Hawthorne Terrace Care Home

Allegation investigated: Staff do not prevent resident from not treating residents with dignity and respect.

On 04/30/2026, Licensing Program Analyst (LPA) Socorro Leandro initiated a complaint investigation regarding the allegation listed above. LPA met with the Administrator, Zuo Fen Hauf, and the purpose of the visit was explained. The LPA was allowed entry to the facility. The investigation consisted of the following: A tour of the facility was conducted, interviews were conducted, and records were gathered. Interviews consisted of Resident 1 (R1) to Resident 9 (R9) and Staff 1 (S1) to Staff 4 (S4). Facility records gathered consisted of Register of Facility Residents dated 01/19/2025; Personnel Report dated 04/10/2026; and staff trainings. R1’s records were gathered which consisted of the California Assisted Living Waiver (ALW) Program Individual Service Plan (ISP) dated 11/18/2022; Physician’s Report dated 01/06/2023; Preplacement Appraisal Information dated 03/31/2023; and Medical Documents dated 03/11/2026 to 04/22/2026. Substantiated The investigation revealed the following: Allegation: “Staff do not prevent resident from not treating residents with dignity and respect.” Interviews conducted with R1 to R9 revealed the following: 5 out of 9 residents agree with the allegation; 3 out of 9 residents denied the allegation; 1 out of 9 residents indicated that they have heard a resident use profanity but were unsure if staff intervened (because they were in their room and could not see the incidents). Interviews conducted with S1 to S4 revealed the following: 3 out of 4 staff indicated that they ignore R1 when they are verbally aggressive toward other residents; 2 out of 3 staff indicated that they do attempt to de-escalate R1 when they are verbally aggressive toward other residents by talking to R1 in a calm voice and telling other residents to go to their rooms; 1 out of 4 staff indicated that they have not witnessed residents being verbally aggressive toward other residents. The Administrator indicated that they have not trained staff on R1’s care plan for de-escalation. R1’s California Assisted Living Waiver (ALW) Program Individual Service Plan (ISP) dated 11/18/2022 revealed the following: “Socialization: Participant at risk for episodes of verbal aggression towards other residents and staff…Interventions/Plan: RCFE staff to use thoughtful and careful redirecting as needed to diffuse aggressive/inappropriate social behavior.” R1’s Medical Documents dated 03/11/2026 revealed the following: “Chief complaint:..Concerns: responds to internal stimuli (talks to self), verbal aggression/profanity toward self/staff/residents…” R1’s Medical Documents dated 04/22/2026 revealed the following: it indicated that R1’s “baseline” remains the same. Observations on 04/30/2026 revealed the following: R1 used profanity in a very loud voice; according to S1 and S4 R1 was in their room talking to themselves. Staff trainings revealed the following: staff have been trained on resident rights and behavioral expression management. Based on observations, interviews and record reviews, 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 are being cited on the attached LIC 9099D. An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator, Zuo Fen Hauf.the state’s words, verbatim · CDSS document, Apr 30, 2026 · control 11-AS-20260428112843

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: May 14, 2026

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 evidenced by: Based on observations, interviews, and records reviewed the licensee did not comply with the section cited above not by residents not being treated with dignity by other residents in the facility.the state’s words, verbatim · CDSS document, Apr 30, 2026

Plan of correction: The Administrator has agreed to train staff on resident personal rights, R1’s care plan and create de-escalation methods for R1. The Administrator will email staff trainings to Socorro.Leandro@dss.ca.gov.

Type of visit: Case Management - Deficiencies

On 04/30/2026, Licensing Program Analyst (LPA) Socorro Leandro observed deficiencies relating to complaint investigation control number: 11-AS-20260428112843. Deficiencies Observed: Resident 1's (R1) outdated Appraisal & Needs Services Plan. R1's Preplacement Appraisal Information is dated 03/31/2023. The Administrator indicated that they have not updated R1's Appraisal & Needs Services Plan. R1 has an outdated annual routine medical assessment. R1's Physician’s Report is dated 01/06/2023. Deficiencies are being cited based on records reviewed in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator, Zuo Fen Hauf.the state’s words, verbatim · CDSS document, Apr 30, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: May 30, 2026

Reappraisals (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Based on records reviewed the licensee did not comply with the section cited above not by not having an updated Reappraisals for R1.the state’s words, verbatim · CDSS document, Apr 30, 2026

Plan of correction: The Administrator has agreed to update R1’s reappraisal and email it to Socorro.Leandro@dss.ca.gov.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(h)(1-3) · Plan of correction due date: May 30, 2026

Reappraisals (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. (1) Documentation of the annual routine visit, such as a visit summary, shall be added to the resident's record. (2) Documentation of a resident's refusal to receive an annual routine visit, or if applicable, their representative's refusal on their behalf, shall be added to the resident's record. (3) If a resident refuses to receive an annual routine visit, or if applicable, their representative refuses an annual routine visit on their behalf, but later agrees to one, documentation of the annual routine visit shall be added to the resident’s record. This requirement is not met as evidenced by: Based on records reviewed the licensee did not comply with the section cited above not by not having an updated annual medical assessment for R1.the state’s words, verbatim · CDSS document, Apr 30, 2026

Plan of correction: The Administrator has agreed to assist R1 in scheduling a physical exam and have the physician complete the physicians report. The Administrator will email R1’s physicians report to Socorro.Leandro@dss.ca.gov.

