Ivy Park at Laguna Woods

Type of visit: POC

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a proof of correction visit. LPA met with Executive Director in Training (EDT) Jessica Hernandez and explained the reason for the visit. 3 citations were issued as a result of the complaint investigation for complaint # 22-AS-20260727134625 dated July 27, 2026. In regards to the citation CCR 87468.1(a)(6), facility staff is in the process of being training on that regulation. The correction is not complete but is in process. The EDT asked for an extension because of the number of staff that require training. LPA granted and extension for the correction of this citation. The correction for this citation is due September 11, 2026. The EDT stated she understood. The EDT reported that once training is complete, the in service training roster will be forwarded to the LPA. The citation for CCR 87468.2(a)(6) has been corrected. LPA observed Resident 1 (R1) is no longer wearing the Wanderguard. LPA provided the proof of correction letter for this citation to the EDT. The correction for CCR 87507(g)(3)(B)(5) has not been completed The EDT requested an extension as the new updated care plan is in the process of being changed/updated. LPA advised the new care plan should be completed and submitted to the LPA by Tuesday September 8, 2026. LPA informed the EDT that subsequent visits to verify the corrections of the citations are possible, the EDT stated she understood. During the visit no deficiencies were observed. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Sep 3, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced case management visit. LPA met with Executive Director in training Jessica Hernandez and explained the reason for the visit. During the investigation of complaint # 22-AS-20260727134625, dated July 27, 2026, the plan of operation for the facility was reviewed. The plan of operation for the facility submitted at the time of Licensing (facility was licensed on July 26, 2023) did not include a Dementia Care plan and did not include any provisions for utilizing resident tracking devices such as Wanderguards. The Executive Director reported that the facility does have a plan for Dementia Care and for using Wanderguards. LPA explained to the Executive Director that changes and updates to the plan of Operation must be provided to the Regional Office for approval prior to the facility implementing the change or update. At this time the facility has 9 residents who are wearing Wanderguards, including Resident 1 (R1) who has been diagnosed with Dementia. As of August 31, 2026, the Regional Office has not received a change or update to the plan of operation for Dementia Care or for utilizing Wanderguards. Facility does not have an approved Dementia Care plan, or provision for using Wanderguards at the facility, on file with the Agency. The facility is not following their current plan of operation. During this visit no other deficiencies were observed. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulation (CCR). An exit interview was conducted with the Executive Director in training and a copy of the report provided along with appeal rights.the state’s words, verbatim · CDSS document, Aug 31, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87208(a) · Plan of correction due date: Sep 15, 2026

The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so... This requirement is not being met was evidenced by, a review of records shows the facility plan of operation does not include a Dementia Care plan and has no providsions for using a resident tracking device or Wanderguard, but Resident 1 resides at the facility and the facility has R1 wearing a wanderguard. This poses an immediate personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 31, 2026

Plan of correction: Licensee agrees to update the plan of operation to include a Dementia Care plan and a plan to utilize resident tracking devices like a Wanderguard.

