Hollenbeck Palms

Allegation investigated: Staff does not provide and safe and healthful environment for resident in care.

Licensing Program Analysts (LPA) Luis De Leon conducted an initial unannounced complaint investigation visit for the allegation listed above. LPA met with the CEO Erika Castile and explained the reason for the visit. The investigation consisted of the following: On today’s visit, LPA De Leon toured the physical plant with Coordinator Stephanie Prado and obtained the current resident and staff roster. In addition, LPA obtain LPA Luis De Leon toured the physical plant with assistance of S2. LPA’s obtained the current client and staff roster, and R1s Admission Agreement, Physician’s Report, Needs and Service Plan, Preplacement Appraisal Information, and Staff Training. Report continues on page LIC-9099C... Unsubstantiated Regarding allegation: Staff does not provide and safe and healthful environment for resident in care. It is alleged that the facility does not provide a safe and healthful environment for residents in care. The investigation reveals the following: Interview with six (6) out of seven (7) residents denied the above allegation. All six (6) residents stated that they feel safe and taken care at the community. Residents stated that staff is attentive to their needs and provide assistance with activities, appointments, and activities of daily living (ADL). Residents are not aware of any incidents where residents have been disrespectful to other residents, including roommates. R1 described incident with roommate being loud when speaking and described it as screaming. LPA interview with R2 revealed that R2 is hard of hearing and speak at a higher tone of voice. Interview with staff revealed that seven (7) out of seven (7) staff were not aware of above allegation. Staff were not aware of any incident with residents being disrespectful with each other or their roommates. Staff stated that most residents may raise their voices to staff when assisting with morning activities like showering, dressing, or assistance with ADLs. Staff stated that Staff is not aware of any resident screaming to other residents. LPA reviewed facility training and observed staff training on personal rights, identify behavior changes, and Dementia training. LPA observed residents involved in group activities and did not observe any issues among residents’ interaction. All residents were engaged and participating with staff group activity. LPA observed enough staff supervising residents in care. Based upon the investigation, resident, and staff interviews, document review, and LPA observations, the facility is proving a safe and healthy environment for residents in care. 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 held with CEO Erika Castile. A copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 27, 2026 · control 28-AS-20260422162227

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual visit at the facility using the CARE inspection tool. LPA met with Administrator Diana Macias-Medina and the reason for the visit was explained. This facility is licensed to serve elderly residents, age 60 and above. The facility’s capacity is 185 residents, which is approved to have 100 ambulatory and 85 non-ambulatory residents. The facility campus consisted of memory care building, independence living building and assisted living buildings. The main building is the assisted living and has two (2) floors. The first floor is approved to have 20 non-ambulatory residents, and the second floor is approved to have 32 non-ambulatory residents. The memory care building has two (2) floors which is approved to have 33 non-ambulatory residents and delayed egress. The memory care has eight (8) hospice waivers in place. Today’s inspection consisted of applying CARE tool, conducting physical plant, reviewing staff/resident records, checking food supply/medication, and interviewing staff/residents. Infection Control: Facility maintains an infection control plan was on file. Staff were observed practicing safe hand washing. Hand sanitizing was observed throughout. Hygiene supply and sanitizing materials were observed in each bathroom and changing station. (-continued on LIC 809C-) Physical Plant & Environmental Safety: The facility campus has four (4) separate buildings, including one (1) skilled nursing building, one (1) assisted living building, independence living building and one (1) memory care building. The assisted living buildings have resident rooms, kitchenettes, laundry rooms, activity areas, a gym, a main dining room, a commercial kitchen, and common areas for resident use. The memory care building consists of resident’s rooms, resident activity areas with a big TV, dining room, and a commercial kitchen. Physical plant tour was conducted and observed the facility is in good repair indoor and outdoor. Residents’ rooms are clean and comfortable temperature is maintained. Outdoor space is furnished, shaded, and accessible to clients. A bodily of water is located between the independence living building and assisted living buildings and is secured with a 5 ft fence. Cleaning supplies and sharps were locked and inaccessible to clients. Passageways and exit areas were observed free of obstructions. Restrooms were observed clean. Water temperature was measured and in compliance. The facility had a system monitoring hot water temperature by testing hot water temperature in random rooms every two weeks. The emergency call system was tested in ten (10) resident rooms. The responding time was from 2 minutes to 7 minutes. Five (5) extinguishers were checked and they were fully charged. Their last service was on 2/25/26. Smoke detectors and carbon monoxide devices were monitored by a company, Absolute Fire Protection, Inc. Last alarm test was conducted on 11/19/25. Food Service: The kitchen was clean. The required two (2) days of perishable and seven (7) days of nonperishable were observed and stored separately from toxic/cleaning supply. Health-Related Services and Disaster Preparedness: Medications were reviewed. Medications are centralized stored and inaccessible to the residents. Last fire drill was performed on 2/27/26 and it was done quarterly in every shift. Emergency Disaster Plan LIC610E was observed. (-continued on LIC 809C-) Staff/ Residents Records review: Administrator certificate is current, and the expiration date is 10/10/27. Staff and resident’s records were reviewed and they were in compliance. Exit: No deficiencies were noted during this visit per California Code of Regulations, Title 22, Division 6. Exit interview was conducted with Administrator Diana Macias-Medina and LIC 809s were provided.the state’s words, verbatim · CDSS document, Mar 5, 2026

