed bug was discovered, the facility does not have an infestation of pests nor has not been neglectful. The maintenance staff has been inspecting rooms weekly to ensure there are no bugs. 4. Allegation - Facility does not provide meals and snacks for diabetic diet. Administrator and staff stated their meal plans are created and meets the dietary needs of the residents. The foods are cooked with minimal salt and offer sugar-free desserts. LPA also interviewed the dietitian via telephone, who stated a visit is conducted monthly to ensure there is adequate food supplies, cleanliness of the kitchen, and the menu is appropriate for residents’ diets. At the visit today, LPA observed serving of foods that meet the different food groups. They had rice, chicken, soup, vegetables, and jello. 7 out of 8 residents stated the facility serves foods that are appropriate for those who are diabetics or have dietary restrictions. One stated he/she cooks own food and does not eat the food served at the facility. 5. Allegation - Facility does not provide adequate food service. It was alleged the facility rarely serve the foods reflected on the menu. Per administrator, the cook will replace an item in the menu if it is not available that day and stated it does not occur often. The cook stated the menu is generated ahead of time and they will ensure there is sufficient items. Cook will also follow the menu and cook with less salt/sugar. They also have alternatives if residents do not want the main course. 6 out of the 8 residents interviewed stated the facility serve the foods according to the menu. 6. Allegation - Resident is not receiving mail. Administrator stated mails are received usually in the mornings and are distributed to the residents while they are having lunch or are brought to the resident rooms. Staff stated they are sometimes asked to deliver their mails and do not open their mails. LPA interviewed 8 residents, and all stated they receive their mails unopened. 7. Allegation - Resident did not get 60-day notice of rent increase. The administrator stated the rent increases as the Social Security office increases the SSI amount. A notice is provided to the person who pays the rent, which is either the resident or family member. The letter is given ahead of time and when the facility receives notification of increase for SSI recipients only. LPA reviewed 5 resident files and observed they have signed admission agreement acknowledging the increased rates. One resident refused to accept the rent increase and did not sign form. 3 of the 8 residents interviewed stated they will receive notification before the rent increases, while one indicated the facility did not provide notice. The rest of the residents either have not had an increase of rent at the moment or someone else pays their rent. 8. Allegation - Facility does not provide activities. LPA toured the facility and observed an activity calendar. There are board games and books available for residents to use. The ping pong table is available when requested. Administrator and staff stated they provide activities to residents daily. The residents interviewed stated there are some types of activities provided daily, but some do not wish to participate. They also have board games, coloring, and books available. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with administrator Jacobo. A copy of this report along with the appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 30, 2023 · control 28-AS-20210629134833

Allegation investigated: Resident sustained bruising at the facility. Facility is not maintained clean. Residents are not fed nutritious foods at the facility. Residents do not have access to healthcare while at the facility. Facility house-keeping staff is bathing residents at the facility.

Licensing Program Analyst (LPA) Tena Herrera made an unannounced subsequent visit to the facility and met Administrator Maria Jacobo, the purpose for todays visit was explained. The investigation consisted of the following: On 12/23/21 LPA Glenn Truman conducted the initial 10 day visit and interviewed Resident's 1-6 and Staff 1-2, toured dining room, observed dinner meal being served and obtained copies of Resident and Staff Rosters. LPA Tena Herrera conducted a subsequent on 9/21/23, obtained a copy of the Staff/Resident rosters, copies of the 4 rotating food menus, toured the facility with Administrator Maria Jacobo, observed lunch being served for day, interviewed 6 Staff and 8 residents, and obtained copies of staff trained to assist residents with Activities of Daily Living. (continued on 9099-C) Unsubstantiated The investigation revealed the following: Allegation: Resident sustained bruising at the facility. It is alleged that residents at the facility have complained about physical abuse and there are claims of having photos to prove alleged abuse. LPA’s Herrera and Truman conducted a total of 13 interviews combined and 12 out of 13 residents deny the above allegation and state that they have never been abused or bruised by staff. Resident 1 (R1) provided photos of bruising to LPA Herrera although the photos do contain bruising on ankle, hand, and other unknown areas, it could not be determined that the bruising was caused by staff as there were no other witnesses or video footage of incident. Interviews with staff present during alleged abuse incident (Staff 1, 3 and 4) denied causing injury or bruising to R1 and state they were unaware of any bruising and do not know how resident sustained bruises and/or injuries. LPA observed police report provided by R1, however, report does not indicate bruising or supportive evidence that the officers observed the alleged injuries. Allegation: Facility is not maintained clean. It is alleged that the facility is visibly filthy. LPA toured both floors of facility during todays visit including common areas, kitchen and 5 resident rooms. Facility appeared to be clean and sanitary, beds were made, floors in rooms were clean and trash within rooms were empty. LPA observed house keepers cleaning and moping resident rooms during tour. 12 out of 13 residents interviewed denied the above allegation, stated that the facility is cleaned daily, rooms get a deep cleaning weekly, housekeepers make beds and take out residents trash within rooms daily. 6 out of 6 staff interviewed denied the above allegation and stated that the facility is cleaned regularly during each shift and as needed, deep cleaning in residents rooms are scheduled for once weekly, however, housekeeping makes beds and takes out residents trash within their rooms daily. Allegation: Residents are not fed nutritious foods at the facility. It is alleged that the facility provides a poor nourishment to the residents in care. LPA toured kitchen and meal served during lunch hour, the kitchen had proper food supply to meet regulations. Meal was observed to be of proper nutrition and included fruit, vegetable, meat and bread, alternate lunch was also observed. LPA reviewed monthly menu, facility has 4 different month menus that are rotated. (Continued on 9099-C) 11 out of 13 residents interviewed denied the above allegation and state that the food served is of proper nutrition and satisfying. 6 out of 6 staff interviewed stated that the facility follows menu schedule, they offer alternative menu options and meals are of proper nutrition. Allegation: Residents do not have access to healthcare while at the facility. It is alleged that the facility provides residents with a lack of proper access to health care. No additional information was provided. 6 out of 6 Staff interviews revealed that some residents are independent and prefer to handle their own medical needs, however, there is an in house primary physician and psychiatric doctor who visit with residents on a monthly basis, this option is offered upon admission and the facility provides transportation for residents who need to see doctors outside of the facility. 12 out of 13 residents deny the above allegation and state that the facility provides access to in house visits with the facilities primary doctor and/or psychiatric doctor monthly, those who are independent and handle their own medical appointments stated that the facility provides them with the transportation needed to visit with their doctor. Allegation: Facility house-keeping staff is bathing residents at the facility. It is alleged that the facility house-keeping staff is assisting with bathing residents. No additional information was provided. 6 out of 6 interviews with staff revealed that all staff are trained in assisting with residents activities of daily living (ADL’s) which include bathing, incontinence care and grooming. LPA reviewed training logs for staff and observed staff listed as “house-keeping” and "kitchen staff" have received the proper training to assist residents with ADL’s. Of the 8 interviews conducted during todays visit only 1 resident requires assistance with bathing and stated that a caregiver is who assists with their bathing and grooming. Based on statements and interviews conducted with staff/clients, review of training records and LPA observations, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided to Administrator Maria Jacobo.the state’s words, verbatim · CDSS document, Sep 21, 2023 · control 28-AS-20211222080952