Allegation investigated: Staff stole resident's personal items

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegation. LPA arrived at the facility and was greeted and granted entry. LPA met with Zehra Syed, Executive Director, and explained the purpose of the visit. Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, police report and interviews conducted. It is alleged that staff stole resident’s personal items from resident (R1) locked closet in their apartment and from resident (R2) personal items stored in two assigned storage units. Interview with 2 of 2 staff stated that R1 was installed a lock in a closet in their apartment, when lock was installed, staff gave R1 Continued on LIC9099-C Unsubstantiated two sets of keys. R1 was the only person with keys to the lock. For R2 when the license and the building were under the previous license, they had issued lockers at no charge to residents, and R2 was one of the residents’ assigned to the lockers. When a resident moves into the community they are given the LIC621 resident personal property and valuables form to fill out along with appendix K theft and loss policy in the admissions agreement. It is the responsibility of the resident to complete the form and submit it to staff and/or when they bring new items it is their responsibility to update the form and inform the staff. On both incidents staff were made aware weeks after the assumed theft and law enforcement was called as per protocol. Since LIC621 was blank for both R1 and R2 staff couldn’t verify what items were stolen or in their respected locked units. LPA toured the physical plant of the facility and observed a locked closet door in between the living room and bedroom in R1’s apartment. It was noted that a new replacement lock had been installed by R1’s family member after the incident. Tour of the storage units LPA observed various storage units with pad locks, zip ties and a simple plastic tie used for a lock. Record review revealed LIC621 for both R1 and R2 were blank and signed by the resident and/or responsible party. Appendix K theft and loss policy from the admissions agreement for both residents are signed by the resident and/or responsible party. Appendix K stated the following: Inventory: Policy: We will maintain a current inventory of all personal property identified by residents on licensing form LIC621. Procedure: Upon admission the resident or responsible part will be provided with a blank LIC621. If the resident or responsible party wishes to inventory personal property, they will complete the inventory in ink and it will be signed and dated by the resident or responsible party, and an Ivy Park representative. A copy will be provided to the resident or responsible party. The facility copy will be maintained in the administrative file. If a resident or responsible party does not complete an inventory or wishes to exclude certain items from the inventory, they will indicate by marking “waived” and sign and date the form. If an inventory is being maintained, as the resident or responsible party brings in new items or removes items, they will be responsible for notifying Ivy Park in writing so that Ivy Park can update their copy if the inventory form. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Jul 29, 2026 · control 22-AS-20260424145046

Allegation investigated: -Staff consume drugs during work hours, impairing their ability to provide adequate care and supervision, which presents a risk to residents in care. -Staff mismanage residents' medications.

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegations. LPA spoke with Zehra Syed, Executive Director and explained the purpose of the visit. Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted, and copies of pertinent records. It is alleged staff consume drugs during work hours, impairing their ability to provide adequate care and supervision, which presents a risk to residents in care, specifically to second floor having a strong smell of marijuana. LPA Martinez conducted a facility visit on April 28, 2026, and conducted a tour of the physical Continued LIC809-C Unsubstantiated plant of the facility. LPA did not observe any staff to be under the influence of drugs or did not observe the facility to have a strong smell of marijuana. Interview with 3 of 3 staff stated that they have not observed any staff under the influence or drugs or the facility to have a strong smell of drugs. Interview with 8 of 8 residents stated that they have not seen any staff under the influence of drugs or have smelled any marijuana in the facility. It is alleged staff mismanage residents’ medication, specifically residents (R1-R9). Record review revealed resident R1, R2, R5, R7, and R8 are not on medication management and per medical assessment are able to handle their own medication, which is stored in their perspective apartments. Residents R3, R4, and R9 are management by facility. Interview with residents R3, R4, and R9 stated they had no issues with medication, medication is handed to them by staff and staff wait till resident takes all medication before leaving their apartment. If a pill falls staff picks it up for them and hands it to resident. Staff do not leave their apartment until all medication is taken by resident. Interview with 2 of 2 medication technicians stated that when medication is passed out they take it to the resident in their apartment, hand the medication to the resident and wait till the resident takes all their medication before leaving their apartment. Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegations are deemed Unsubstantiated. An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Jul 20, 2026 · control 22-AS-20260421093457