Allegation investigated: Staff are not distributing resident's medication as prescribed

*** This licensing report supersedes the licensing report dated 11/24/25. The licensing report is being reissued to clarify information obtained during the investigation; however, the findings remain the same*** On today’s visit, Licensing Program Analysts (LPA) Luis De Leon conducted an subsequent unannounced complaint investigation visit for the allegation listed above. LPA met with Administrator Diana Medina and explained the reason for the visit. During the 11/24/25 visit, LPAs Ellena Mallett and Luis De Leon toured the physical plant with assistance of Assisting Living Coordinator Odily Franklin. LPA’s obtained the current client and staff roster, and R1s Admission Agreement, Physician’s Report, Physician’s Order, MARs log, Needs and Service Plan, Stored Medication and Destruction Record. Report continues on page LIC-9099C... Unsubstantiated Regarding allegation: Staff are not distributing resident's medication as prescribed. It is alleged that the facility is not properly distributing residents in care with prescribed medication. The investigation reveals the following: Interview with ten (10) out of ten (10) residents denied the above allegation. All residents stated that staff have not ever missed any medication. One (1) of ten (10) residents has observed staff coming to dining area to distribute prescription medications to residents, and reported that staff are conscientious about medications and give R1’s spouse medication as needed. One (1) of Ten (10) residents stated that residents complain about food, but the resident has never heard any complaints about prescription medications not being administered to residents by staff. LPAs interviewed W1 who stated that staff have responded to R1’s call for assistance for activities of daily living (ADLs) in a timely manner. In addition, W1 stated that staff have never forgotten to give R1’s prescribed medication. Interviews with staff revealed that ten (10) out of ten (10) staff denied above allegation. Interview with staff revealed that staff follow medication procedure where staff have a two-hour window before and after the prescription is scheduled to be administered to residents. Staff try to locate residents by phone or search in common areas. If resident is not located, charge nurse is notified and charge nurse reports it to doctor for missed medication. S1 stated that after two-hour window, the prescribed medication is destroyed and missed residents medication is documented in the Stored Medication and Destruction Record. S1 stated that medication is destroyed in order to prevent Med Tech confusion and to prevent residents from receiving double doses for the next scheduled medication time. Staff stated that residents who are going to be absent from facility are given prescriptions medications to take with them, and family is instructed to distribute the prescription medication to residents. LPAs reviewed three (3) residents’ prescriptions medications and did not find any health and safety risks to residents in care. Based upon the investigation, client and staff interviews, document review, and LPA observations, the facility is distributing resident’s medication as prescribed. 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 held with Administrator Diana Medina. A copy of the report was provided.the state’s words, verbatim · CDSS document, Feb 26, 2026 · control 28-AS-20251119132345

Allegation investigated: Staff are not distributing resident's medication as prescribed

