Hopkins Manor

Type of visit: Required - 1 Year

On 9/10/2026, LPA Grace Donato arrived at the facility to conduct the annual inspection. LPA met with Ricardo Aban, Executive Director and explained the purpose of the visit. LPA toured the physical plant. All bedrooms were observed to have the required furniture and sufficient lighting. The indoor and outdoor passageways were free of obstruction. The facility was maintained at a comfortable temperature of 71 degF. Hot water temperature was measured at 115 degF. The facility's fire alarms and carbon monoxide detectors were observed to be in working order. The facility's fire extinguishers were observed to be fully charged. The facility had the required 7 days of non perishables and 2 days of perishables on site. Facility has additional food storage at the basement. Ten resident records and six staff records were reviewed. Centrally stored medication was locked and inaccessible by residents. All medication was labeled and sorted by resident name. All medication logs are complete and updated. LPA also reviewed Personal and Incidental (P&I) monies kept at the facility which matched the facility records. No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Sep 10, 2026

Allegation investigated: Staff have not completed required training Staff mishandled resident's medication Staff spoke to resident in an inappropriate manner

On 7/9/2026 LPA Grace Donato conducted an unannounced 10-day complaint inspection. LPA met with Administrator (ADM), Ricardo Aban and explained the purpose of today's visit. Regarding the allegation of Staff have not completed required training, LPA obtained the training certificate of staff member (S1) and it confirms 8 hours of Medication Management training signed on 6/4/2026. S2 also mentioned that he/she did not say that the S1 was not trained. According to ADM, all staff has medication pass training and there are only 5 staff members who have the Medication Management training. For the allegation of staff mishandled resident's medication, LPA reviewed records and it shows in the Medication Administration Record (MAR) that all the medications for the resident (R1) have been given except when the resident refused. According to S1, the medications that he/she was answering the questions of R1 as to what medications S1 were currently giving at that time. S1 asked R1 if he/she would want the eye drops administered but R1 refused so S1 had to call another staff to assist. page 1 of 2 Unsubstantiated On the allegation of Staff spoke to resident in an inappropriate manner, during the interview S1 denied shouting at R1 when R1 did not want to take the medication. S1 called assistance from S2 to help with R1. Additionally, LPA interviewed 5 random residents and all stated that they do not have any issues with the staff and that no one has been inappropriate to them. Based on interviews and observations, the department has determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Jul 9, 2026 · control 14-AS-20260707121308

Allegation investigated: Staff do not ensure food is of good quality and quantity Staff do not ensure residents incontinence care needs are being met in a timely manner Staff do not ensure the facility is kept free of mal odors Staff do not have the ability to communicate with the residents

On 5/8/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to deliver conclusionary findings received by the Department on 2/2/2026. LPA Calandra was greeted by Susan Roquel, Assistant Manager and explained the purpose of the visit. Complaint alleged that staff don't ensure that food is of good quality and quantity. LPA toured the kitchen, pantry, and dining room during lunch. No food was expired and the facility had the required 7 days of non perishables and 2 days of perishables on the premises. In addition, LPA Calandra observed dining staff serving a lunch consisting of a starch, vegetables, protein, and fruit. Based on interviews, residents are served 3 meals a day, and snacks whenever they would like them. Complaint also alleged that staff do not ensure residents incontinence care needs are being met in a timely manner. Based on interviews, staff are able to ensure residents' incontinence needs are being met. Unsubstantiated Complaint also alleged that staff do not ensure the facility is kept free of mal odors. LPA toured the physical plant. This is a 3-story building but residents only reside on the 2nd and 3rd floors. LPA Calandra toured the entire building but did not observe any malodorous smells. Complaint also alleged that staff do not have the ability to communicate with residents. Based on interviews and observations, residents are able to communicate with residents and meet their needs. According to the Assistant Manager, Susan Roquel, if staff don't understand a resident, English speaking staff are always available to help translate. Based on interviews and observations, the above allegations are 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 above allegations are unsubstantiated at this time. No deficiencies cited during today’s visit. An exit interview was conducted. A copy of this report was provided to the facility representative.the state’s words, verbatim · CDSS document, May 8, 2026 · control 14-AS-20260202140353

Type of visit: Required - 1 Year

On 9/25/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. LPA Calandra toured the physical plant. This is a 3 story building with 54 bedrooms and 21 bathrooms, staff rooms, lounge, dining room, kitchen, front lobby, beauty salon, and medication room. All bedrooms were observed to have the required furniture and sufficient lighting. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. Hot water temperature was measured within the required range of 105-120 degrees Fahrenheit. The facility's fire alarms and carbon monoxide detectors were observed to be in working order. The facility's fire extinguishers were observed to be fully charged and last checked on February 19, 2025 The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. All soap, sharp objects, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 5 resident files and 6 staff files. All were observed to be complete. LPA also reviewed Personal and Incidental (P&I) monies kept at the facility which matched the facility records. LPA Calandra reviewed Centrally Stored Medications Records(CSMR). A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. During the visit, LPA collected the following documents: Administrator's certificate LIC 610E-Emergency Disaster Plan LIC 500 Liability Insurance Surety Bond LPA requested the following documents be sent to the Department by 10/03/2025: Deed/Control of Property Transportation Policy No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representative and a copy provided via email.the state’s words, verbatim · CDSS document, Sep 25, 2025

Allegation investigated: Staff mishandled a resident's personal belonging

On 9/16/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to deliver conclusionary findings for this complaint investigation. LPA was greeted by facility representative and explained the purpose of the visit. Complaint alleged that facility staff mishandled a resident’s belonging. According to the Reporting Party(RP), R1 had articles of clothing removed by facility staff. Based on document review and interviews, the facility explained to R1 that the facility was going to replace the article of clothing for them and purchased said article of clothing. Based on the fact that facility staff replaced R1’s article of clothing, the allegation is unsubstantiated. 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 above allegation is unsubstantiated at this time. Nothe state’s words, verbatim · CDSS document, Sep 16, 2025 · control 14-AS-20250813095143