Allegation investigated: Resident sustained injuries while in care. Staff allowing residents access to medication room.

The purpose of the visit is to add additional details to the 9099 A and 9099 D. Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The visit is a subsequent visit to investigate the above allegations and deliver findings. The initial visit was conducted on 06/30/2021 and the following was done: The purpose of the visit is to conduct a Health and Safety check. Tour of the facility was conducted at 2:00 PM with LPA and Administrator and included the following: 1st floor rooms 1-32 and 2nd floor rooms 33-80, dining room, kitchen, activity room, library, med room, nurses room and 2 outdoor patios. LPA Trueman conducted interviews with the Administrator and S 1 from 2:25 PM to 2:50 PM. At today's visit 08/17/2023 from 8:45 AM to 9:15 AM Staff S 2- S 4 were interviewed. From 9:15 AM to 10:40 AM Resident's R2- R 11 were interviewed. In regards to Resident sustained injuries while in care, based on interviews conducted and information gathered interviews with 10 out of 10 resident's who all stated they had not witnessed or heard of staff Unsubstantiated harming or injuring resident's in any way. 10 of 10 resident's stated that staff are doing a good job and carry out all their responsibilities and have not witnessed staff treating resident's badly in any way. Staff interviewed stated that S 2- S 4 had gone to R 1's room to discuss the rent raise. Stated that they had handed the letter to R 1 with the rent increase and R 1 was the one to cause injury by slamming the door on S 2's foot. Law Enforcement did arrive at the facility and there were no charges against facility staff. There is no evidence provided to support that facility staff caused the injuries to R 1. 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. In regards to the allegation Staff allowing residents access to medication room, based on interviews conducted and information gathered 10 out of 10 resident's stated that staff does a good job assisting them with their medication. Stated that the med-tech is in the med- room to assist with all their medications and that the resident's do not have access to the med room. All 10 stated staff is always there and if not the door is always locked. Staff interviewed stated that resident's definitely do not have access to the med room and it is always locked or staff are in the med room. 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. Rent was to be increased commencing 01/01/2021. LPA observed facility letters of rent increase dated 11/01/2020, 02/16/2021, and 06/24/2021. Interviews conducted revealed that Staff confirmed that Resident R 1 was the only resident that was informed by 3 staff in person. Based on LPA's observations, and interviews, conducted the preponderance of evidence standard has been met, therefore the above allegation is found Substantiated. California Code of Regulations Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview was conducted with Maria Jacobo Administrator and a copy of this report, LIC 9099D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 12, 2023 · control 28-AS-20210629154733

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 24, 2023

Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by; Based on interviews conducted licensee failed to ensure that resident's be accorded dignity in their personal relationships with staff, with 3 staff harassing R1 by going to their room about the rent which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 12, 2023

Plan of correction: Facility to review regulation regarding Personal Rights of Residents in All Facilities and conduct a staff training regarding personal rights and submit a signed log of those who attended by POC due date.