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1 Year Inspection. LPA was greeted and granted entry by the receptionist after stating the reason for the visit. LPA was later greeted by Executive Director (ED) Zehra Syed. The facility is licensed for 233 residents of which 75 are ambulatory, 158 non-ambulatory, and 8 may be bedridden. Facility maintains a hospice waiver approved for 15. As of today’s date, the resident census is 204 of which 7 are receiving hospice care. Facility is operating within the conditions and limitations specified on the license. The ED has a valid administrator’s certificate expiring June 7, 2028. At or approximately 9:43am, LPA and Maintenance Director (MD) Jorge Aguirre toured the physical plant including all common areas. The facility is a three story property housing Assisted Living (AL) residents. LPA and MD observed the facility to be clean, sanitary, and in good repair. Hallways were free of clutter. LPA inspected a sample size of 10 resident units, however one resident refused the inspection for a personal reason. The resident bedrooms had all required elements with ample lighting. The residents’ personal bathrooms were checked. Toilets and water faucets worked properly, and the grab bars were secure. Showers were free of mold/mildew, and slip resistant mats were available. The hot water temperature in the resident bathrooms measured within range between 107.4-111.9 degrees Fahrenheit. LPA observed medications unsecured and accessible to residents in two units who are not authorized to manage their own medications per review of the Physician's Report (LIC602). All shared bathrooms in the common areas had sufficient supply of soap, toilet paper, and paper towels. LPA and MD inspected the kitchen and dining area. Facility maintains ample supply of two day perishables and seven day supply of non-perishable food. LPA and MD observed staff engaged in food preparation wearing gloves and adhering to food sanitation practices. LPA observed medications are centrally stored in the medication room/carts with the exception of two resident units. Medications were administered as prescribed per review of the medications and Medication Administration Records (MARs). Toxins, chemicals, cleaning solutions are stored in a locked closet. The Complaint Poster (PUB 475) meets the size requirement and was posted in the entry way. LPA and MD toured the outside grounds. The outdoor passageway is free of obstruction and slip hazards, and there are sufficient seating and shading. The swimming pool and exit gates are secured for the safety of the residents. Facility maintains two portable generators, emergency food supply, and (6) 200 gallon water containers. The fire extinguishers are mounted, charged, and serviced monthly per inspection tags noted June 15, 2026. The carbon monoxide detectors were available on levels 1 and 3 and tested operational. Per the fire alarm report, the smoke/carbon monoxide was tested on June 6, 2026. LPA and MD tested the dual functioning smoke/carbon monoxide detectors in 9 of 10 units. No issues found. The evacuation chairs were observed in each stairwell. Facility staff conducts monthly emergency disaster training which was last completed on June 11, 2026. During inspection, LPA reviewed the Emergency Disaster Plan (LIC610E) and Provider Information Notice (PIN) Summary 25-06-ASC pertaining to Calling 9-1-1 in Residential Care Facilities for the Elderly (RCFE) . LPA conducted a review of 11 residents' and 3 staff files. No discrepancies noted. The medications and Medication Administration Records (MARs) were reviewed for 5 residents. No discrepancies noted. LPA also interviewed 6 residents today. The ED was reminded of the importance of ensuring medications are secured and inaccessible to residents who are not authorized to have access, store, administer own medications per doctor's order, to call 9-1-1 timely per PIN 25-06-ASC, and to update the Emergency Disaster Plan annually per feedback. Based on the observations made, no deficiencies are being cited. However, a deficiency will be cited regarding the medications in connection to complaint control number: 22-AS-20260708102400. Advisory Notes (LIC9102s) are being issued during today's visit. An exit interview was conducted with Executive Director Zehra Syed, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 10, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility is without power

Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to deliver findings into complaint investigation. During investigation, Department conducted tour, gathered & reviewed documents as well as conducted interviews with Staff and residents. The following was based on information gathered from investigation. Based on record review, Incident Report dated 2/28/2025, stated that Fire Department arrived at facility to check on smoke that was coming from main breaker panel near garage area. Report stated that power went out in facility approximately at 3:30AM. Report stated that Southern California Edison also came out and shut off main power to entire building for purposes of electrician to work on panel. At 6:45AM, same day 2/28/2025, Business Office Director had sent out email blast to residents informing of power outage, stating that facility was working on restoring issue as soon as possible, asking residents to remain in apartments for delivery of meals. CONTINUED ON 9909-C Unsubstantiated On 5/5/2025, Executive Director sent out letter notifying residents of a scheduled power shut off on 5/7/2025 from 10:00am to 2:00pm to help assist with repairs to power outage that occurred on 2/28/2025, letter mentioned that elevators wont be working during scheduled time and meals were being delivered to resident apartments. Based on interviews with staff, two of seven staff stated that facility had a unexpected power outage early in the AM on 2/28/2025, both staff members stated that facility power was out the entire day due to electrician working on panel with damaged gear which had over smoked. Staff members stated that residents & responsible parties were informed same day via emails and flyers on door that power was out and facility was working on the issue. Staff interviews stated that facility does not have a backup generator but provided meals to apartments, facility had portable generator power packs available to recharge assistive devices and emergency lighting was available in hallways of each floor. Four of seven staff stated they did not recall power outage on 2/28/2025 but stated that when facility has scheduled power outages, facility protocol is to provide meals to resident apartments, medications to residents, flashlights, and notifications regarding outage. Staff interviews stated that staff are assigned on each floor and check in on residents every hour, especially those who are oxygen dependent and fall risk. Interviews with residents stated that one of nine residents stated that facility had power outage on 2/28/2025 and staff did not inform residents reason or proper updates on outage. Seven of Nine residents interviewed recalled power outage and stated that Facility communicated with flyers on doors and emails about outage. Seven of nine residents stated that meals were delivered to resident rooms for those who stood in place inside apartments, and staff went door to door providing safety checks & flashlights. Eight of Nine residents stated that facility staff does a good job communicating with residents during incidents whether scheduled or unexpected and has no concerns with the care that is being provided. Based on information gathered from complaint, the allegation Facility is without power was deemed Unsubstantiated meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove or refute the alleged violation did or did not occur as reported. An exit interview was conducted with Executive Director Zehra Syed and copy of report was provided.the state’s words, verbatim · CDSS document, May 22, 2026 · control 22-AS-20250228160500