Type of visit: Case Management - Other

On 07/31/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management inspection visit in response to Redwood City - Building Inspection and Code Enforcement's notice of violation letters regarding their findings of building A and building C of their notices. LPA met with lead staff Susan Roquel. Administrator Ricardo Aban is out of the facility on leave. During today's visit LPA Vado toured the areas the notice indicates as the basement of building A and C. Basement of building C, rooms 26 through 30 as identified by Susan, are the rooms or area, as far as she knows that code enforcement identified as needing residents to move out of. Her understanding is that notices were provided to those residents and they are scheduled to move out of those rooms prior to the August 18, 2025 deadline given by code enforcement to vacate those rooms. There are currently 9 residents that reside in those rooms. At the time of today's inspection of those rooms, there are 8 residents present in those rooms while 1 are out in the hospital at this time. Per Susan, 3 of those residents are being relocated to other rooms within the facility while the remaining are being relocated out of the facility. She does not know the exact locations they are moving to at this time. Continued on next page... Page 2 As for the basement of building A as identified in code enforcement's notice of violation, LPA toured these areas with Susan and observed all the rooms where staff resided before are now vacant. The rooms are being used as storage and contain items marked as "for donation". LPA observed 4 rooms that were previously labeled as staff rooms per the floor plan on file with the Department and what was used by the Redwood City Fire Department for fire clearance approval. Plus one additional area that was used as a staff room, totalling 5 rooms. All rooms are vacant based on observations made. The facility at this time still maintains an active fire clearance. LPA Vado is requesting the eviction notices provided to those 9 residents and their responsible parties as well as the possible relocation sites for the 6 that are relocating to other facilities. These items are requested to be received as soon as possible. No citations issued. Report is reviewed with Susan and a copy is provided on this day.the state’s words, verbatim · CDSS document, Jul 31, 2025

Allegation investigated: - Facility staff mishandled a resident's personal funds

On 7/24/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to open this complaint received by the Department on 7/22/2025. LPA Calandra was greeted by Susan Roquel, HR Manager and explained the purpose of the visit. Complaint alleged that facility staff mishandled resident's personal funds. Based on interviews and document review, facility staff do not handle R1's personal funds. R1 is conserved and receives an allowance directly from their Case Manager who receives it from R1's Conservator. The Department has investigated the complaint allegation that facility staff mishandled a resident's personal funds. It was determined the allegations are unfounded, meaning the allegations are false, could not have happened and/or is without a reasonable basis and therefore dismissed. An exit interview was conducted. This report reviewed with facility representative and a copy of the report left at the facility. Unfoundedthe state’s words, verbatim · CDSS document, Jul 24, 2025 · control 14-AS-20250722084436

Type of visit: Case Management - Other

On 5/7/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management follow up visit in regards to a previous visit on 4/11/2025 regarding the immediate exclusion of a staff member, S1. LPA Calandra was greeted by Susan Roquel, HR Manager and explained the purpose of the visit. Per interview with Susan Roquel, HR Manager, S1 was terminated and is no longer an employee of the facility. According to Ms. Roquel, S1 has not returned to the facility. No deficiencies were cited during today's visit. An exit interview was conducted. A copy of the report was left with facility representative.the state’s words, verbatim · CDSS document, May 7, 2025

Type of visit: Case Management - Other

On 4/24/2025, Licensing Program Analyst (LPA) John Calandra arrived at the facility to conduct an unannounced case management visit to deliver amended report. LPA met with Administrator, Ricardo Aban and explained the purpose of today's visit. LPA informed Administrator that the LIC 9099 complaint report dated 04/03/2025 was in error marked as confidential. LPA Calandra explained that the report will now be marked as public and provided a copy of the Amended LIC 9099. No other changes to the report are being made. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with the facility representative.the state’s words, verbatim · CDSS document, Apr 24, 2025

Type of visit: POC

On 4/16/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct an unnanounced Plan of Correction(POC) visit in regards to deficiencies cited during a Case Management visit on 4/11/2025. LPA Calandra was greeted by Susan Roquel, HR Manager and explained the purpose of the visit. Ricardo Aban, Executive Director arrived later during the visit. On 4/11/2025, LPA Calandra cited the facility for California Code of Regulations(CCR) 87468.1(a)(2) Personal Rights of all residents and CCR 87411: Personnel Requirements-General. The deficiencies have been corrected and cleared. Copies of the POC (Licensee stated they would provide additional trainings and rosters of staff present) were collected during the visit. The proof of correction letters were drafted and provided to the facility during the visit. An exit interview was conducted. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Apr 16, 2025

Type of visit: Case Management - Incident

On 4/11/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct an unannounced Case Management follow up in regards to a self reported incident received by the Department on 03/17/2025. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. LPA learned that on 03/15/2025, R1 grabbed S1’s hair and began pulling it. S1 attempted to get R1 to stop pulling on S1’s hair by hitting R1. During the incident, S1 was calling other staff for help. S2 responded and helped R1 release S1’s hair from R1’s grasp. According to Ricardo Aban, S1 was indefinitely suspended pending investigation, and the facility conducted a training on 3/17/2025 on the subject of Dealing with Aggressive Behavior and Language in Caring for Persons with Dementia. LPA reviewed and gathered the following documents while at the facility: -LIC 602 for R1 -Appraisal of Needs and Services for R1 -Training certificates for S1 -Activities calendar for April 2025 Deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the due date may result in civil penalties. An exit interview was conducted. A copy of this report along with Appeal Rights was left was with the facility representative.the state’s words, verbatim · CDSS document, Apr 11, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Apr 12, 2025

87468.1(a)(2) Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights.... This requirement is not met as evidenced by: Based on observation and interview, the Licensee failed to ensure R1’s safety when S1 hit R1’s arm with S1’s fist 8 times attempting to release R1’s grasp of S1’s hair, which is an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 11, 2025

Plan of correction: Licensee will conduct an additional training on the subject of Dealing with Agressive Behavior of Persons with Dementia on 4/11/2025. All staff from morning and afternoon shifts will be attending and an attendance sheet will be sent to the Department.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87411(a) · Plan of correction due date: Apr 12, 2025

87411(a) Personnel Requirements-General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by Based on observation, the Licensee failed to ensure that S1 was competent to follow the protocols they were trained on to meet resident needs, which is an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 11, 2025

Plan of correction: Licensee will conduct a training on 4/11/2025 on the subject of Safe Patient Handling. The Department will receive the training materials and attendance sheet as part of the Plan of Correction.