Allegation investigated: Facility did not follow mask use guidelines. Facility staff did not have adequate PPE. Facility is not cleaning and disinfecting as needed to prevent spread of infection.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent visit to investigate the above allegations. Upon arriving at the facility, LPA met with Assistant Administrator - Carmen Virrueta and Administrator Maria Jacobo who later assisted with the visit, the purpose of today’s visit was explained. The investigation consisted of the following: On 12/16/2021 LPA Glenn Trueman conducted the initial visit and interviewd 3 Staff, due to insufficient information available at the time further investigation was needed. During todays visit LPA Herrera obtained the following documents: Resident/Staff Roster, Infection Control Plan, Covid-19 Mitigation Plan Report, and training logs for ongoing Covid training. Observed sinage thoughout the facility for disinfection, cough ettiquette, and hand washing procedures, along with a storage room filled with PPE supplies that included: masks, disposible gowns, face shields, gloves, hand sanitizer, and antigen Covid tests. Interviewed 8 Residents and 5 Staff (all of which were living/employed at facility during pandemic). (Continued on 9099-C) Unsubstantiated The investigation revealed the following: Allegation: Facility did not follow mask use guidelines. It is alleged that at the time the order was given to wear masks at all times residents were not prompted to do so, only time they were was when taking a Covid test. Review of training logs showed ongoing training of Covid guidelines for mask use. During interviews with Staff 5 out of 5 Staff stated that during the Covid period staff tried their best efforts to mandate the masking requirements, although sometimes residents would not wear their masks and give some push back, Staff would continuously remind them to put on their mask and wear them properly at all times, after the reminders the residents would cooperate. During interviews with residents 8 out of 8 residents denied the above allegation and stated that they were constantly encouraged and reminded to wear masks and if a resident wasn't wearing a mask staff would ask them to put one on or provide them with a mask and have them put it on. Allegation: Facility staff did not have adequate PPE. It is alleged that PPE supplies was not readily available until after a quarantine was issued. LPA observed the PPE supply during todays visit, there was a storage room that had cabinets filled with masks, gowns, shield, gloves, Lysol and hand sanitizer. LPA interviewed Staff and 5 out of 5 Staff all stated that the facility has maintained sufficient PPE supplies since the start of the pandemic and that supplies were provided regularly by the city, licensing and purchased by facility as well. Staff also stated that there were PPE supply stations throughout the facility so that it was readily available when needed, and would be refilled when running low. During interviews with Residents 8 out of 8 residents interviewed denied the above allegation. Residents interviewed stated that they never had issues with getting any masks or sanitizer during that time or now, they also stated that masks were always readily available and if they didn't have a mask or other PPE supplies they could ask for some at the front desk and supplies were provided right away. Allegation: Facility is not cleaning and disinfecting as needed to prevent spread of infection. It is alleged that there is insufficient deep cleaning and disinfection done at the facility. LPA interviewed 5 Staff and 5 out of 5 Staff stated that the cleaning was increased once the pandemic hit, disinfection and cleaning was done hourly and even in-between as needed, and staff are still practicing the disinfection procedures. Review of training logs showed ongoing training of Covid guidelines for disinfection and (Continued on 9099-C) cleaning. LPA interviewed 8 Residents and 8 out of 8 denied the above allegation and stated that they noticed Staffs increase of cleaning and disinfecting. Residents interviewed stated they feel that staff was cleaning all the time and all throughout the day. Based on statements and interviews conducted with staff and residents, and review of training and Infection Control Plan, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided to Administrator Maria Jacobo.the state’s words, verbatim · CDSS document, Sep 7, 2023 · control 28-AS-20211208141338

Allegation investigated: Staff did not ensure the activities calendar was posted Staff are not providing activities to residents in care Staff did not ensure the menu was up to date and posted

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegations. At today's visit the following was done: On 08/31/2023 Resident and Staff Roster submitted. Interviews were conducted with Administrator and Resident's R1-R 6 from 1:10 PM to 2:20 PM. In regards to the allegation Staff did not ensure the activities calendar was posted, based on interviews conducted and information gathered 6 of 6 residents stated that the activities calendar has not been posted. Interview with Administrator who confirmed that activities calendar was not posted when Ombudsman had visited the facility on 3 different occasion's. At today's visit LPA did not observe the Activity calendar posted. Based on LPAs observations and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Substantiated Title 22, Division 6 and Chapter 8 is being cited on the attached LIC 9099D. In regards to the allegation Staff are not providing activities to residents in care, based on interviews conducted and information gathered 6 of 6 resident's stated that there are no group activities done by a facility staff member on a daily basis. All 6 stated that they do no activities other than only Bingo on Tuesday's. Said they just watch television and hang out all day. Interview with Administrator who stated that they do Bingo and there is not 1 full time staff member responsible for doing activities with the resident's. Based on LPAs observations and interviews which were conducted 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 and Chapter 8 is being cited on the attached LIC 9099D. In regards to the allegation Staff did not ensure the menu was up to date and posted, based on interviews conducted and information gathered, at today's visit LPA saw the menu was posted, but it was dated 08/20 to 08/26 which was for the previous week. Interviews with 2 of 6 resident's who stated that the menu posted is not accurate. Interview with Administrator who confirmed that at Ombudsman's visit the menu was outdated and then staff brought current one. Based on LPAs observations and interviews which were conducted 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 and Chapter 8 is being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, Aug 31, 2023 · control 28-AS-20230823145835