Type of visit: Case Management - Incident

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Ruth Martinez to follow up on an incident reported to Community Care Licensing. LPA met with Zehra Syed, Executive Director and explained the purpose of today’s visit. Incidents were self-reported on January 27, 2026, regarding resident (R1’s) incidents date unknown. Resident (R1) informed staff that a care staff had been rough with them. R1 was unable to recall the date or time frame other than it happened in the evening. R1 stated it happened only once and no other incidents. There was no noted injuries, other residents had no details or complaints for staff, and care staff schedules has been adjusted to accommodate concern. R1 insisted it was two care staff however R1 is a one person assist and never has two care staff assisting Staff made the necessary changes to R1's care, staffing schedule and observations despite of not having accurate details of time and date of incident from R1. Facility staff had no notice a change in condition and there has been no complaints or incidents since then. LPA found that the facility acted appropriately and in a timely manner to address the incident and all other immediate attention to injuries in question. LPA did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Executive Director, and a copy of the report was furnished to the facility.the state’s words, verbatim · CDSS document, May 19, 2026

Type of visit: Case Management - Incident

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Ruth Martinez to follow up on an incident reported to Community Care Licensing. LPA met with Zehra Syed, Executive Director and explained the purpose of today’s visit. Incidents were self-reported on March 16, 2026, regarding resident (R1’s) incidents on March 2, 2026. Resident (R1) informed by family to do a status check and resident was found sitting in their recliner and reported not feeling well without being to ambulate. 911 was immediately called and R1 was sent out for evaluation. During hospital evaluation it was determined R1 had a fall in the lobby of the facility. Upon return staff re-assessed R1 and there was no changes other than re-evaluating their assisted devices, and shoes. R1 upon return was placed on increase care services and medication assistance. facility has continued to monitor R1 for any changes. R1 is not a fall risk resident. R1 was sent back to the facility with home health physical and occupational therapy for rehabilitation in the community. There has been no further incidents, or changes with R1 since the incident and has been fine in the community. No issues to report for R1. LPA found that the facility acted appropriately and in a timely manner to address the incident and all other immediate attention to injuries in question. LPA did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Executive Director, and a copy of the report was furnished to the facility.the state’s words, verbatim · CDSS document, May 19, 2026

Allegation investigated: Residents Room is not cleaned Silverware not sanitized Food is being served cold Facility is short staffed caregivers and housekeepers