Type of visit: Case Management - Other

On 4/11/2025, Licensing Program Analyst(LPA) John Calandra met with administrator, Ricardo Aban and delivered letter of immediate exclusion for staff #1.the state’s words, verbatim · CDSS document, Apr 11, 2025

Allegation investigated: Facility continues to have bed bug(s) despite professional services being retained.

***THIS IS AN AMENDED REPORT: MARKING THE REPORT AS PUBLIC*** On 4/3/2025, Licensing Program Analyst(LPA) John Calandra met with Ricardo Aban, Executive Director for this conclusionary complaint inspection. On 1/16/2025, LPA Calandra conducted initial complaint inspection and conducted interviews and took a tour of the physical plant. Complaint alleged that the facility continues to have bed bug(s) despite professional services being retained. Based on document review and interviews, staff stated that they have not seen nor received any reports of bed bugs in the facility. Based on review of pest control/exterminator service reports for bed bugs, it is determined that the scope of services covers the interior of the facility on a monthly basis. Based on the Department's investigation, it was determined there was a lack of sufficient evidence to support or deny the allegation. Based on this information, the findings of this allegation are unsubstantiated. This report was reviewed and discussed with facility representative and a copy ofthe state’s words, verbatim · CDSS document, Apr 3, 2025 · control 14-AS-20250114094138

Allegation investigated: Staff do not respond to resident's call button in a timely manner.

On 3/28/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to deliver conclusionary findings for this complaint. LPA was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. LPA gathered documents and conducted interviews during initial complaint investigation on 12/16/2024. LPA later gathered additional documentation regarding the above allegation of a possible personal rights violation in the facility. Complaint alleged that facility staff did not respond to a resident’s call button in a timely manner. Per record review and interviews, staff stated that they did respond to R1's call button and assisted R1 with activities of daily living. Unsubstantiated 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. An exit interview was conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 28, 2025 · control 14-AS-20241211152136

Allegation investigated: Resident was financially abused.

On 1/29/2025, Licensing Program Analyst John Calandra arrived at the facility at 3:15 PM to deliver conclusionary findings for a complaint received on 4/29/2024. LPA was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. Regarding the allegation that a resident (R1) was financially abused, the Department reviewed documents and conducted interviews. S1 stole R1’s driver’s license and other documents and used them to open a bank account under R1’s name without R1’s permission. Based on document review and interviews, LPA Calandra learned that S1 was a caretaker for a private caregiving company and did not work at the facility during the time that the theft took place. Unfounded The Department has investigated the complaint alleging that resident was financially abused. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jan 29, 2025 · control 14-AS-20240429110747

Allegation investigated: Facility staff did not prevent physical altercation(s) between residents which resulted in multiple injuries and hospitalization. Facility staff punched resident in the face. Facility staff do not dispense medications as prescribed. Facility staff do not ensure the facility is free of hazards. There is no night supervision staff on duty who stays awake.

On 1/29/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 12:35 PM to deliver conclusionary findings for a complaint received by the Department on 7/16/2024. LPA met with Ricardo Aban, Executive Director and explained the purpose of the visit. Regarding the allegation that facility staff did not prevent physical altercation(s) between residents which resulted in multiple injuries and hospitalization. The reporting party stated that R1 had sustained significant injuries including head trauma and a fracture. Information regarding time and date could not be obtained. RP also stated that R1 had obtained scars, but no documentation of scars could be provided. In addition, the inspector could not verify scarring based on observation. Based on interviews and document review, no evidence of head trauma or fracture was found. Unsubstantiated Complaint alleges that facility staff punched resident in the face. According to the Reporting Party, R1 was attacked by staff on two separate occasions. Based on interviews and document, R1 was admitted to the hospital but no documentation of R1’s injuries could be obtained. Through the course of the investigation, it was learned that R1 had assaulted staff on one of these occasions. Additional details could not be obtained on either attack such as date, time, place, assailant, etc. Furthermore, it is unknown whether R1 was the assailant or victim as no injuries were sustained. Regarding the allegation, that facility staff do not dispense medications as prescribed, LPA reviewed documents and interviewed staff. According to the reporting party, the Facility did not get a resident’s medication on time and the resident had to wait 30 days. Reporting party states that one resident’s medication consistently went missing.Record reviews showed that medications were given on time and that no medications were missing for R1. Regarding the allegation, that facility staff do not ensure the facility is free of hazards, LPA toured the physical plant. According to the reporting party, the facility has electrical outlets with open wires, a ramp outside that has holes, and a bathroom has a towel rack where a grab bar should be installed. Based on observations, none of these hazards are present. Complaint alleges that there is no night supervision staff on duty that stays awake. Per Reporting Party, staff are not awake and asleep in the Executive Director’s office. Based on document review, the facility does have awake night supervision staff. Through interviews, LPA learned that the Administrator’s office is locked in the evenings and night supervision staff are unable to access it. The Agency has investigated the above allegations. The allegations are UNSUBSTANTIATED meaning that 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. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jan 29, 2025 · control 14-AS-20240717093038

Allegation investigated: Lack of supervision resulted in resident falling and sustaining multiple fractures Facility staff did not seek timely medical attention for resident

On December 18, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 8:40 AM to conclude a complaint investigation. Initial complaint visit was on 5/1/2024. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. Regarding the allegation that lack of supervision resulted in resident falling and sustaining multiple fractures, the Department reviewed documents and conducted interviews. Based on document, R1 was a fall risk. Based on interviews, staff were aware that R1 had multiple fall incidents but were not able to provide details on how many times R1 fell, and there is no documentation about any injuries from R1's falls. In addition, some staff were unaware that R1 was a fall risk. On 3/6/2024, R1 fell at 0500 hours,but staff were unaware R1 had fallen until it was reported by R1 at approximately 0900 hours. Furthermore, staff were aware that R1 had fallen multiple times but did not know R1 had sustained fractures. Substantiated Regarding the allegation that facility staff did not seek timely medical attention for resident the department conducted an investigation. Based on interviews and records, R1 had a fall at the facility on 3/6/2024 at approximately 0500 hours and family was contacted at 0900 hours. Family did not arrive at the facility until between 1000-1100 hours at which time R1 was found in bed and 911 was called. In addition, facility staff indicated a change in condition but did not call 911 or seek timely medical attention. A finding that the complaint is SUBSTANTIATED means that the allegations are valid because the preponderance of evidence standard has been met. An LIC421IM form issuing an immediate civil penalty of $500 was provided. The immediate civil penalty of $500 was issued today due to absence of supervision that occurred on 03/06/2024 in which a resident fell but facility staff were unaware of the fall until 4 hours after the incident. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. An exit interview was conducted and appeal rights provided. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Dec 18, 2024 · control 14-AS-20240430084430