Type of visit: Required - 1 Year

On 11/24/2025, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD), Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator, Zuo Fen Hauf. The purpose of the visit was explained, and the LPA was allowed entry to the facility. This facility is licensed to serve 14 adults ages 60 and above, of which 6 maybe non-ambulatory, and 6 maybe on hospice. A total of 10 residents were currently residing in this facility. The Annual Licensing Fees are current. Facility Layout: The facility is a one-story house located on a main street. The home consists of 7 resident bedrooms, 1 staff bedroom, 3 full bathrooms, 1 toilet room, 1 main entrance/living room, 1 kitchen, 1 dining/living room, 1 laundry room, 1 attached garage, 1 backyard area with shaded seating. Outside Grounds: were toured no bodies of water were observed, walkways around the home were clear of hazards, and there were no security bars or weapons on the premises. Kitchen Area/Facility Food: The facility has supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept inaccessible to residents in care. There is a fire extinguisher near the kitchen area, and it was last serviced on 07/23/2025. Living Room/Community Indoor Space: There is a landline telephone in the main entrance room / living room. There are games/activity work (i.e. board games, books, magazines, and puzzles) in both living rooms. Resident Bedrooms: 7 out of 7 resident bedrooms were toured. There is adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Bathrooms: Toilets, showers, and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries were accessible to residents. The hot water temperature measured 112.8 Fahrenheit. Medications: were inaccessible to residents in care. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. 9 out of 10 Medication Administration Records (MARs) were reviewed, 1 out of 9 MARs did not document prescription or nonprescription PRN medication as required by the California Code of Regulations. Garage: is used as a storage room. The garage has extra food supplies. Miscellaneous: Documents are posted as mandated. Last disaster/fire drill was conducted on 11/15/2025. The fire alarm panel was replaced on 11/17/2025. The facility has a monthly service of central station monitoring for fire alarm system. The facility has a current liability insurance. First aid kit is fully stocked with manual. There were no activity posting. 5 staff records were reviewed, 3 out of 5 staff records had required documentation, 2 out of 5 staff records had expired first aid certificates. 5 resident records were reviewed, 5 out of 5 resident records had required documentation. Technical violations are being provided regarding staff having current first aid certificates, posting activity schedule, and documentation of PRN medication. No deficiencies are being cited based on observation and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and a copy of this report was left with the Administrator, Zuo Fen Hauf.the state’s words, verbatim · CDSS document, Nov 24, 2025

Allegation investigated: Staff behavior is preventing a resident from sleeping. Staff do not prevent the residents from arguing. Staff did not prevent a resident from falling out of bed. Staff is retaliating against a resident.