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings into the complaint investigation into the allegations listed above. LPA met with Business Office Manager Jessica Hernandez and explained the reason for the visit. The investigation into the allegation, resident's room is not cleaned, revealed the following. It was reported that Resident 1’s (R1) room was not cleaned for over a week and the floor in the bathroom was not cleaned under the bath mats. No other details were provided regarding R1’s room not being cleaned. It was alleged a housekeeper (no name provided) reported that rooms were not cleaned thoroughly because of a lack of staff and due to time constraints. This report could not be verified. 3 out of 3 housekeeping staff reported that they clean anywhere from 8 to 10 rooms a day and have not missed any of the residents’ rooms. R1 reported that their room was not cleaned properly, especially the floors. Unsubstantiated LPA toured R1’s room and observed that the room and the floors were clean. R1 reported that they wanted the carpet cleaned with a machine. R1 reported that they have not requested that service from housekeeping. The House keeping director reported that all resident rooms are cleaned once a week and if residents require another cleaning or want something specific done such as carpet cleaning it must be requested. The House keeping director reported that staff do not move furniture or personal items when cleaning a room. 4 out of 4 residents interviewed reported that their rooms are cleaned regularly and they have no issues with housekeeping. None of the evidence gathered supports the allegation, resident's room is not cleaned, therefore the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, silverware not sanitized, revealed the following. It was reported that after residents finish their meal, glasses and silverware are re-used. It was reported that there are water spots on silverware and lipstick on glasses that are given to residents to use. LPA toured the dining room during lunch. LPA did not observe any silverware or glasses that had water spots or lipstick. LPA interviewed the head chef who reported that all tables are cleared after a resident leaves and all items are washed and sanitized in accordance with Orange County Health Care Agency standards. LPA observed the dishwashing station which includes an automatic dishwasher. LPA observed the dining room and kitchen were clean and organized. LPA interviewed 4 residents who reported that they have never seen or used any silverware or glassware that wasn’t clean. The head chef reported that all silverware is replaced whenever someone leaves the table even if they didn’t use it, as per Orange County Health Care Agency guidelines. LPA interviewed 3 dining room staff who reported that if they see any silverware or glassware that is not clean, they return it to the kitchen. 3 out of 3 dining room staff reported that they make sure all items served to residents are clean. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, food is being served cold, revealed the following. It was reported that the facility serves cold food to residents. It was alleged that numerous residents have complained about the temperature of the food being served. No names were provided of the individuals who reported receiving cold food. LPA observed lunch being served in the dining room. After residents order lunch and it has been prepared the kitchen staff put it on the server station and then dining room staff take it to the residents. LPA observed that all of the orders placed during the visit were all served to residents within 3 minutes of being put on the server station. LPA interviewed 5 residents. 5 out of 5 residents reported that they had no complaints about the food except they wish there was a bigger selection of menu items. 3 out of 3 dining room staff reported that they never leave food on the server station for longer than a few minutes because they are not supposed to keep the residents waiting and the food would get cold. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation, facility is short staffed caregivers and housekeepers, revealed the following. It was reported that 4 housekeepers quit in December 2024, and it caused a delay in the cleaning of rooms. The housekeeping director reported that staff occasionally leave for other opportunities, but 4 staff did not leave in December 2024 and there are enough housekeeping staff (3) to clean all the residents rooms in a timely manner. The Executive Director reported that there haven’t been any drastic changes in staff and there are enough staff to take care of all the residents. No specific details were provided concerning the allegation the facility is short staffed caregivers. LPA interviewed 5 residents who reside in assisted living. 5 out of 5 residents reported they have no issues or concerns with the caregivers. 3 out of 3 caregivers reported there is enough staff to provide care to all the residents. During the visit LPA did not observe any concerns regarding the health and safety of the residents. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted, and a copy of the report provided.the state’s words, verbatim · CDSS document, Apr 29, 2026 · control 22-AS-20241217161129

Allegation investigated: Resident sustained neck bruising.

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to investigation the above identified complaint allegation. LPA met with Zehra Syed, Executive Director and explained the nature of the visit. During the course of the investigation, interviews were conducted, a tour of the physical plant of the facility was conducted, a review of resident records was completed and copy of pertinent documents obtained. It is alleged that resident sustained neck bruising. LPA obtained resident roster at the facility and observed resident (R1) was not listed. Interview with 2 of 2 staff stated that R1 moved into the facility on January 3, 2026, and on January 8, 2026, R1 was sent to the hospital via 911 due to finding R1 in distress in their Continued on LIC9099-C Unsubstantiated apartment upon staff doing a resident status check. R1’s daughter informed that facility on January 9, 2026, that hospital informed them that due to having a stroke R1 would expire within hours. On January 10, 2026, facility received information that R1 had passed away at the hospital. Due to R1’s status LPA was unable to verify the allegation or interview R1. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Jan 13, 2026 · control 22-AS-20260112093724

Allegation investigated: -Facility threatened to evict resident -Facility did not allow resident to reject medical care or other services -Facility is not providing Basic Services to resident -Facility coerced resident into accepting medication management