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Dec 18, 2024

87465(g) Incidental Medical and Dental Care: The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat.... This requirement was not met as evidenced by: Based on interviews, R1 fell at the facility at 0500 hours but facility staff did not call 911 until R1’s family arrived at the facility 5-6 hours later. This is an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 18, 2024

Plan of correction: Licensee/Administrator to submit to CCLD details on additional training to be conducted on 911 including attendee log, details such as topics covered, and qualifications of professional trainer. Licensee changed policy to conduct hourly checks on residents who are identified as a fall risk. Licensee also conducted a 911 training on 9/5/2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Dec 19, 2024

87464(f)(1) Basic Services: Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on record review and interviews, R1 fell in their bathroom and staff did not know R1 had fallen until four hours later. Per documents review, R1 was a fall risk. In addition based on staff interviewed, staff were to conduct hourly checks on R1 however, due to a lack of supervision, R1 fell and the facility did not know until four hours later. This is an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 18, 2024

Plan of correction: Licensee/Administrator shall increase monitoring of residents who are identified as a fall risk to 30 minutes. Additional training on room checks and identifying to staff which residents are a fall risk will be conducted. Licensee/Administrator to submit plan of dates of training, content, trainer qualifications/contact information, list of attendees.

Allegation investigated: Facility staff did not properly address pest infestation. Facility staff did not ensure timely medical attention resulting in injury.

On November 14, 2024, Licensing Program Analyst (LPA) John Calandra arrived at the facility to conclude a complaint investigation. Initial complaint was conducted on 10/23/2024. On previous visit on 10/23/2024, LPA interviewed residents and staff. Also, LPA requested documents during last visit and those have been reviewed. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. Regarding the allegation that facility staff did not properly address a pest infestation in the facility, LPA interviewed staff and collected documents. Based on record review, it was found that the facility’s pest control company was providing bed bug mitigation services indicating that the facility had a bed bug infestation from 3/1/2024 to 8/1/2024 which led to a resident being sent to the hospital for the worst case of bed bugs. Regarding the allegation that facility staff did not ensure timely medical attention resulting in injury, LPA interviewed staff and Executive Director. Based upon interview of Executive Director, it was found that (R2) had been found in R2’s room with R2’s head bleeding. Facility staff provided first aid care and then waited for the Executive Director to come to the facility before calling 911. While being transported to the hospital R2 reported being attacked by R2’s roommate. A finding that the complaint is SUBSTANTIATED means that the allegations are valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal rights provided. Substantiatedthe state’s words, verbatim · CDSS document, Nov 14, 2024 · control 14-AS-20240801084531

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(2) · Plan of correction due date: Nov 15, 2024

87307(d)(2): Personal Accommodations and Services - The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Based on record review, it was found that the facility’s pest control company was providing bed bug mitigation services indicating that the facility had a bed bug infestation from 3/1/2024 to 8/1/2024 which led to a resident being sent the hospital for the worst case of bed bugs. a resident (R1) went to the hospital with a nurse reporting that R1 was infested with bed bugs. This is an immediate health and safety hazard to residents in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Licensee/Administrator shall submit a plan in writing from the exterminator showing how all bed bugs will be eradicated from the facility including the date when services will be concluded.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Nov 15, 2024

87468.1(a)(2): Personal Rights of Residents in All Facilities - To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interview of Executive Director and staff, R2 was found in R2’s room with blood on R2’s face. 911 was called by the Executive Director to rule out possible further injuries and told the Paramedics and Police that R2 was attacked by R2’s roommate which shows that R2 was not afforded safe, healthful accommodations and is an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Administrator/Licensee to submit a plan of correction showing how they will ensure the safety of residents in the facility. This shall include any trainings provided to staff, list of staff attending, and any other changes to protocol.

Type of visit: POC

On October 31, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 2:45PM to conduct a Plan of Correction (POC) visit to stop Civil Penalties assessed on October 21, 2024 regarding complaint #14-AS-20241015090138 and clear the deficiencies. LPA Calandra was greeted by Susan Roquel HR Manager and explained the purpose of the visit. Ricardo Aban, Executive Director arrived later during the visit. No deficiencies were cited during today's visit. An exit interview was conducted and this report was reviewed with Ricardo Aban, Executive Director and a copy along with the POC clearance letters left at the facility.the state’s words, verbatim · CDSS document, Oct 31, 2024

Type of visit: Case Management - Other

On October 21, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to deliver a copy of amended report from 10/18/24 and issue and immediate $500.00 civil penalty in relation to complaint control: 14-AS-20241015090138 for facility violating California Code of Regulation (CCR) 87468.1 Personal Rights of Residents in All Facilities. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit. Report is reviewed with Administrator and a copy is provided. A copy of the civil penalty and appeal rights is also provided.the state’s words, verbatim · CDSS document, Oct 21, 2024