***This amended report supersedes the report dated 03/21/24. This report is created to serve as an amendment to clarify findings. *** On March 8, 2025, the California Department of Social Services/Community Care Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent, unannounced complaint visit. The Administrator Josephine Hauf greeted the (LPA). The (LPA) explained that the purpose of this visit was to investigate the allegations mentioned above. The investigation included interviews, collection of records and tour of the facility. Interviews were conducted with staff members #1 to #3 (S1-S3), and resident members #1 to -#5 (R1-R5). The Department reviewed several documents, including the Facility Staff Roster, the Resident Roster, Unusual Incident Reports, Staff Hands-On Training, Personal Rights, Centrally Stored Medication, (Evaluation Report continues LIC9099-C) Unsubstantiated Identification and Emergency Information, Physician Report, Resident Appraisal, Admission Agreement, Daily Notes/Staff Notes/ Facility Notes (dated 02/21/24 through 03/20/24), and other pertinent records associated with this complaint. INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff behavior is preventing a resident from sleeping. The complaint alleges that facility staff are preventing Resident #1 (R1) from sleeping. It is reported that both staff and residents are disrupting (R1) due to ongoing arguments. No additional details were provided regarding this matter. On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed staff members identified as Staff #1, Staff #2, and Staff #3 (S1-S3) who is not able to support this claim. Three (3) out of the (3) staff members revealed confirmation that there were no concerns related to staff behavior or any reported incidents that interfered with residents' ability to sleep. (S1-S3) reported that no behaviors were observed, which resulted in (R1) being unable to sleep. On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed resident members identified as Resident #1 to Resident #5 (R1-R5). Three (3) out of the five (5) residents indicated that they did not experience any behavior issues caused by staff or other residents that interfered with their sleep. Resident #1 (R1) stated everything was fine and confirmed no interruptions from either staff or residents affecting (R1's) ability to sleep. In contrast, Resident #2 and Resident #4 expressed concerns; they mentioned that a staff member and a resident were disruptive; however, they found it challenging to identify specific dates that would support their claims about the disturbances. The Department reviewed staff training records and resident personal rights, revealing that the staff have completed training related to Redirecting, De-escalating Conflicts, Personal Care Techniques, Physical Needs of Elderly, and Psychosocial Needs of the Elderly. Based on the information gathered, there is not enough evidence to support the allegations mentioned above. (Evaluation Report continues LIC9099-C) Allegation #2: Staff do not prevent the residents from arguing. The details of the complaint alleged staff are unable to prevent residents from arguing. According to the report staff do not prevent the residents from having arguments. No additional details were provided regarding this matter. On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed staff members identified as Staff #1, Staff #2, and Staff #3 (S1-S3) who is not able to corroborate this claim. Three (3) out of the (3) staff members reported taking proactive measures to de-escalate tense situations among residents, preventing disputes from escalating. (S1) added the facility is equipped with a surveillance camera designed to monitor and record all activities, ensuring a level of security and accountability. (S1) mentioned one resident had a disagreement with the staff, not with other residents, which was resolved. On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed resident members identified as Resident #1 to Resident #5 (R1-R5). Three (3) out of the five (5) residents to have issues with any staff members. (R1) observed staff and residents disagreeing at times. However, the staff managed these disputes quickly, resolving conflicts quietly. This approach maintained a pleasant situation and made both staff and residents feel heard and acknowledged. Resident #2 (R2) admitted a genuine confusion about the distinctions that separate arguing, debating, and discussing, highlighting a critical opportunity for deeper engagement, and understanding. The Department reviewed staff training records and resident personal rights, revealing that the staff have completed training related to Resident Rights, Resident Behavior Changes, Cultural Competency, and Sensitivity Issues. The Department observed surveillance cameras in common areas during the inspection. These cameras record activities for security and safety purposes. Allegation #3: Staff do not prevent a resident from falling out of bed. The complaint alleges that the staff failed to prevent Resident #1 (R1) from falling out of bed. It was reported that R1 fell from the bed a week ago due to its placement within the room. Additionally, it has been noted that the room's configuration makes the door too narrow for R1 to pass through, requiring R1 to crawl into the room. (Evaluation Report continues LIC9099-C) On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed staff members identified as Staff #1, Staff #2, and Staff #3 (S1-S3) who is not able to validate this claim. Three (3) out of the (3) staff members expressed the facility takes precautions to prevent falls with residents in care. According to (S1), the facility is fully equipped with effective fall prevention devices for all residents, including bed rails, floor mats, and call alarms. (S2-S3) reported to ensure resident safety, bed rails are used, beds are kept at the lowest level, and fall mats are placed beside the beds. Residents at higher risk are monitored more closely. (S1) reported a resident tried to get out of bed independently, despite being told to call for help. This triggered the call alarm, but staff quickly assisted. On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed resident members identified as Resident #1 to Resident #5 (R1-R5). Four (4) out of the five (5) have avoided falls and have not witnessed any incidents with other residents in care. (R1) stated to have not experienced a fall or witnessed one; only heard about it. (R1) indicated is able access the room easily, without using a wheelchair, and encountered no difficulties with the door. (R2) noted that falls occurred with one resident but lacked detailed information. The Department examination of the records, encompassing daily observations, staff documentation, and facility logs spanning from February 21, 2024, to March 20, 2024. This review uncovered that there had been no incidents of falls among any residents during this period, reflecting the effective safety measures in place and the care provided by the staff. An analysis of the completed staff training included Postural Support, Safe Use of Medical Equipment, and Techniques for Personal Care Services. During the inspection visit, the Department noted that half-bed rails were used for all residents in care. Based on the information gathered, there is not enough evidence to support the allegations mentioned above. Allegation #4: Staff is retaliating against a resident. The complaint details alleged that the staff retaliated against Resident #1 (R1). It is reported Staff #1 (S1) has shown increasingly harsh behavior towards (R1) since (R1’s) last report. It is also noted that (R1) is being restricted from smoking. No additional details were provided regarding this matter. (Evaluation Report continues LIC9099-C) On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed staff members identified as Staff #1, Staff #2, and Staff #3 (S1-S3) who disputed this accusation. Three (3) out of the (3) staff members uttered we genuinely value and appreciate every resident, regardless of how they may respond to the staff. We understand that some might perceive rule enforcement or care procedures as punitive, but these measures are vital for ensuring their health and safety. We strive to maintain transparency by documenting all interactions, which promotes clarity and fairness. What might feel like retribution is our commitment to upholding rules that safeguard everyone. As (S1) stressed, we diligently follow each resident's care plan and deliver essential services. Any feelings of being disciplined often stem from misconceptions about our dedicated care and the consistent application of rules meant for everyone's benefit. S1-S3 expressed residents are permitted to smoke outside the facility without restrictions. On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed resident members identified as Resident #1 to Resident #5 (R1-R5). Three (3) out of the five (5) asserted that they have never encountered any behavior of that nature from the staff and cannot support the claim. (R1-R2) reported that staff members limited communication between residents for safety and privacy reasons. However, they did not provide specific details or reasons for these restrictions. Four (4) out of five (5) claimed their facility did not have smoking restrictions and that smoking was allowed outside the facility. (R1) confirmed that the facility operated without restrictions, ensuring accessibility and flexibility. The Department reviewed the records, including daily observations, staff documentation, and facility logs, from February 21, 2024, to March 20, 2024. This review found no evidence of behaviors intended to harm or punish individuals for their actions. Moreover, an analysis of the hands-on training conducted by staff included De-Escalation Techniques, Resident Rights, and Personal Care Procedures. Based on the information gathered, there is not enough evidence to support the allegations mentioned above. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. While the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegations are deemed Unsubstantiated. An exit interview was conducted with Mary Hauf, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Mar 8, 2025 · control 11-AS-20240314140250