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(d) · Plan of correction due date: Sep 1, 2023

Planned Activities In facilities licensed for seven (7) or more persons, notices of planned activities shall be posted in a central location readily accessible to residents, relatives, and representatives of placement and referral agencies. Copies shall be retained for at least six (6) months. This requirement is not met as evidenced by: Licensee failed to post activities calendar as confirmed by 6 of 6 resident's, observation by LPA and confirmation by administrator which poses an Immediate Health and Safety Concern to resident's in care.the state’s words, verbatim · CDSS document, Aug 31, 2023

Plan of correction: Facility to post Activity's calendar and submit by POC due date proof that it is posted.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(f) · Plan of correction due date: Sep 5, 2023

Planned Activities In facilities licensed for fifty (50) persons or more, one staff member shall have full-time responsibility to organize, conduct and evaluate planned activities, and shall be given such staff assistance as necessary in order for all residents to participate in accordance with their interests and abilities. The program of activities shall be written, planned in advance, kept up-to-date, and made available to all residents. The responsible employee shall have had at least one year of experience in conducting group activities and be knowledgeable in evaluating resident needs, supervising other employees, and in training volunteers. This requirement is not as evidenced by: Licensee failed to have one staff member having full time responsibility to organize, conduct and evaluate planned activities with 6 of 6 resident's stating there are not group activities being done which poses an Immediate Health and Safety Concern to resident's in care.the state’s words, verbatim · CDSS document, Aug 31, 2023

Plan of correction: Facility to submit to Licensing by POC due date staff member to have full time responsibility of activities and submit verification of 1 year experience in conducting group activities and be knowledgeable in evaluating resident needs, supervising other employees, and in training volunteers.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(6) · Plan of correction due date: Sep 5, 2023

General food Service Requirements The following food service requirements shall apply: In facilities for sixteen (16) persons or more, menus shall be written at least one week in advance and copies of the menus as served shall be dated and kept on file for at least 30 days. This requirement is not met as evidenced by: Facility at today's visit had menu posted dated 08/20 to 08/26 which is not the current week which poses an Immediate Health and Safety Concern to resident's in care.the state’s words, verbatim · CDSS document, Aug 31, 2023

Plan of correction: Administrator to self-certify that all menus posted will be current and submit by POC due date.

Allegation investigated: Resident sustained injuries while in care. Staff allowing residents access to medication room.

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The visit is a subsequent visit to investigate the above allegations and deliver findings. The initial visit was conducted on 06/30/2021 and the following was done: The purpose of the visit is to conduct a Health and Safety check. Tour of the facility was conducted at 2:00 PM with LPA and Administrator and included the following: 1st floor rooms 1-32 and 2nd floor rooms 33-80, dining room, kitchen, activity room, library, med room, nurses room and 2 outdoor patios. LPA Trueman conducted interviews with the Administrator and S 1 from 2:25 PM to 2:50 PM. At today's visit 08/17/2023 from 8:45 AM to 9:15 AM Staff S 2- S 4 were interviewed. From 9:15 AM to 10:40 AM Resident's R2- R 11 were interviewed. In regards to Resident sustained injuries while in care, based on interviews conducted and information gathered interviews with 10 out of 10 resident's who all stated they had not witnessed or heard of staff Unsubstantiated harming or injuring resident's in any way. 10 of 10 resident's stated that staff are doing a good job and carry out all their responsibilities and have not witnessed staff treating resident's badly in any way. Staff interviewed stated that S 2- S 4 had gone to R 1's room to discuss the rent raise. Stated that they had handed the letter to R 1 with the rent increase and R 1 was the one to cause injury by slamming the door on S 2's foot. Law Enforcement did arrive at the facility and there were no charges against facility staff. There is no evidence provided to support that facility staff caused the injuries to R 1. 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. In regards to the allegation Staff allowing residents access to medication room, based on interviews conducted and information gathered 10 out of 10 resident's stated that staff does a good job assisting them with their medication. Stated that the med-tech is in the med- room to assist with all their medications and that the resident's do not have access to the med room. All 10 stated staff is always there and if not the door is always locked. Staff interviewed stated that resident's definitely do not have access to the med room and it is always locked or staff are in the med room. 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.the state’s words, verbatim · CDSS document, Aug 17, 2023 · control 28-AS-20210629154733

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 24, 2023

Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by; Based on interviews conducted licensee failed to ensure that resident's be accorded dignity in their personal relationships with staff, with 3 staff harassing R1 by going to their room about the rent which caused an immediate health and safety concern to resident's in care.the state’s words, verbatim · CDSS document, Aug 17, 2023