Type of visit: POC

On October 21, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced plan of correction visit in response to a visit that was conducted on 10/18/2024. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit. On October 18, 2024, LPA Charitra conducted a complaint visit and issued a deficiency for CCR 87303(a) Maintenance and Operation. The due date for this deficiency was 10/19/2024. In addition, LPA conducted an unannounced case management visit for CCR 87205(a) Accountability of Licensee Governing Body and 87405(h)(1) Administrator- Qualifications and Duties. The due date for these deficiencies were 10/19/2024. 87205 - Accountability of Licensee Governing Body – Regarding this POC you submitted, please provide clarification regarding the following: Since using the same exterminator as used previous, please explain how facility will eradicate bed bugs for entire facility. The administrator will provide detailed exterminator contract services being provided at facility with specifics in regard to: dates of services, how frequent, duration, areas covered, how residents are and will be affected, how will they be accommodated, how will residents and their families be notified? How will facility ensure the safety of residents during extermination services? What are the “bed bug detection tools being referenced to and in what manner being used for specifically? 87405 Administrator-Qualifications and Duties - Proof that the pest control company he hires is licensed, and perhaps a estimate or written outline from the exterminator on their letterhead what their plan is for treating bed bugs. Who is providing the staff training and following facility’s established bed bug management policy – what is the policy? What specifically are the staff going to be trained in and who is providing the training? When will the training be conducted? How often? Will it be logged and sent to licensing? Transparent communication with residents and their families; how will this be done? What method and how frequent? He talks about cost efficiency. What does that mean in terms of the pest control services? How will you be in compliance with health department guidelines and please specify what those are? What are the alternate accommodations being referred to for residents in the event that is needed? 87303 Maintenance and Operation - How often will CCL be notified and specifically state how you will ensure you will be in compliance with the regulation section – maintenance and operation. Provide a written estimate from an exterminator company that specifies the services covered; frequency of extermination services; if there will be a possibility that residents may have to relocate due to harmful toxics during fumigation, what and where does the administrator accommodate them; how often he will notify CCL, i.e. weekly, monthly, etc and for how long? Finally, how will you ensure compliance with this regulation? (Cont. to 809C) Due to the citation 87303(a) Maintenance and Operation, not being corrected by 10/19/24 a civil penalty is being assessed in the amount of $100 a day from 10/20/24-10/21/24 and will continue to accrue until corrected. Due to the citation 87205(a) Accountability of Licensee Governing Body, not being corrected by 10/19/24 a civil penalty is being assessed in the amount of $100 a day from 10/20/24-10/21/24 and will continue to accrue until corrected. Due to the citation 87405(h)(1) Administrator- Qualifications and Duties not being corrected by 10/19/24 a civil penalty is being assessed in the amount of $100 a day from 10/20/24-10/21/24 and will continue to accrue until corrected. Report is reviewed with Administrator. A copy of the report is provided. A copy of the civil penalties is provided with appeal rights.the state’s words, verbatim · CDSS document, Oct 21, 2024

Allegation investigated: -Facility has bed bugs.

On October 21, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced visit to deliver a copy of amended LIC9099 and LIC9099D report from 10/18/24 and issue an immediate $500.00 civil penalty for facility violating CCR 87468.1 Personal Rights of Residents in All Facilities. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit. The Department assesses a civil penalty for a Zero Tolerance Violation (ZTV) for a violation of a licensing requirement that falls under one of the following categories: Violation that resulted in the injury or illness of an individual in care. The facility was found to be in violation of this section as facility was found to be unsafe and unhealthy due to R1 being bitten by bed bugs as indicated by medical discharge notes in the hospital ER on 10/12/2024. This is an immediate health and safety hazard to residents in care. On October 18, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced 10-day complaint visit. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit. Regarding the allegation, facility has bed bugs, it was reported that the facility has bed bugs. It is further alleged that residents complained to several staff regarding this issue as they have been enduring repeated incidents for 7 months of getting bitten several times by the bed bugs. Although staff members were aware of this, it had not been addressed resulting in at least one resident (R1) being transported to the hospital on 10/12/2024 where he was treated in the emergency room. During the investigation, LPA interviewed staff, resident, reviewed documents, and interviewed third party exterminating company. According to administrator interviewed, the bed bug issue at the facility has been going on since March of 2024 and the facility has had third party vendor, Western Exterminator Company coming into the facility every month to eradicate specific rooms at the facility that have bed bugs based on the inspection conducted by Western Exterminators. In addition, according to the administrator, the facility has not been fully treated by Western Exterminator Company and plans on scheduling a treatment plan which includes phases to eradicate the entire facility. According to the third-party exterminating company, it was indicated that the facility has a monthly agreement with the exterminators for rodents and insects which is under the general pest control agreement between the facility and Western Exterminator Company. (Cont. to 9099C). Substantiated Based on what R1 requests, staff deny that R1 has requested this medication be given this frequent, it is our (4) times a day, it cannot be determined if there is a violation due to conflicting statements. Based on the Department's investigation, it was determined there was a lack of sufficient evidence to support or deny the allegation. Based on this information, the findings of this allegation is unsubstantiated. This report was reviewed with Administrator, Ricardo Aban, and a copy is provided. A copy of this report must be made available for public review upon request. In addition, it was stated that the bed bugs service is under a different agreement which needs to be requested from the other party. According to the administrator and invoices provided by the facility as a contract between Western Exterminator Company and Hopkins Manor was not provided, it was noted that the bed bug monthly inspection initially began in March of 2024 when a housekeeper observed bed bugs, however all invoices show that specific rooms were only treated. LPA reviewed records and conducted interviews with R1 and staff (S1) and (S2). Upon review of the hospital discharge papers, it was indicated that the cause of R1's bites was the result of bed bugs. Based on all the above information, along with the hospital discharge note where a medical professional determined the bites were the result of bed bugs, this allegation is found to be true. Based on the investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. The deficiencies cited on the following page are in violation of the California Code of Regulations, Title 22, Division 6, Chapter 8, Article 5. Failure to correct said deficiencies may result in additional civil penalties. This report was reviewed with Administrator, Ricardo Aban, and a copy is provided. A copy of this report must be made available for public review upon request. Appeal rights given and explained during the visit.the state’s words, verbatim · CDSS document, Oct 18, 2024 · control 14-AS-20241015090138

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Oct 19, 2024

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. This requirement is not met as evidenced by: Based on obtained relevant records including: incident reports indicating bed bug issues (dated from March 2024 – current); medical documentation of R1 discharge notes that indicate R1 had bites due to bed bugs, and facility invoices for exterminator services. This resulted in a resident (R1) going to the hospital ER on 10/12/2024 with doctors determining the bites were caused by bed bugs. This is an immediate health and safety hazard to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2024

Plan of correction: Licensee/Administrator shall submit a plan in writing on how to ensure bed bugs are being eradicating throughout the entire facility. Plan shall include, company name, how often exterminators will come, where the exterminators with eradicate. Plan shall also include informing CCL regarding all services moving forward to ensure facility is in compliance with CCR 87303(a).