Type of visit: Required - 1 Year

On 10/10/2024 at around 8:30 AM, Licensing Program Analyst (LPA) Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator Zuo Fen Hauf. LPA explained the purpose of the visit and was accompanied by a staff inside and outside the facility during this inspection. This facility is licensed to serve 14 adults ages 60 and above, of which 6 maybe non-ambulatory, and 6 maybe on hospice. A total of 10 residents are currently residing in this facility. The Annual Licensing Fees are current. The facility is a one-story house located on a main street. The home consists of 7 resident bedrooms, 1 staff bedroom, 3 full bathrooms, 1 toilet room, 1 entry/living room, 1 kitchen, 1 dining/living room, 1 laundry room, 1 attached garage, 1 backyard area with shaded seating. Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. There are no security bars or weapons on the premises. LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet. LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last earthquake drill was conducted on 09/12/2024. First aid kit is fully stocked with manual. The facility has a fire control panel, pull fire alarms and sprinklers. The fire system is connected to their local Fire Department. The facility pays a monthly payment to the All-American Fire System Inc. There are several fire extinguishers on the premises, and they were last serviced on 04/30/2024. There are two landline telephones; both telephones are in each living room. There is a videoconferencing device dedicated for client use in the area. 7 out of 7 residents’ bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. LPA observed that closet doors were in disrepair in rooms 2, 3, and 4. LPA observed that 1 bathroom sink was in disrepair. Bathroom toilets and grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit. This facility provides residents with hygiene products as nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. 5 staff records were reviewed, 5 out of 5 staff records had required documentation. 5 resident records were reviewed and, 4 out of 5 resident records had required documentation and 1 out 5 resident records did not have consent forms. Administrator agrees to document residents consent forms. Deficiencies are being cited based on LPA observation in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding facility being in disrepair. An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator.the state’s words, verbatim · CDSS document, Oct 10, 2024

Allegation investigated: Resident fell and sustained a fracture due to staff neglect. Facility staff did not provide an adequate quantity of food to resident.

On 5/15/2024 LPA Alfonso Iniguez conducted a subsequent complaint visit to deliver findings about IB investigation. LPA Iniguez met with /Administrator and explained the purpose of this visit. Investigation Consisted of: On 11/6/23 Licensing Program Analyst-LPA Alfonso Iniguez conducted a 24-hrs visit at the facility and gathered documentation from (R#1). LPA Iniguez gathered this information during the visit: Physician Orders for Life-Sustaining Treatment(POLST),Residential Appraisal, Physicians Report for Residential Care Facilities for the Elderly, paper sheet with information, discharge paper from Primrose Post Acute, Face sheet from Primrose Post Acute, Covid 19 test dated on 12/27/2022, Post acute PPD test result dated on 10/26/2022, Primrose Post Acute Order Summary Report from 12/27/2022, Discharge summary Primrose Post Acute 12/27/2022, (R#1) labs results done at TridentCare on 12/17/2022, Initial Assessment for Skilled Nursing Applicants, See LIC 812 for more detatils... Unsubstantiated Investigation Revealed the Following: Allegation: Resident fell and sustained a fracture due to staff neglect. The details of the complaint alleged that a resident sustained fracture due to facility staff neglect. On 11/6/23, complaint was accepted by IB for a full investigation and assigned to Special Investigator Lorraine Patterson. As part of the investigation, investigator Patterson obtained the (R#1)’s facility file, (R#1)’s medical records from Centinela Hospital, (R#1)’s interview, facility staff interview(S#1-S#2), witnesses’ interviews(W#1-W#2), facility administrator interview(A#1) and an Attempted contact with Reporting Party (RP) Investigator Patterson conducted the following based on interviews. On 12/11/23, Investigator Patterson spoke with Administrator (A#1), she stated that she does not suspect any neglect which led to (R#1)'s fall and subsequent fracture while in care. She maintained that during the time of their back-to-back falls on 05/2/23 and 05/03/23, they were medically and physically stable, and there was no change in their baseline that contributed to their fall. According