Plan of correction: Facility to review regulation regarding Personal Rights of Residents in All Facilities and conduct a staff training regarding personal rights and submit a signed log of those who attended by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Staff Carmen Virrueta and explained the reason for the visit. The purpose of the visit is to complete the required inspection. Shortly thereafter Administrator Maria Jacobo arrived. LPA Trueman toured the facility along with Staff Carmen Virrueta today 06/29/2023 at 11:15 AM and the following was observed: Facility contains 80 Bedrooms and 80 Bathrooms for residents, dining room, 2 TV rooms , and outdoor patio area.. LPA inspected 10 Rooms which included on the 1st Floor # 3, 20, 25, 26 and 31 and on the 2nd Floor # 36, 55, 61, 73 and 78. Hot water temperature measured between 105 F. and 120 F. meeting Title 22 Regulations. Room 3 (108.1), Room 20 (111.7), Room 25 (113.5), Room 26 (114.6) and Room 31 (115.5). Room 36 (116.2), Room 55 (114.4), Room 61 (114.4), Room 73 (116) and Room 78 (117.1). Required Annual inspection included Infection Control Practices, Operational Requirements, Physical Plant/ Environmental Safety, Staffing, Personnel Records/ Staff Training, Resident Records/ Incident Reports, Resident Rights/ Information, Planned Activities, Food Service, Incidental Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. LPA observed sufficient supply of 2 day perishables and 7 day non perishables. All staff were cleared and associated. Visitation signage was posted along with signage for hand washing and proper sanitizing. Staff responsible for providing care and supervision received training in First Aid. Licensee maintained an individual admission agreement for each client. Fire Clearance has been maintained. Each client has personal rights free from corporal or unusual punishment, infliction of pain, humiliation, ridicule, coercion, threats, mental abuse, or other actions of a punitive nature. Program site was clean, safe, sanitary, and in good repair at all times for the safety and well being of clients, employees and visitors. Medication was reviewed for 7 Resident's. 7 Resident Files and 7 Staff Files were reviewed. Interviews were conducted with 5 Resident's and 3 Staff. No deficiencies. Exit interview conducted.the state’s words, verbatim · CDSS document, Jun 29, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The purpose of the visit is to complete the required inspection. LPA Trueman toured the facility along with Administrator Maria Jacobo today 01/25/2023 at 1:30 PM and the following was observed: Facility contains 80 Bedrooms and 80 Bathrooms for residents, dining room, 2 TV rooms , and activity room. Required Annual inspection included Infection Control Domain and check of the food supply, medications and criminal clearance check. LPA observed sufficient supply of 2 day perishables and 7 day non perishables. All staff were cleared and associated. Visitation signage was posted along with signage for hand washing and proper sanitizing. Temperature checks are conducted 2x a day and logged. Staff have been trained in hand washing. Staff are sufficient with no shortages and there is a plan to replace workers if ill. There are rooms available if isolation is needed. Staff wear masks, gloves and face shields. Bathrooms have proper signage for hand washing. There are multiple stations for hand sanitizing. Social distancing is implemented. Meal times are sanitized after each meal. Facility has sufficient supply of PPE. Facility has a specific plan to ensure proper cleaning and disinfection of environmental surfaces and laundry; commonly touched surfaces are cleaned and disinfected at least once every shift . Plan when to notify medical provider if symptoms develop or COVID-19 exposure or when to call 911 for severe respiratory distress. No deficiencies. Exit interview conducted with Administrator.the state’s words, verbatim · CDSS document, Jan 25, 2023

Allegation investigated: Staff are forcing resident to take medicine. Staff are withholding resident's money.

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegations. At today's visit the following was done: On 12/23/2022 from 9:45 AM to 11:15 AM Administrator, Staff S1 and Resident's 1-8 were interviewed. Resident and Staff Roster submitted. File was reviewed for Resident R 9 and Medication Sheet and Physician's Report submitted for Resident R 9. In regards to the allegation Staff are forcing resident to take medicine, based on interviews conducted and information gathered it was revealed that 8 of 8 residents that were interviewed all have been administered their medication correctly without error and have never been forced to take medication. Stated staff have done a good job and get it correct all the time. Residents interviewed range from 5 to 14 years residing at the facility. Unsubstantiated Staff interviewed stated that medication has always been given correctly and they have never forced any resident to take medication. Documentation from the Medication List for R 9 shows from 12/1-12/22 that R 9 has refused medication. 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. In regards to the allegation Staff are withholding resident's money, based on interviews conducted and information gathered it was revealed that 8 of 8 residents that were interviewed all stated that on the 1st of the month they have received $154 and the facility has always given that amount without missing and without error. Residents interviewed range from 5 to 14 years residing at the facility. Staff interviewed stated that $154 is always given the 1st of the month and there have been no errors. Stated that R 9 has always received the $154. Administrator provided copies of R9's monthly checks from County of Los Angeles Public Administrator in the amount of $1231.77 and $154. Client/Resident Cash Sheet was observed with signatures of residents receiving the monthly $154. 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.the state’s words, verbatim · CDSS document, Dec 23, 2022 · control 28-AS-20221219122950

Allegation investigated: Staff sedated resident with meds causing resident to pass out Staff not making sure resident is given enough water