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Oct 22, 2024

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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interviews conducted and records obtained: R1 was transported to the hospital ER on 10/12/2024 where doctors determined he had been bitten by bed bugs at the facility. This is an immediate health and safety hazard to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2024

Plan of correction: Licensee/administrator shall submit a plan in writing on how to ensure the bed bugs at the facility will be eradicated. Plan shall include notifying CCL with eradication process, invoices from exterminators, how often the exterminators will be coming in. An immediate civil penalty for a zero tolerance violation in regard to a violation of personal rights of the California Code of Regulations Title 22 is hereby assessed for $500.. Subsequent violations will result in additional civil penalties.

Type of visit: Case Management - Deficiencies

On October 18, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit in relation to complaint #: 14-AS-20241015090138. LPA met with Administrator, Ricardo Aban and explained the purpose of the visit. During the complaint investigation conducted on 10/18/24, the facility has had bed bugs as an ongoing problem since March 7, 2024. LPA reviewed and obtained documentation related to exterminator services conducted by Western Exterminator Company. Based on review of this, it appears these services have been ongoing for ten (10) years with monthly provider services. However, upon further review of this, this extermination services contract with facility indicates, the services are specific for rodents and insects. Nowhere in these extermination services is listed as bed bugs being addressed. Based on this, it proves there was a lack of follow through on the part of the facility administrator for accountability, failing to ensure the best interest and welfare of their residents, and failing to establish policies regarding operation within licensing regulations. In addition, the administrator also failed to take responsibility and administer the facility operation in accordance with licensing regulations, resulting in an unsafe environment for residents. The deficiencies cited on the following page are in violation of the California Code of Regulations, Title 22, Division 6, Chapter 8. Failure to correct said deficiencies may result in additional civil penalties. This report was reviewed with facility representative, and a copy of this report must be made available for public review upon request. A copy of this report is provided to the facility. Appeal rights discussed and provided to facility representative during the visit.the state’s words, verbatim · CDSS document, Oct 18, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87205(a) · Plan of correction due date: Oct 19, 2024

87205 Accountability of Licensee Governing Body: (a)The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This regulation is not met as evidenced by: Based on information obtained, the facility having ongoing bed bug problems since March of 2024. The licensee did not exercise general supervision of the facility that resulted in ongoing issues of bed bugs wherein R1 was directly harmed and bitten by bed bugs. This resulted in R1 being transported to the hospital emergency room where a medical professional determined R1 had been bitten by bed bugs. This is an immediate health and safety hazard to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2024

Plan of correction: Licensee/administrator to submit a plan in writing to describe how ensure compliance with CCR 87205(a).

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(h)(1) · Plan of correction due date: Oct 19, 2024

87405 Administrator - Qualifications and Duties: (h) The administrator shall have the responsibility to: (1) Administer the facility in accordance with these regulations and established policy, program and budget. This regulation is not met as evidenced by: Based on LPAs review of records and interviews regarding the Administrator failing to take responsibility and administer facility operation in accordance with licensing regulations. It is noted that facility has exterminator monthly services, however upon review of this, the services do not address extermination of bed bugs for the entire facility. This resulted in at least one resident (R1) being harmed and bitten by bed bugs. This is an immediate health and safety hazard to residents in car. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2024

Plan of correction: Licensee/administrator to submit a plan in writing to describe how administrator will comply with CCR 87405 Administrator Qualifications and Duties.

Type of visit: Case Management - Other

On September 25, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 1:05 PM to conduct an unannounced Case Management visit in regards to an incident involving a resident who attacked another resident reported by the licensed facility on September 5, 2024. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. Based on review of the incident report, staff interviews, and document review, the facility did not ensure residents’ were afforded safe, healthful, and comfortable accommodations which lead to a resident being attacked in their shared room by another resident. A Type A violation was provided for not ensuring residents were afforded safe, healthful, and comfortable accommodations in their shared room. The deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the due date may result in civil penalties. An exit interview was conducted. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report along with Appeal Rights was left at the facility.the state’s words, verbatim · CDSS document, Sep 25, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Sep 26, 2024

87468.1(a)(2): 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:….. (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by interviews of staff in which the LPA learned that staff were on the other side of the facility, and unable to hear the attack occurring in the resident’s room therefore not being able to prevent it from occurring.the state’s words, verbatim · CDSS document, Sep 25, 2024

Plan of correction: Administrator/Licensee to submit proof of correction and a written plan outlining how this violation will be avoided in the future to licensing office by due date.

Type of visit: Case Management - Annual Continuation

On September 25, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to complete the unannounced 1-year required Annual Inspection. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. LPA Calandra reviewed 6 resident files. All were observed to be complete. A review of the facility first aid kit showed that it had all the required components: a current edition of the first aid manual approved by the American Red Cross, sterile first aid dressing, bandages, scissors, tweezers. LPAs also reviewed Personal and Incidental (P&I) monies kept at the facility. All P&I money kept at the facility matches the facility records. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Sep 25, 2024

Type of visit: Case Management - Other

On September 20, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 8:35 AM, to conduct a Case Management visit regarding an incident that occurred on August 29, 2024, in which a resident attacked another resident. LPA Calandra was greeted by Susan Roquel, HR Manager and explained the purpose of the visit. Ricardo Aban, Executive Director arrived later during the visit. LPA Calandra requested and reviewed the following documents: -LIC 602: Physician's reports for both residents involved -Most up to date LIC 500: Personnel Summary Report(lists all staff working at the facility and their shifts) -Staff meeting sign in sheet for latest training post incident -Dementia Care Plan of Operation LPA Calandra also interviewed staff. Based on these interviews and review of the facility updated LIC 500, the Dementia Care Plan, etc., LPA found that the facility was following their own policies/procedures and not in violation of Title 22 or the Health and Safety Code. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Sep 20, 2024

Type of visit: Required - 1 Year

On September 20, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 1:00 PM to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. LPA Calandra toured the physical plant. This is a 3 story building with 54 bedrooms and 21 bathrooms, staff rooms, lounge, dining room, kitchen, front lobby, beauty salon, and medication room. All bedrooms were observed to have the required furniture and sufficient lighting. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. Hot water temperature was measured within the required range of 105-120 degrees Fahrenheit. The facility's fire alarms and carbon monoxide detectors were observed to be in working order. The facility's fire extinguishers were observed to be fully charged and last checked on February 26, 2024 The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. All sharp objects, poisons, and cleaning supplies were observed to be locked and in-accessible to persons in care. LPA Calandra reviewed 6 staff files. All were observed to be complete. A review of Centrally Stored Medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. No deficiencies were cited during today's visit. The Annual inspection will be completed at a later date. An exit interview was conducted. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Sep 20, 2024