Licensing Program Analysts (LPAs) Ellena Mallett and Luis De Leon conducted an initial unannounced complaint investigation visit for the allegation listed above. LPA met with President CEO Morris Shockley and explained the reason for the visit. The investigation consisted of the following: On today’s visit, LPAs Ellena Mallett and Luis De Leon toured the physical plant with assistance of Odily Franklin, Assisting Living Coordinator. LPA’s obtained the current client and staff roster, Admission Agreement, Physician’s Report, Physician’s Order, MARs log, Needs and Service Plan, Stored Medication and Destruction Record. Report continues on page LIC-9099C... Unsubstantiated Regarding allegation: Staff are not distributing resident's medication as prescribed. It is alleged that the facility is not properly distributing residents in care with prescribed medication. The investigation reveals the following: Interview with ten (10) out of ten (10) residents denied the above allegation. All residents stated that staff has not ever missed any medication. R5 stated that R5 has observed staff coming to dining area to distribute prescription to residents. R5 added that staff “never ever forgot to give wife medication.” R5 added that staff is very conscientious about medication. R4 stated that residents complain about food, but R4 has never heard any complaints about prescription not being administered to residents. LPAs interviewed W1 who stated that staff has responded to R1’s call for assistance in a timely manner. In addition, W1 stated that staff have never forgotten to give R1’s medication. Interviews with staff revealed that ten (10) out of ten (10) staff denied above allegation. Interview with staff revealed that following staff has a two-hour window before and after the prescription is scheduled to be distributed to residents. Staff try to locate residents by phone or search in common areas. If resident is not located, charge nurse is notified and charge nurse reports it to doctor for missed medication. S1 stated that after two-hour window, the prescription is destroyed and missed medication is documented in the Stored Medication and Destruction Record. S1 stated that medication is destroyed in order to prevent Med Tech confusion and to prevent residents from receiving a double-doses for the next medication dose. Staff stated that residents who are going to be absent from facility are given prescriptions to take with them, and family is instructed to distribute prescription to residents. LPAs reviewed three (3) residents’ prescriptions and did not find any health and safety risks to residents in care. Based upon the investigation, client and staff interviews, document review, and LPA observations, the facility is distributing resident’s medication as prescribed. 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 held with Erika Castile, Vice President, COO. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 24, 2025 · control 28-AS-20251119132345

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Kimberly Ramirez and LPA Blanca Gonzalez conducted a subsequent annual inspection visit on 04/17/2025 and was greeted by Administrator Diana Medina. LPA Ramirez conducted initial annual inspection on 03/25/2025 and due to time restraints, LPA needed to return another to complete annual inspection. LPA Ramirez identified herself and explained the purpose of the visit. The facility is located on a main street and has multiple dwellings. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Residents with Special Needs: Large bodies of water were observed and were observed to be fenced and inaccessible to residents. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Emergency pull cords were tested and were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication room and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Diana Medina 10/12/2025. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for five (5) out of the five (5) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for five (5) out of the five (5) personnel record reviewed. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: Licensee may serve elderly residents age 60 and up. Approved for 100 ambulatory and 85 non-ambulatory. 20 non-ambulatory in 1st floor of main building and 32 non-ambulatory on the 2nd floor of the main building. 33 non-ambulatory in memory care building. Approved for delayed egress. This facility may retain no more than eight (8) hospice residents. Resident Records/Incident Reports: LPA reviewed resident records for eight (8) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. No deficiencies were observed during this visit. Exit interview conducted. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Apr 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an annual inspection visit on 3/25/2025 and was greeted by Administrator Diana Medina. LPA Ramirez identified herself and explained the purpose of the visit. The facility is located on a main street and has multiple dwellings. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected eight (8) resident rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in grooming and bathing areas were measured to be over 120 degrees F. LPA Ramirez will issue Type A deficiency based on this observation. LPA Ramirez will issue $250 civil penalty due to repeat violation. On 4/26/24, the facility was cited during an annual inspection for violation of 87303(e)(2). LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed no-slip coating in showers. LPA Ramirez observed seated shower chairs in bathrooms. Water temperature in 2nd floor laundry room sink, was measured to be over 125 degrees F. No warning signs indicating water may go above 125 degree F was observed. This laundry room is accessible to residents. LPA Ramirez will issue Type A deficiency based on observation. Food Service: LPA Ramirez observed sufficient supply of nonperishable for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. LPA Ramirez observed several residents engaging in seated exercises in the facility memory care activities room. SEE 809-C for continued report. Operational Requirements: The fire clearance is approved for one hundred (100) ambulatory residents and eighty-five (85) non-ambulatory residents, over the age of 59 years. Twenty (20) non-ambulatory on 1st floor of main building and thirty-two (32) non-ambulatory on the 2nd floor of main building. Thirty-three (33) non-ambulatory in memory care building. The facility has a hospice waiver approved for eight (8). There were two (2) residents on hospice during inspection. Due to time restraints, LPA Ramirez will return to complete annual inspection. Two (2) deficiencies were observed. A copy of this report, 809-D, LIC 421FC repeat violations, and appeals rights was provided.the state’s words, verbatim · CDSS document, Mar 25, 2025

Allegation investigated: Staff financially abused resident.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 08/08/2024 regarding the above allegation. LPA Ramirez was greeted by Administrator Diana Medina and explained the purpose of the visit. The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff#1 interview (S1), Resident#1 (R1) Admission Agreement, Resident Assessment Report, Emergency Notification Form, Physician Report, and physical plant tour. The investigation revealed the following. Regarding Allegation: Staff financially abused resident- It is alleged R1 withdrew large amounts of money from R1’s 401k account and gave it to the facility. SEE 9099-C for continued narrative. Unfounded The facility is licensed as a Residential Care Facility for the Elderly/Continuing Care Retirement Community. Upon record review, it was revealed R1 resides in the facility independent living accommodation and has an Admissions agreement to corroborate R1 does not receive care and supervision from the facility. Per Health and Safety Code section 1569.80 (e)- If the residential care facility for the elderly is a continuing care retirement community, as defined in paragraph (10) of subdivision (c) of Section 1771, this section shall apply only to residents who require care and supervision, as defined in subdivision (b) of Section 1569.2." Based on the records reviewed and interview conducted, we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.the state’s words, verbatim · CDSS document, Aug 8, 2024 · control 28-AS-20240802132026