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Assistant Administrator Carmen Virrueta and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegations. At today's visit 08/05/22 at 9:30 AM S1 was interviewed. Staff S1 stated Resident R1 was not a resident at this facility and resides at another licensed facility. LPA spoke with S2 staff at another licensed facility who confirmed that R1 is a resident at that facility. Resident Roster was submitted at today's visit and it does not list R1 as a resident. Based on interviews conducted and review of rosters it was determined that R 1 does not reside at this facility. Based on the information gathered during this visit, the allegations are deemed UNFOUNDED. A finding of UNFOUNDED means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. Unfoundedthe state’s words, verbatim · CDSS document, Aug 5, 2022 · control 28-AS-20220728164752

Allegation investigated: Staff does not safeguard resident's personal items

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegation. At today's visit the following was done: Interviews were conducted with Resident's R1-R 7 from 9:15 AM to 10:15 AM. Interviews were conducted with Administrator and Staff S1 from 8:45 AM to 9:15 AM. Tour of Resident 1's Room # 35 was conducted with LPA and Administrator. In regards to the allegation Staff does not safeguard resident's personal items, based on interviews conducted and information gathered Resident R 2 stated that a brand new pair of pants that were left in her room were missing. Stated she had told the Administrator about it. Interview was conducted with the Administrator who confirmed that the resident had told her about the item missing and that the facility will replace the item. R 2 also stated that about a year ago she had been at the hospital and when she returned to the facility Substantiated her fur coat, a jacket and purses were missing. It should be noted that on tour of R1's room container to make coffee was inside the room and wasn't missing. There was no flashlight observed in the room. Based on LPAs observations and interviews which were conducted 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 and Chapter 8 is being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, Jun 23, 2022 · control 28-AS-20220616113336

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87218(a)(2) · Plan of correction due date: Jun 27, 2022

Theft and Loss (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to meet each requirement specified in Section 1569.153. This requirement has not been met as evidenced by: Resident #2's new pants were missing from her room which was confirmed by the Administrator in which it was not included in the residents personal property, or valuables which causes an Immediate Health safety Risk to residents in care.the state’s words, verbatim · CDSS document, Jun 23, 2022

Plan of correction: The licensee will ensure to help monitor and safeguard all of the residents property and valuables while in care. The licensee/Administrator will replace residents #2's item that is missing and submit receipt by POC due date..

Allegation investigated: Resident is threatening other residents.

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA met with Maria Jacobo Administrator and explained the reason for the visit. The investigation consisted of the following: On 11/17/21 LPA Flores interviewed administrator, resident #1(R1),#2(R2),#3(R3),#4(R4), requested staff/resident roster, incident reports for the last month, face sheets, physician's reports, medication sheets, and needs/care appraisal. On 6/6/22 LPA Flores requested a copy of current resident/staff roster, interviewed staff #2(S2),#3(S3),#4(S4),#5(S5), Resident #5(R5),#6(R6), #7(R7),#8(R8), and requested copies of R5,R6,R7,R8 identification and emergency sheet, physician's report, medication sheets, needs/care appraisal, and incident report dated 12/21/21. (CONTINUED ON LIC9099C) Substantiated The investigation revealed the following: Regarding allegation: Resident is threatening other residents. It is alleged R1 tried to throw a bottle at R2 and that R1 was going to harm R2. Interviews with residents revealed 5 out of 8 residents interviewed stated to have observed residents get into verbal arguments and residents use threats toward other residents during those verbal arguments and staff have not intervene on such instances. 2 out of 8 residents have not observed residents involved in verbal arguments or residents threatening other residents. 1 out of 8 residents refused to be interview. Interviews with staff revealed 4 out of 5 staff interviewed have observed residents involved in verbal arguments but no threats have been heard. 1 out of 5 stated to have not observed residents get into any arguments. 5 out of 5 staff stated to intervene and/or notify the office staff when residents are observed engaging in arguments. Administrator stated steps are taken when such behaviors are not resolved after speaking with the residents. Documents reviewed revealed 8 out of 8 residents are ambulatory. 5 out of 8 residents required assistance with handling medication and 3 out of 8 residents handle their own medication. Medication sheets for the 5 residents receiving assistance show resident were taking their medications daily. Incident reports revealed, R1 went out to hospital on 11/17/21 and choose not to return to the facility and R2 went out to the hospital on 12/21/21 and R2's family decided that upon discharge R2 will move to a facility closer to family. Based on LPA's observations, and interviews, conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found Substantiated. California Code of Regulations Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview was conducted with Maria Jacobo Administrator and a copy of this report, LIC 9099D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 6, 2022 · control 28-AS-20211110122839

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jun 13, 2022

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidence by: Based on interviews conducted licensee did not ensure residents are not threating at facility as 5 out of 8 residents have observed residents threating other residents which poses an immediate health, safety, or personal rights risk of persons in care.the state’s words, verbatim · CDSS document, Jun 6, 2022

Plan of correction: Administrator will provide in-service training to staff and residents on section 87468.1 and submit a copy of the agenda and sign in log to the department by 6/13/22.

Allegation investigated: Staff is financially abusing resident while in care. Staff left resident soiled for an extended period of time. Staff did not safeguard resident's personal items.