Type of visit: Case Management - Other

On September 4, 2024, Licensing Program Analysts(LPAs) John Calandra and Kiran Jain arrived at the facility to deliver an Amended report that was written on August 1, 2024. LPAs Calandra and Jain were greeted by Quennie Ramos, Medtech and Caregiver. Susan Roquel, HR Manager and Ricardo Aban, Executive Director joined the visit later. An exit interview was conducted. This report was reviewed with Susan Roquel, HR Manager and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Sep 4, 2024

Type of visit: Case Management - Other

On August 30, 2024, Licensing Program Analysts(LPA) John Calandra arrived at the facility at 8:30 AM to conduct a Case Management visit in response to a complaint investigation visit conducted on August 15, 2024. LPA Calandra was greeted by Susan Roquel, HR Manager and explained the purpose of the visit. During the visit on August 15, 2024, LPA Calandra learned that the incident had not been reported to Licensing. LPA Calandra explained Community Care Licensing's reporting requirements to Ricardo Aban on August 15, 2024. A Type B violation is being provided today, August 30, 2024, for not reporting the incident. An exit interview was conducted. This report was reviewed with Susan Roquel, HR Manager and a copy of the report along with Appeal Rights left at the facility.the state’s words, verbatim · CDSS document, Aug 30, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 15, 2024

CCR 87211(a)(1)(D) Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department..A written report shall be submitted to the licensing agency within seven days of the occurrence. This requirement is not met as evidenced by an interview with Ricardo Aban, Executive Director, in 2 out of 2 incidents, which was not reported to Licensing, which poses a potential health/safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 30, 2024

Plan of correction: Licensee/Administrator to submit proof of correction and a written plan outlining how this violation will be avoided in the future to licensing office by due date.

Type of visit: Case Management - Incident

On August 30, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 8:30 AM to conduct a Case Management visit to follow up on an incident that occurred on July 25, 2024 in which it was noticed that R1 had blood coming from R1's head. LPA Calandra was greeted by Susan Roquel, HR Manager and explained the purpose of the visit. LPA Calandra interviewed Susan Roquel, HR Manager. As of the date of the interview, the facility is still investigating the incident. An exit interview was conducted. This report was reviewed with Susan Roquel, HR Manager and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Aug 30, 2024

Type of visit: POC

On August 30, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Plan of Correction clearance visit in regards to a citation delivered on August 30, 2024. As of today, August 30, 2024, the Deficiency is considered cleared. An exit interview was conducted. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Aug 30, 2024

Allegation investigated: -Staff spoke innapropriately to residents

Licensing Program Analysts(LPAs) John Calandra and Kiran Jain met with facility representative to open the complaint received on 8.12.2024 and to deliver conclusionary findings for this complaint. LPAs were greeted by Ricardo Aban, Executive Director and explained the purpose of the visit. Regarding the allegation that staff spoke inapropriately to residents, LPAs Calandra and Jain interviewed residents. Through these interviews, the LPAs learned that it is not staff but other residents who are yelling inappropriate language and bad words at other residents and that staffing is not a problem at the facility. The agency has investigated the allegation that staff spoke inapropriately to residents. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted. This report was reviewed with Ricardo Aban, Executive Director and a copy of the report left at the facility. Unfoundedthe state’s words, verbatim · CDSS document, Aug 15, 2024 · control 14-AS-20240812164942

Type of visit: Office

On 06/21/2024, San Bruno Regional Office conducted a non-compliance conference meeting with licensee members Wendy Wong, Olive Manalastas, Carrie Bautista, and John Lee. Administrator Ricardo Aban and attorney Jake Reinhardt are also in attendance on behalf of the facility. Present in the meeting is Regional Manager, Vivien Helbling, Licensing Program Managers April Cowan, Andrea Medlin, and Licensing Program Analysts, Jaime Vado and Alicia Delmundo. During this non-compliance meeting, the following violation was discussed, Incidental Medical and Dental Care. Additionally it was discussed that the facility will be cited under 87469(c)(2) - Incidental Medical and Dental Care. The facility staff did not inform 911 of the advance directive for R1 and did not provide emergency services the advance directive information at time of arrival of medical services and the fire department which caused confusion during an emergency situation. This poses an immediate health and safety risk to residents in care. During this meeting, it was discussed, Licensee will receive more frequent monitoring inspection visits to ensure compliance with this compliance plan and Title 22 Regulations for 2 years. Licensee was provided the link below for resources and guidance to improve facility operations: https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers Deficiencies of the California Code of Regulations, Title, 22 are cited on the attached LIC809D. Additional civil penalties may be assessedthe state’s words, verbatim · CDSS document, Jun 21, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87469(c)(2) · Plan of correction due date: Jun 22, 2024

87469 Advanced Directives and Requests Regarding Resuscitative Measures:(c) If a resident who has an advance directive and/or request regarding resuscitative measures form on file experiences a medical emergency, facility staff shall do one of the following:(2) Immediately give the advance directive and/or request regarding resuscitative measures form to a physician, registered nurse or licensed vocational nurse if the physician or nurse is in the resident’s presence at the time of the emergency and assumes responsibility. This regulation has not been met as evidenced by: Based on the investigaton interviews it was discovered that the facility staff did not inform 911 of the advance directive for R1 and did not provide emergency services the advance directive information at time of arrival of medical services and the fire department at time of their arrival which caused confusion during an emergency situation. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 21, 2024

Plan of correction: The licensee shall develop a written plan the facility written plan for staff regarding training on what to do during an emergency, what documents are to be provided to emergency personnel, identify staff who will call 911. Describe staff responsibilities during initiation of 911. Who will provide the advance directive and/or request regarding resuscitative measures form to emergency or medical personnel in the time of an emergency.