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA) Erik Zaragoza conducted a subsequent unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools in order to complete the annual inspection. LPA explained the purpose of the visit Diana Medina, administrator for the facility, and was granted entrance. There are one-hundred and sixty-two (162) residents currently living in the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices and Personal Protective Equipment (PPEs) were observed. · Infection control plan is on file. Physical Plant/Environment Safety: · The facility consists of four separate buildings all located on a campus. It is licensed for a capacity of one-hundred (100) ambulatory and eighty five (85) non-ambulatory residents, with a hospice waiver approved for eight (8) residents. LPA toured building #1 which has a total of forty-five (45) resident bedrooms, building #2 which has sixty-two (62) bedrooms, Building #3 which has a total of sixty-five (65) bedrooms, and Building #4 which has thirty-three (33) bedrooms and also serves as the facility’s memory care unit. Buildings 1-3 have rooms that contain kitchenettes, laundry rooms, and common areas for resident use. The facility has resident activity areas available in each building. The main building which is building #1 contains two activity areas, a gym, dining room, main dining room and a commercial kitchen. Building #4 contains an activity room for residents. The facility has a signal system that properly works from residents living units and bathrooms. The facility was observed to be in good repair. ·The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. A water fountain on the facility premises is properly fenced and in compliance with state and local building codes. The facility has multiple fully charged fire extinguishers located throughout all four (4) building of the campus. There were no sharp objects that were left accessible to residents. · Water temperature readings in four (4) out of twenty-eight (28) resident rooms reviewed fell below the required range of 105 - 120 degrees Fahrenheit. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for a capacity of one-hundred (100) ambulatory and eighty five (85) non-ambulatory residents, with a hospice waiver approved for eight (8) residents. · Care and supervision to meet the clients’ needs was observed. Staffing: · A total of one-hundred and sixty-seven (167) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Eight (8) staff files were reviewed for criminal background clearance and training. · Personnel records have health/TB screenings, CPI training, certifications, and 1st Aid/CPR training. Resident Rights/Information: · Physician orders were reviewed for eight (8) resident files. · Medications were also reviewed for eight (8) residents. Resident Records/Incident Reports: · Eight (8) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan was publicly posted and found within the facility. · An emergency and disaster drill was last conducted on 3/19/2024. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs: · The facility has a non-ambulatory fire clearance for each room that will be used to accommodate residents with a dementia diagnosis. · Staff that provide direct care to residents with dementia receive training related to dementia care. · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit are documented on the LIC809D. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 16, 2024

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Erik Zaragoza and Daniel Konishi conducted an unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Morris Shockley, President and CEO of Hollenbeck Palms, and was granted entrance. Administrator Diana Medina arrived shortly thereafter. There are one hundred and sixty-two (162) residents currently living in the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Physical Plant/Environment Safety: · The facility consists of four separate buildings. It is licensed for a capacity of one hundred (100) ambulatory and eighty five (85) non-ambulatory residents, with a hospice waiver approved for eight (8) residents. LPAs toured building 1 which has a total of forty-five (45) resident bedrooms, and building #2 which has a total of sixty-two (62) resident bedrooms. Buildings 1-2 have rooms that contain kitchenettes, laundry rooms, and common areas for resident use. The facility has resident activity areas available in each building. The main building which is building #1 contains two activity areas, a gym, dining room, main dining room and a commercial kitchen. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for a capacity of one hundred (100) ambulatory and eighty five (85) non-ambulatory residents, with a hospice waiver approved for eight (8) residents. · Care and supervision to meet the clients’ needs was observed. Staffing: · A total of one hundred and sixty-seven (167) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Eight (8) staff files were reviewed for criminal background clearance and training. Resident Rights/Information: · Physician orders were reviewed for eight (8) resident files. · Medications were also reviewed for eight (8) residents. Resident Records/Incident Reports: · Eight (8) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Due to time constraints, LPAs were not able to complete the annual inspection during today's visit. LPAs will return at a later date in order to complete the inspection.the state’s words, verbatim · CDSS document, Apr 4, 2024

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.