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The purpose of the visit is to deliver the findings from the original complaint dated 3/8/22. At initial visit the following was done: Resident #1's file was reviewed at 1:15 PM. On 3/17/2022 from 2:00 to 3:00 PM Resident's # 1-6 and Staff Maria Jacobo, Robert Blanco and Fernando Castillo were interviewed. Physician for Resident #1 was interviewed at 1:40 PM. In regards to the allegation Staff is financially abusing resident while in care, based on review of financial records the facility did deposit into an account for Resident 1 the amount of $1200 on 6/3/2020 and $1400 on 4/7/21 which were the amounts for the different stimulus payments. From 6/15/21 to 12/3/21 withdrawals for Resident #1 were made totaling $1887. Administrator had stated that payments had been made to Resident #1 a year ago and were kept by home Unsubstantiated office and the resident will make weekly withdrawals. 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. In regards to the allegation Staff left resident soiled for an extended period of time, based on interviews conducted and information gathered Physician's Report dated 1/5/22 stated that Resident 1 can care for his own toileting needs and is able to leave the facility unassisted. Interview conducted with Medical Doctor for Resident 1 stated that he considers him independent and has never seen him incontinent. Stated he is on Oxybutin to control the bladder. Review of the Medication Log shows that Oxybutin 5mg. had been administered for morning and evening dose and there were no doses missed. 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. In regards to the allegation Staff did not safeguard resident's personal items, based on interviews conducted and information gathered staff interviewed stated that any clothes brought into the facility for residents are put on an inventory list. Admission Agreement states that facility will only inventory and provide the resident or responsible party with a copy of the resident's personal properties/valuables as inventoried items if said items are entrusted to the facility and are stored in a secured area. Based on interviews conducted clothes that were reported missing had not been entrusted with the facility and inventoried. 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.the state’s words, verbatim · CDSS document, Mar 29, 2022 · control 28-AS-20220308100453

Allegation investigated: Residents smoke inside of facility

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The purpose of the visit is to deliver the findings from the original complaint dated 2/18/22 At initial visit the following was done: On 2/24/2022 from 12:45 PM to 2:15 PM Resident's 1-9 and Staff Maria Jacobo were interviewed. In regards to the allegation Residents smoke inside of facility, based on interviews conducted and information gathered it was revealed that there are residents smoking pot on the outside courtyard. Four of the residents stated they have witnessed residents smoking pot and also have smelled it on courtyard. One resident confirmed that he does smoke pot on the facility courtyard. Based on LPAs observations and interviews which were conducted 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 and Chapter 8 is being cited on the attached LIC 9099D. Substantiatedthe state’s words, verbatim · CDSS document, Mar 17, 2022 · control 28-AS-20220218111751

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Mar 21, 2022

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by; During the visit conducted on 2/24/212, LPA Trueman toured the courtyard of the facility facility and based on statements obtained, LPA learned that residents have been observed smoking marijuana in the courtyard area. This poses an immediate Health and safety Risk to residents iin care.the state’s words, verbatim · CDSS document, Mar 17, 2022

Plan of correction: Administrator will review Title 22 Regulations Section 87468.1 on Personal Rights of Residents in All Facilities and develop a written Plan of Correction (POC) to ensure compliance. Written POC must be submitted to CCL by the POC due date.

Allegation investigated: When resident was diagnosed with COVID, the facility staff refused to care for him. Staff are complaining to the resident about family concerns. Staff are taking things out of the residents room.

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The purpose of the visit is to deliver findings from the original complaint dated 1/27/22. Initial visit was conducted 2/3/22 and from 10:35 AM to 12:05 PM Staff 1-3 and Resident's 1-5 were interviewed In regards to the allegation When resident was diagnosed with COVID, the facility staff refused to care for him, based on interviews and information gathered resident's interviewed stated that if residents had Covid they were brought to a convalescent hospital so they can isolate for 14 days. Stated that staff are good handling the care of Covid resident's. Staff interviewed stated Resident 1 was weak so he was taken to hospital and residents will have a choice where to quarantine. Stated staff are sufficient to provide care and supervision for Covid resident's. 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. Unsubstantiated In regards to the allegation Staff are complaining to the resident about family concerns, based on interviews and information gathered resident's stated there has not been any situations where staff told them that their family or visitors are bothering them about their concerns. Staff interviewed stated that they have not complained to any residents about their family or visitors concerns. 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. In regards to the allegation Staff are taking things out of the residents room, based on interviews conducted and information gathered residents stated that there has not been anything taken from their rooms. They have not seen or heard of staff doing this. Staff interviewed stated that Resident 1 had moved out of his room and there was trash still there and a radio was left behind. Staff stated they did not know that it belonged to Resident 1, but once made aware returned it. He had thought it was Resident 1's roommate who had passed away. 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.the state’s words, verbatim · CDSS document, Mar 9, 2022 · control 28-AS-20220127161150

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 16, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. Based on observation, interviews, and record review, the elevator is currently not working which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 9, 2022

Plan of correction: Licensee will ensure the elevator is in good repair/operable and submit proof of invoice showing the repairs made. The POC must be submitted to CCL by the due date of 03/16/22.