Allegation investigated: - Staff do not answer residents calls for assistance timey

On 06/10/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver the findings regarding the allegation received. LPA met with the administrator Ricardo Aban and explained the purpose of today's visit. During the investigation, LPA conducted interviews with staff, R1, and reviewed pertinent documents. Per interviews it was found there were call button calls made by R1 to the front desk nurses station. The button was pressed about 2 to 3 times during the time frame of 630pm to 7pm by R1 according to the staff person who worked that evening at the front desk. The staff person interviewed indicated that the call button system was working. The front desk staff alerted caregiving staff via facility radio to assist R1 but had no way of confirming that staff did respond timely to assist R1. Per documentation reveiwed and interviews conducted this allegation is substantiated. Based on LPA interviews and items letters received, 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, are being cited on the attached LIC9099D. Report is reviewed with Ricardo and copy is provided. Substantiatedthe state’s words, verbatim · CDSS document, Jun 10, 2024 · control 14-AS-20240503102451

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jun 14, 2024

87468.2 (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This regulation has not been met as evidenced by: This regulation has not been met as evidenced by: Per interviews and documentation reviewed, it was found that there were confirmed call button pushes between 630pm and 7pm at least 2 or 3 times indicating staff did not meet the calls for assistance of R1 to meet their needs.the state’s words, verbatim · CDSS document, Jun 10, 2024

Plan of correction: Facility shall develop a paln of correction to ensure this regulation is met at all times. Such plan shall be received by the due date indicated.

Allegation investigated: - Staff did not notify the fire department of a death at the facility in a timely manner

On 05/08/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigaiton visit in order to deliver the findings for the above allegation. LPA met wtih the administrator Ricardo Aban and explained the purpose of today's visit. During the investigation period it was found that S1 and S2 went to check on R1 between 530am and 6am and R1 was alert and they cared for R1 and by the time they finished caring for R1, R1's eyes were closed, but did not appear to be asleep. R1 appeared stiff and not moving. S3 was contacted via text and called at 619am from S2 who infomred that R1 was non-responsive. S4 instructed them to call 911. S3 informed 911 dispatcher that the resident had been non-responsive for an hour, factoring in the time S1 and S2 met with R1 to provide care, the time it took to provide the care, the time they took to notify S4, and when S3 called and spoke with 911 dispatcher. S4 stated that staff should have call 911 instead of calling him/her first. This allegation is substantiated. Based on LPA interviews and items, and letters received, 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, are being cited on the attached LIC9099D. Report is reviewed with administrator and a copy of this report is provided. Substantiatedthe state’s words, verbatim · CDSS document, May 8, 2024 · control 14-AS-20231218104902

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(2) · Plan of correction due date: May 9, 2024

87465 Incidental Medical and Dental Care - (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement has not been met as evidenced by: Based on the investigation conducted, caregivers S1, S2, and S3 did not seek timely medical attention for R1. S1, S2, and S3 did not call 911 immediately but sought advice from S4 on what to do in this situation. 911 was alerted approximatley after 1 hour after R1 was found unresponsive. Timely medical attention was not sought in a timely manner.the state’s words, verbatim · CDSS document, May 8, 2024

Plan of correction: Facility shall develop a plan of correction (POC) to ensure compliance with Sec.87465(a)(1). Facility will develop a plan to address meeting the resident's medical attention in a timely manner without delay. That plan will be received in CCLD to address deficiency.

Allegation investigated: - Facility is unsanitary - Facility is unkempt - Facility staff does not ensure the facility is free of hazards

On 03/20/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to deliver findings regarding the allegations received. LPA met with the administrator Ricardo Aban. During the investigation LPA conducted interviews and made facility observations. LPA observed the kitchen area during a meal time, and after, and there were no observations of rodents, or other pests. The facility is contracted with a pest control company regularly who visit twice a month going back several years as a precaution to prevent any pests or rodents. LPA observed the way excess meals are stored for residents as covered and labled with names. Bathrooms were inspected and did not see it as unkempt. Interviews show that there is a cleaning schedule in place and LPA observed staff cleaning the kitchen post lunch being served and there are janitor services in place. In regards to the facility free of hazards, it was referenced that there was construction and maintenance. LPA observed outside area under maintenance as being roped off with yellow caution tape and two contractors were in the area. The tools and supplies were pushed to the sides and out of residents way. Construction materials were observed as well stored under a sheltered area along the sides of the facility out of walkways. These allegations are unsubstantiated based on observations and interviews conducted. Based on these observations, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 20, 2024 · control 14-AS-20240112085327

Type of visit: Case Management - Incident

On 02/06/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - incident visit regarding an incident report received on 02/05/2024 and discussed with administrator Ricardo on the same day. R1 left the facility on 02/04/2024 around 5:00pm but didn't return back to the facility by 7:30pm so the facility began to search the neighborhood by car as the weather was bad due to the storm that hit the area. Staff physically went to the local hospitals, hotels, and the church R1 regularly attended every Sunday. By 10pm R1 had not returned to the facility so the facility filed a missing person report with the police department on the same day. On 02/05/2024 by around 11:00am the police department and coroners office visited the facility and informed them that R1 had passed away near the facility. R1 was struck by a vehicle that did not stop at a crosswalk during the stormy weather and the traffic lights were out due to power outages in the area. The facility did not suffer from a power outage. Staff was able to positively identify that it was R1 per the physical description provided to the facility. Administrator provided LPA with resident documents on this day and discussed the timeline of events and indicated that responsible parties were notified,the Department, including the local Long Term Care Ombudsman as well. Administrator stated the police department and coroners office did not provide report numbers or death reports to the facility at their time of visit on 02/05/2024 as the death is still under investigation. Report is reviewed with administrator Ricardo.the state’s words, verbatim · CDSS document, Feb 6, 2024

Allegation investigated: - Staff confined resident in his room - Staff did not provide a safe and comfortable environment for resident

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to investigate the allegations received. LPA met with the administrator Ricardo Aban and explained the purpose of this visit. During the course of the investigation, LPA made observations of the room of R1, locking mechanism of the door of R1, reviewed pertinent documents, and conducted interviews. LPA observed the lock on the door of R1 as not facing out, but rather is lockable from inside the room of R1. LPA checked the door and locking it from the inside. Although the door is lockable from inside the room of R1staff can open it without a key. When observing the room of R1 he/she was in the room and LPA observed him close the door and lock the door on his own. Later during the visit LPA observed him leaving his room and walking around the facility. These allegations are unsubstantiated. Based on these observations, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. Report is reviewed with the administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 10, 2024 · control 14-AS-20231122083602