to her, (R#1) was able to "push" themselves around and ambulate in their wheelchair while in care. (R#1) could call for help and make their needs known. On 12/11/24, Investigator Patterson spoke with facility staff (S#1 and S#2), (2) out of (2) denied neglect/lack of supervision and care contributed to (R#1)’s falls that lead to (R#1)’ fractures. On 12/11/24, Investigator Patterson spoke with residents in care (R#2 and R#3), (2) out of (2) state that they denied suspecting and or witnessing neglect from facility staff contributed to (R#1)’s falling sustaining a fracture or injury. Evaluation Report continues LIC 9099-C On 1/17/2024 Investigator Patterson arrived unannounced at Hawthorne Convalescent Home Center to conduct an in-person interview with (R#1). (R#1) confirmed while they lived in care at Hawthorne Terrace Care Home, they sustained two falls (05/02/23; 5/03/23). (R#1) told investigator during their first fall they “slipped” while reaching for a paper because they had an appointment with the doctor that day and they needed to call transportation to pick them up. (R#1) stated that their first fall they injured their nose. (R#1) told investigator during his second fall that the “same” thing happened. (R#1) stated they “reached” for a potato chip on the floor and slipped out of his wheelchair. (R#1) told investigator during their second fall they sustained a broken hip. (R#1) denied neglect and or physical abuse that led/contributed to their fall sustaining a hip fracture. (R#1) told investigator after both falls 911 was called and they were taken right away to the hospital. (R#1) admitted facility staff instructed them to ask for help but they did not follow instructions. The review of the Centinela Medical Center (#M000233890) dated 5/3/2023 revealed that (R#1) was admitted through the emergency room and the reason for the visit was right hip pain. The Chief Complaint stated that (R#1) had a mechanical fall from a wheelchair prior to their arrival while reaching for trash on the ground. (R#1) fell out of the wheelchair on their right side. (R#1) reached for something while in his wheelchair and fell. The Hospital Summary Report stated No suspected abuse. The Discharge Summary/Diagnosis stated: Neglect/Abuse Screening: None. Social Services Issues: None. Hip fracture, status post open reduction internal fixation. Discharge on 5/9/23. Evaluation Report continues LIC 9099-C Allegation: Facility staff did not provide an adequate quantity of food to resident. The details of the complaint alleged that facility staff did not provide an adequate quantity of food to residents. During the physical tour of the facility's kitchen and food pantry, LPA observed an abundance of perishable and non-perishable food available for residents in care, as well as a 7-day food supply for emergencies. During an interview with the administrator (A#1), she stated that the facility serves three meals per day to the residents: breakfast, lunch, and dinner, along with two snacks. Ambulatory residents are also able to help themselves to snacks in the kitchen. Additionally, when it comes to serving well-balanced and nutritious meals, (A#1) stated, "Yes, we serve good meals to residents. We provide protein, vegetables, and carbohydrates in every meal." Furthermore, (A#1) states that the facility has enough perishable and non-perishable food for residents in care, ensuring that residents do not go to bed hungry. During interviews with residents (R#1-R#7), (5) out of (7) stated that the facility offers them three meals per day plus snacks. They mentioned that the facility provides well-balanced and nutritious meals consisting of protein, vegetables, and carbohydrates. Additionally, (5) out of (7) residents stated that the facility has enough food for them and the rest of the residents in care, and they have never gone to bed hungry. During interviews with staff (S#1-S#2), both staff members stated that the facility offers three meals per day to residents in care: breakfast, lunch, and dinner, as well as snacks between meals. Additionally, both staff members stated that the residents receive well-balanced and nutritious meals that include protein, vegetables, and carbohydrates. They also mentioned that the facility has enough food available for all residents in care. Furthermore, both staff members stated that the residents do not go to bed hungry. Evaluation Report continues LIC 9099-C During this investigation, LPA found did not find sufficient evidence to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. 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, and a copy of the Complaint Report was given to Josephine Hauf /Administrator.the state’s words, verbatim · CDSS document, May 15, 2024 · control 11-AS-20231103143116