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrive at facility was greeted and granted entry. LPA spoke with Zehra Syed, Executive Director and explained the purpose of the visit. Findings are based upon this investigation which included resident file review, facility file review, tour of the physical plant of the facility and interviews conducted. It is alleged facility threatened to evict resident, specifically to receiving a letter signed and dated letter declaring that resident will either face eviction or agree to the services and charges. LPA Martinez requested a copy of the letter however such letter was never made available. LPA is unsure if the letter exist. Interview Continued on LIC9099-C Unsubstantiated with staff stated that an eviction was never given, however it was suggested if resident was unhappy with the services and care of the facility that they could move out at their leisure without penalty. Resident (R1) had been having changes in condition and temporary admittance to a skilled nursing facility and required change in services. It is alleged that facility did not allow resident to reject medical care of other services. Record review revealed that R1 moved into the facility February 18, 2022 and after a few incidents and a short stay at a skilled nursing facility on April 8, 2024 R1 had a re-assessment. Resident appraisal dated February 16, 2022, reflected that resident required minimal services, due to R1 being independent. Assessment dated April 8, 2024, reflected that there was a change in the following areas personal care services for dressing, transfers, bathing, toileting needs, medication assistance, and fall risk. Per Tittle 22 regulations it the responsibility of a licensed facility to provide Care and Supervision" means those activities which if provided shall require the facility to be licensed. It involves assistance as needed with activities of daily living and the assumption of varying degrees of responsibility for the safety and well-being of residents. "Care and Supervision" shall include, but not be limited to, any one or more of the following activities provided by a person or facility to meet the needs of the residents. It is alleged that facility is not providing basic services to resident. Interview with 3 of 3 staff stated that services were provided to resident despite of the disagreement with R1’s responsible party. Staff providing basic services to R1 is the reason staff identified that resident may have had a change of condition, and staff acted accordingly. R1 had a serious of events that led to going to the hospital and then later transferred to a skilled nursing facility. Staff would check on R1 often and would notice changes in the residents living environment. It is alleged that facility coerced resident into accepting medication management. Interview with 3 of 3 staff stated that when resident initially moved in the facility, they were able to manage their own medication, R1 moved in February 18, 2022. Staff when providing services noted that there would be medication spilled on the floor and on R1’s bed. Therefore staff did the necessary for the noted change in condition and obtained new assessments to place resident on medication management if required. Record review revealed that due Continued on LIC9099-C to a noted change in condition R1’s LIC602 Physicians report was updated on April 11 and 16, 2024, which noted on page 4 number 16 that R1 needed medication management and resident was unable to administer their own medication. R1’s responsible party upon disagreement had a new LIC602 Physicians report dated May 4, 2024, page 4 number 16 as yes able to manage own medication but to see section 19. Section 19 states R1 needs medication management that would be provided by patient’s son. Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted with Executive Director and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Oct 22, 2025 · control 22-AS-20240506152040

Allegation investigated: Staff stole a resident's personal property Staff did not respond to residents calls for assistance timely