Allegation investigated: Resident's sliding door is in disrepair

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The purpose of the visit is to conduct a 10 day complaint visit in regards to the above allegation. At today's visit the following was done: On 12/16/2021 at 12:15 P.M. Administrator Maria Jacobo was interviewed. At 12:30 P.M. Maintenance Staff Fernando Castillo was interviewed. At 12:40 P.M. to 1:15 P.M. Resident 1 - Resident 3 was interviewed. At 1:15 P.M. LPA Trueman along with Maintenance Staff Fernando Castillo toured Rooms 1, 2, 3 and 12. In regards to the allegation Resident's sliding door is in disrepair, during tour LPA observed in Room 1 that the sliding door would not open and the door was not able to move at all through the track on the floor. There also was an open space where air from the outside could come into the room when the door was closed. In Room 3 the sliding door did not move smoothly though the track on the floor. Interview was conducted with Client 1 who said the door was hard to close. Substantiated Maintenance Staff interviewed said that dirt and rain can go into track and make it hard to close the door. Stated that in Room 1 the door has not been used, but it is not sliding open. Based on LPAs observations and interviews which were conducted 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 and Chapter 8 is being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, Dec 16, 2021 · control 28-AS-20211206122909

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 20, 2021

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 facility failed to have the facility in good repair at all times with Room 1 having a sliding door that was inoperable and didn't slide open which caused an Immediate Health and Safety Risk to residents in care,the state’s words, verbatim · CDSS document, Dec 16, 2021

Plan of correction: Facility to submit proof by POC due date that sliding door in Rooms 1 and 3 are fully operable and in good repair.

Allegation investigated: Resident is being illegally evicted from the facility.

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Staff Carmen Virrueta and explained the reason for the visit. The purpose of the visit is a subsequent visit and to deliver findings in regards to the above allegation. The initial visit was conducted on 10/12/2021 and the following was done: At 9:45 A.M. Staff Robert Blanco was interviewed. At 10:00 A.M. Resident 1 was interviewed. At 10:30 A.M. Administrator Maria Jacobo was interviewed. At 10:50 A.M. Maintenance Staff Fernando Castillo was interviewed. At today's visit 11/23/2021 Resident 2 was interviewed at 1:45 P.M. In regards to the allegation Resident is being illegally evicted from the facility, based on interviews conducted with staff and residents and documents reviewed from the file of Resident 1 it was revealed by Resident 1 that her family member did come into the facility office and grab a key and throw it at the Administrator. Special Incident Report (SIR) dated 8/17/2021 was submitted by the facility stating that family member of Resident 1 threw office keys at the Administrator and 911 was called. Police were called . Unsubstantiated Staff interviewed stated that family member of Resident 1 had cursed out another resident recently and wanted to fight that resident. Resident 2 stated that family member of Resident 1 had cursed at him and spit on him. Staff said family member would fight with Resident 1 and curse at her. LPA witnessed a video of family member pushing Resident 1 in front of the facility. Admission Agreement dated 06/27/2019 under Eviction procedures states that upon 30 day written notice in writing can evict for failure of resident to comply with general policies of the facility. Said general policies must be in writing. In Admissions Agreement under House Rules it states that no resident may have family/visitors that are abusive to other residents/staff nor upset the general facility population. Title 22 Regulations 87224(a) states the following: The licensee may evict a resident for one or more of the reasons listed in section 87224 (a)(1) thru (5). Notated in (3)- Failure of the resident to comply with general policies of the facility. Said general policies must be in writing, must be for the purpose of making it possible for residents to live together and must be made part of the admission agreement. 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 copy to be provided via e-mail.the state’s words, verbatim · CDSS document, Nov 23, 2021 · control 28-AS-20211008094807

Allegation investigated: Facility has bed bugs

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Maria Jacobo and explained the reason for the visit. The purpose of the visit is to deliver findings from the original complaint dated 8/18/2021. The initial visit was conducted on 8/19/2021 and the following was done: LPA Trueman conducted interviews with the Licensee ,Administrator, Staff S 1-3 and Resident's R 1-8 from 12:45 PM to 2:00 PM. LPA along with Maintenance Staff toured the facility and inspected Rooms 14, 22, 25, 28, 30, 31,34 A, 37, 46, and 74. In regards to the allegation facility has bed bugs, based on interviews conducted and information gathered all clients interviewed stated that there have been no bed bugs that they have seen in their room or in the facility. Staff interviewed stated that there has been no bed bugs. Maintenance staff stated they have turned over mattresses and washed bedspreads and have not seen any bed bugs. Facility submitted Pest Control Documentation from visits to the facility 7/23,7/30, 08/06 and 08/13. Unsubstantiated LPA along with Maintenance Staff toured the facility on 8/19/2021 and inspected Rooms 14, 22, 25, 28, 30, 31,34 A, 37, 46, and 74.. Upon inspection there were no bed bugs observed in the rooms toured. 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 copy to be provided via e-mail.the state’s words, verbatim · CDSS document, Aug 25, 2021 · control 28-AS-20210818111726