Allegation investigated: Staff behavior is preventing a resident from sleeping Staff do not prevent the residents from arguing Staff did not prevent a resident from falling out of bed Staff is retaliating against a resident

****This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 03/21/2024.** On 03/21/2024 at 8:54 am Licensing Program Analyst (LPA) David España conducted an unannounced complaint investigation visit for the allegation listed above and was greeted by Administrator Josephine Hauf. Investigation consisted of the following: On 03/21/2024 LPA España explained the purpose of this visit is to gather information and conduct interviews with staff for the allegations mentioned above. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. LPA España was granted access and allowed to enter the facility to conduct inspections. LIC9099 Continued Unsubstantiated The investigation consisted of the following continued: A tour of the facility was conducted on 03/21/2024 at 10:23 am. LPA España interviewed Resident 1- Resident 5 (R1-R5). LPA España interviewed Staff 1-Staff 3 (S1-S3). LPA Espana requested and received the following documents: Staff and resident roster; SIR reports; dated weekly employee time schedule; RCFE license certificate; verification of first aid training; criminal record statement; verification of staff training; personal rights; client resident personal property and valuables; centrally stored medication and destruction record; identification and emergency information; physician's report; resident appraisal; admission agreement; home health agency (list of all who provide services to residents/contact information); daily notes/staff notes/facility notes (1-month records); records or procedures of eviction; records of all evictions (log records) of the past 1 month (30 days); records of diapers or pull-ups of all residents in the facility and other pertinent records associated with this complaint. The investigation revealed the following: Allegation: Staff behavior is preventing a resident from sleeping. Administrator Josephine Hauf was interviewed by LPA España on 03/21/2024 at 9:07 am. Administrator stated that the night shift is managed by the Administrator and that staff do not prevent residents from sleeping. Administrator mentioned a ratio of 10 residents to 3 staff members, with herself covering the night shift. LPA España interviewed Resident 1- Resident 5 (R1-R5). LIC9099 Continued LPA España interviewed Staff 1-Staff 3 (S1-S3). Of those interviewed, S1-S3 stated there were no issues with staff behavior or preventing a resident from sleeping. On 03/21/2024, Residents (R1-R5) were interviewed, with 3 out of 5 residents stating they had no issues with sleeping. Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is Unsubstantiated. Allegation: Staff do not prevent the residents from arguing. On 03/21/2024, LPA España interviewed S1-S3. Of those interviewed, 3 out of 3 staff stated they stepped in to prevent residents from arguing and added that only one resident argues with them. On 03/21/2024 LPA España Interviewed R1-R5. Of those interviewed, 3 out of 5 residents had no issues with S1-S3, either during day or night shifts. 3 out of 5 residents also confirmed they did not engage in arguments with staff, nor did staff argue with them. Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is Unsubstantiated. LIC9099 Continued Allegation: Staff did not prevent a resident from falling out of bed. On 03/21/2024, LPA España interviewed Staff 1-Staff 3 (S1-S3). Of those interviewed, 3 out of 3 stated facility takes precautions to prevent falls, and two staff added that one resident did fall out of bed after declining staff assistance. Additionally, LPA España interviewed Resident 1- Resident 5 (R1-R5), of those interviewed 4 out of 5 had no issues with falls. Additionally,3 out of 5 residents also confirmed being checked by staff regularly. On 03/21/2024, LPA España conducted records reviews at facility. Daily notes/staff notes/facility notes (1-month records), which indicated no falls for any of the residents in the period between February 21 to March 20, 2024. Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is Unsubstantiated. Allegation: Staff is retaliating against a resident. On 03/21/2024, LPA España spoke to Administrator Josephine Hauf regarding the allegation, administrator Hauf stated that no residents were subjected to retaliation. LIC9099 Continued On 3/21/2024 LPA España interviewed Resident 1- Resident 5 (R1-R5) and Staff 1-Staff 3 (S1-S3). On 03/21/2024, LPA España interviewed S1-S3 who stated they had not retaliated against residents. LPA España interviewed Resident 1- Resident 5 (R1-R5), of those interviewed 3 out of 5 stated they had seen not retaliatory behaviors fromss staff. Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is Unsubstantiated. No were no deficiencies cited at the time of visit. An exit interview was conducted with Mercedes Espino, Caregiver and a hard copy was provided. Intentionally Blank Intentionally Blankthe state’s words, verbatim · CDSS document, Mar 21, 2024 · control 11-AS-20240314140250

Allegation investigated: Staff did not dispense prescribed medication to resident. Staff refused to return resident’s personal belongings.

On 03/14/24 LPA Villegas conducted a subsequent complaint visit regarding the allegations above. LPA met with Mercedes Espino as the purpose of today’s visit was explained. The investigation consisted of the following: On 01/17/24 LPA interviewed Administrator (A1), staff #1-2 (S1-S2),resident #2-6 (R2-R6) and Witness #1(W1). On 01/17/24 LPA obtained copies of the following; Resident and staff roster, training log for S1, copy of physician license for A1 and the following for resident #1 (R1); Identification and emergency Info form, admission agreement, resident appraisal, physicians report, resident BP/Glucose checks, MAR for October-December 2023, Centrally stored medication and destruction record, admission record from prior facility. The investigation revealed the following: Allegation:Staff did not dispense prescribed medication to resident. It is being alleged R1 had not received prescribed insulin since R1 started living at the facility. Unsubstantiated On 01/17/24 LPA interviewed A1 regarding the allegation above, A1 denied the allegation above. Per A1, insulin was administered daily and would only be withheld if blood sugar was too high, or if R1 would refuse. A1 continued to report that prior to R1 admitting to Hawthorne Terrace care home, LLC it was advised that prior placement educate R1 on how to check blood sugar; however when R1 arrived to Hawthorne Terrace care home, LLC R1 was unable to do. On 01/17/24 LPA interviewed S1-S2 regarding the allegation above, 2 of 2 staff interviewed denied the allegation above. On 01/17/24 LPA interviewed W1 regarding the allegation above, W1 reported R1 was provided with insulin upon discharge however, W1 could not recall if R1 was taught on how to check blood sugar or administer own insulin. W1 also reported W1 could not remember if R1 was medication complaint while in care. On 01/17/24 LPA interviewed R2-R6 regarding the allegation above, 5 of 5 residents interviewed denied the allegation above and reported receiving medication daily. On 01/17/24 LPA conducted review of MAR and did not observe any discrepancies, BP/Glucose checks as well as medication refusals were documented. Allegation: Staff refused to return resident’s personal belongings. It is being alleged facility staff is refusing to return R1’s clothing. On 01/17/24 LPA interviewed A1 regarding the allegation above, A1 denied the allegation. Per A1, R1's belongings have been packed and are ready to be picked up however, there has been no communication from R1's family on when the belongings will be picked up from the facility. On 01/17/24 LPA interviewed S1-S2 regarding the allegation above, 2 of 2 staff interviewed denied the allegation above and stated R1's belongings are packed in 2 boxes and have been ready for pick up. On 01/17/24 LPA interviewed R2-R6 regarding the allegation above, 5 of 5 residents interviewed denied the allegation above and reported that no personal belongings have gone missing while in care. On 01/17/24 LPA conducted a tour of the facility and observed R1's belongings to be packed in boxes and stored in the facilities storage space. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted with Mercedes Espino, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 14, 2024 · control 11-AS-20240109150139

Allegation investigated: Facility staff failed to provide resident with a refund.

On 02/20/24 Licensing program analyst (LPA) Lizeth Villegas conducted an initial complaint visit regarding the allegation above. LPA met with Administrator Zuofen "Josephine" Hauf as the purpose of today's visit was explained. The investigation consisted of the following: On 02/20/24 LPA interviewed Administrator (AD), and obtained copies of the following for R1; Admission agreement, admission record, emergency I.D. form, POLST form, copy of bank statement for Direct deposit dated 02/01/24, copy of communication with CCA from ALW program, attempted communication with family, and a copy of SSI payment rates. It is being alleged that facility staff received R1 Social Security Income (SSI) check for the month of February in the amount of $1575.07. According to the Complainant R1 did no longer resided at the facility as of January. The complainant stated R1 is unable to move into another facility because Hawthorne Terrace kept his rent check for February. On 2/20/24 at 10:00am LPA Villegas interviewed the Substantiated Administrator (AD) regarding the allegation and AD confirmed receiving R1 SSI check for the month of February in the amount of $1575.07 was direct deposited into the facility account. AD stated there was no refund provided as R1 owed Hawthrone Terrace $2,648 dollars for past due rent for the Month of December 2023 and January 2024. AD continued to report that the SSI check received via direct deposit was for $1,575.07 which only covered a part of the debt owed, Per AD R1 still owes $1,073 but AD is forgetting about the remaining balance. On 2/20/2024 at 11:00am, LPA Villegas conducted a file review of R1 file and observed an admission agreement dated 10/30/2023 which revealed R1 rent rate would be $1384.82 and indicates R1 source of income as SSI and that the residents participates in the Assisted Living Waiver Program. LPA review invoices for October 2023-January 2024. LPA did not observe an invoice for the month of February but observed an invoice for December 2023 and prorated fees showing R1 February 2024 SSI check was applied for past overdue rent. Based on evidence gathered through the course of the investigation the Administrator used R1 SSI check for February rent not for its intended purpose and did not reach out to the Social Security Information for guidance since R1 no long resides at the facility. Based on LPAs interviews which were conducted and records review that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview conducted with the Administrator, appeal rights explained and copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 20, 2024 · control 11-AS-20240213161521

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Feb 27, 2024

Personal Rights of Residents in All Facilities...To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination Based on interview and records review the Licensee did not comply with the section above. License kept R1 February 2024 SSI check although R1 moved out of the facility in January 2024. As of 2/20/2024, the Licensee has not returned the monies to R1 or contacted SSA. This poses a personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Feb 20, 2024

Plan of correction: Administrator should reach out to the Social Security Administration regarding R1 February 2024 check. Administrator shall develop a plan to comply with Title 22 Regulations to the department by POC due date.

Allegation investigated: Facility retained a resident with a higher level of needs. Staff did not seek medical attention for resident in a timely manner. Staff did not provide resident with a copy of their Admissions Agreement. Staff did not ensure that resident was showered. Staff did not ensure that resident was advised of his personal rights. Staff did not ensure that resident was provided with comfortable living accomodations.

On 1/10/23, Licensing Program Analyst (LPA) Felisa Shirley conducted a subsequent complaint visit at this facility to deliver complaint investigation findings. LPA met with Caregiver Mercedes Espino and explained the purpose of the visit. The investigation consisted of the following: On 1/31/2023, LPA Lourdes Montoya conducted a tour of the inside and outside grounds of the facility with Administrator Josephine Hauf. LPA interviewed two out of nine residents and three out of six staff. Since R1 has already moved out of the facility, LPA attempted to conduct a telephone interview but R1 refused the interview. LPA requested and obtained a client roster, staff roster, food menu, Resident #1's service records and other pertinent records. On 2/6/2023, LPA Montoya conducted a telephone interview with one witness. Investigations revealed the following: Con'd on 9099-C Unsubstantiated Allegation: Facility retained a resident with a higher level of needs. It is alleged that facility retained a resident with a higher level of needs. On 1/31/2023 between 11:05 am - 1:30 pm, LPA interviewed two out of nine residents (R2-R3) and three out of six staff (S1-S3). Since R1 has already moved out of the facility, LPA attempted to conduct a telephone interview but R1 refused the interview. On 2/6/2023, LPA conducted a telephone interview with one witness (W1). Based on interviews conducted with two residents (R2-R3), three staff (S1-S3) and one witness (W1), the facility did not retain a resident with a higher level of needs. Based on records review, the department received an incident report about R1’s medical emergency on 1/17/23 but it does not indicate that R1 requires a higher level of care/needs when R1 returned to the facility on 1/18/23. LPA did not observe any residents requiring higher level of care. Based on information gathered, there is no sufficient evidence to corroborate the allegation above. Allegation: Staff did not seek medical attention for resident in a timely manner. It is alleged that staff did not seek medical attention for resident in a timely manner. On 1/31/2023 between 11:05 am - 1:30 pm. LPA interviewed two out of nine residents (R2-R3) and three out of six staff (S1-S3). Since R1 has already moved out of the facility, LPA attempted to conduct a telephone interview but R1 refused the interview. On 2/6/2023, LPA conducted a telephone interview with one witness (W1). Based on interviews conducted, two residents (R2-R3), three staff (S1-S3) and one witness (W1) denied that staff did not seek medical attention for resident in a timely manner. Based on records review, the department received an incident report about R1’s medical emergency on 1/17/23 which indicates that facility staff called 911 due to a medical emergency. Another incident report was submitted to the department regarding R1’s medical emergency on 1/23/23 and 911 was called. LPA did not observe any medical emergency during the visit. Based on information gathered, there is no sufficient evidence to corroborate the allegation above. Con'd on 9099-C Allegation: Staff did not provide resident with a copy of their Admissions Agreement. It is alleged that staff did not provide resident with a copy of their Admissions Agreement. On 1/31/2023 between 11:05 am - 1:30 pm. LPA interviewed two out of nine residents (R2-R3) and three out of six staff (S1-S3). Since R1 has already moved out of the facility, LPA attempted to conduct a telephone interview but R1 refused the interview. On 2/6/2023, LPA conducted a telephone interview with one witness (W1). Based on interviews conducted, two residents (R2-R3), three staff (S1-S3) and one witness (W1) denied staff did not provide resident with a copy of their Admissions Agreement. Based on LPA’s records review and observation, the facility has an Admission Agreement for R1 signed by the POA. Based on information gathered, there is no sufficient evidence to corroborate the allegation above. Allegation: Staff did not ensure that resident was showered. It is alleged that staff did not ensure that resident was showered. On 1/31/2023 between 11:05 am - 1:30 pm. LPA interviewed two out of nine residents (R2-R3) and three out of six staff (S1-S3). Since R1 has already moved out of the facility, LPA attempted to conduct a telephone interview but R1 refused the interview. On 2/6/2023, LPA conducted a telephone interview with one witness (W1). Based on interviews conducted, two residents (R2-R3), three staff (S1-S3) and one witness (W1) denied that staff did not ensure that resident was showered. Based on records review, the facility daily care log shows R1 had showers/bed baths on 1/2/23, 1/9/23,1/14/23, 1/16/23, and 1/19/23. Based on information gathered, there is no sufficient evidence to corroborate the allegation above. Allegation: Staff did not ensure that resident was advised of his personal rights. It is alleged that staff did not ensure that resident was advised of his personal rights. On 1/31/2023 between 11:05 am - 1:30 pm. LPA interviewed two out of nine residents (R2-R3) and three out of six staff (S1-S3). Con'd on 9099-C Since R1 has already moved out of the facility, LPA attempted to conduct a telephone interview but R1 refused the interview. On 2/6/2023, LPA conducted a telephone interview with one witness (W1). Based on interviews conducted, two residents (R2-R3), three staff (S1-S3) and one witness (W1) denied that staff did not ensure that resident was advised of his personal rights. Based on records review, R1 has an Admission Agreement signed by the POA and it includes an attachment (#4), the Resident’s Personal Rights. Based on information gathered, there is no sufficient evidence to corroborate the allegation above. Allegation: Staff did not ensure that resident was provided with comfortable living accommodations. It is alleged that Staff did not ensure that resident was provided with comfortable living accommodations. On 1/31/2023 between 11:05 am - 1:30 pm. LPA interviewed two out of nine residents (R2-R3) and three out of six staff (S1-S3). Since R1 has already moved out of the facility, LPA attempted to conduct a telephone interview but R1 refused the interview. On 2/6/2023, LPA conducted a telephone interview with one witness (W1). Based on interviews conducted, two residents (R2-R3), three staff (S1-S3) and one witness (W1) denied that staff did not ensure that resident was provided with comfortable living accommodations. Based on review of facility’s incident reports, there are no incidents where residents felt uncomfortable living in the facility. During the investigation, LPA observed the facility is a comfortable place to stay. Based on information gathered, there is no sufficient evidence to corroborate the allegation above. Based on LPA’s observation, interviews conducted, and records review, the preponderance of evidence standard has not been met. 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 conducted and a copy of this report was provided to Caregiver, Mercedes Espino.the state’s words, verbatim · CDSS document, Jan 10, 2024 · control 11-AS-20230123121242

Type of visit: Required - 1 Year

On 11/8/2023, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Zou Fen Hauf/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (14) residents ages 60 and above of which (6) non-ambulatory and (8) ambulatory. Facility has an approved hospice waiver for (6) patients. The facility is a single-story home in a residential area. The facility has seven (7) bedrooms, one (1) staff room, four (4) restrooms (2) full baths, (1) shower, kitchen, (2) sitting areas, laundry area, attached garage and an outside sitting area whit shade. LPA Iniguez toured the physical plant with administrator. There were no bodies of water or obstructions on the premises. A total of (5) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected rooms: #1, #2, and #3 #4 and #5 and smoke and carbon monoxide combo are all in operable conditions. The water temperature properly measured between 105°-120°F: Kitchen 108.5°F, Bathroom #1:105.7°F, Bathroom #2:106.3°F. Evaluation Report Continues LIC 809-C LPA Iniguez observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. A review of (5) residents' service files, (5) staff personnel files and (5) Medication Administration Records (MAR) were maintained in order. First AID kit was checked. Last fire disaster drill was on: 5/14/2023. LPA observed the facility's infection control practices. A copy of the liability insurance was provided to LPA during visit. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Zou Fen Hauf /Administrator.the state’s words, verbatim · CDSS document, Nov 8, 2023