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the five allegations listed above and delivering findings to the licensee. LPA was greeted and granted entry by facility staff after stating the purpose of the visit. Business Office Manager Jessica Hernandez was present on the premises and presented with the allegations as well as the findings. The initial investigation visit was conducted on April 21, 2025, by Licensing Program Analyst (LPA), Kevin Saborit-Guasch. During the visit, LPA accompanied by facility staff conducted a tour of the facility's three levels and common areas. No immediate risk to residents' health and safety was assessed. LPA requested and reviewed records for multiple residents. Resident 1 (R1) was admitted to Ivy Park at Laguna Woods on December 2, 2023. Per the physician report established upon admission, R1 had a primary diagnosis of a history of lung and breast cancer. CONTINUED ON FORM LIC9099 Substantiated CONTINUED FROM LIC9099 There is no indication of dementia or mild cognitive impairment on the medical assessment dated November 29, 2023. Upon admission, it was documented that R1 opted out of providing the facility with an inventory of personal property. R1’s records obtained at the facility additionally included multiple Physician’s Fax Report of Fall dated January 4, 2024, February 13, 2024, June 11, 2024, January 13, 2025, March 5, 2025, March 6, 2025. In each of those instances, the primary care provider was notified and followed up. Adequate calls to 911 for evaluation and either transportation to a hospital or refusal to pursue such evaluation were systematically documented as well, as confirmed by the charting notes obtained and reviewed. A Resident Notice to Vacate was provided by R1’s responsible party to the facility on April 5, 2025 informing the facility of R1’s intent to be discharged from the facility effective April 13, 2025. The motive stated on the notice is “multiple theft of cash and property, right wrist fracture due to employee negligence and involvement in a fall without proper response time”. R1 was therefore no longer a resident at the facility when the investigation was initiated. Regarding the allegation that Staff stole residents personal property, the following has been concluded: During the investigation, licensing staff reviewed video footage from a video device installed by R1’s family inside unit #151. Video reviewed shows staff member S1 going into R1’s bedroom closet and removing items. S1 then comes into view of the camera and appears to back away out of view, before proceeding to walk by with items in hand. S1 is later seen leaving R1’s residential unit with items in hand. According to staff interviews, S1 instructed another staff member to tell her later in the shift, in the presence of other staff, to enjoy the items they gave them (even though staff did not give S1 anything). Accomplice staff agreed, later telling S1 that they hopes they enjoys the items and S1 thanked him for the gifts that he gave her. There is enough evidence to support the allegation that S1 stole items from R1’s residential unit. CONTINUED ON FORM LIC9099-C CONTINUED FROM LIC9099-C Regarding the allegation that Staff did not respond to residents calls for assistance timely, it was determined that: During the investigation, licensing staff reviewed the Unusual Incident Report and interviewed the Med Tech that completed the report. Based on the report, R1 sustained a fall in the bathroom and pulled the emergency cord in the bathroom before crawling to their cell phone in the bedroom. R1 called their family who then called facility staff. R1’s family provided a time-stamped record of the calls confirming multiple phone calls to the facility were made. Once the call was received, the facility responded to provide aid/assistance. Both the report reviewed and a statement made by a staff member interviewed advised that the resident was not wearing her emergency pendant when staff responded. Additionally, there was construction occurring at the facility in which the emergency cords in the bathroom were being removed. As a result, the facility staff stated they had thought the residents’ emergency cord notification was a false alarm due to the ongoing construction. There is enough evidence to support the allegation that there was a delay in providing assistance to R1 in a timely manner. Based on the evidence gathered, the allegations that Staff stole residents personal property and that Staff did not respond to residents calls for assistance timely are both found to be Substantiated, meaning that the preponderance of evidence has been met. See LIC9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to a facility representative. CONTINUED FROM LIC9099-A There is no indication of dementia or mild cognitive impairment on the medical assessment dated November 29, 2023. Upon admission, it was documented that R1 opted out of providing the facility with an inventory of personal property. R1’s records obtained at the facility additionally included multiple Physician’s Fax Report of Fall dated January 4, 2024, February 13, 2024, June 11, 2024, January 13, 2025, March 5, 2025, March 6, 2025. In each of those instances, the primary care provider was notified and followed up. Adequate calls to 911 for evaluation and either transportation to a hospital or refusal to pursue such evaluation were systematically documented as well, as confirmed by the charting notes obtained and reviewed. A Resident Notice to Vacate was provided by R1’s responsible party to the facility on April 5, 2025 informing the facility of R1’s intent to be discharged from the facility effective April 13, 2025. The motive stated on the notice is “multiple theft of cash and property, right wrist fracture due to employee negligence and involvement in a fall without proper response time”. R1 was therefore no longer a resident at the facility when the investigation was initiated. Regarding the allegation that Staff did not seek timely medical care for resident, it was determined that: during the investigation, licensing staff reviewed the facility Charting Notes for R1 and also interviewed facility staff and R1’s family member. The Charting Notes document that R1 sustained an injury from a fall but also that R1 refused to accept treatment/transportation if 9-1-1 emergency personnel were called. R1 requested to be checked out for injury by a family member, who R1 stated is a doctor. Family member confirmed they are a physician and corroborated the account of refusal of medical treatment on the day of the fall incident. A few days later, R1 consented to hospital transportation. There is insufficient evidence to support the allegation of the facility failing to obtain medical attention. Regarding the allegation that Staff financially abused resident, the following has been concluded: During the investigation, licensing staff conducted interviews with facility staff, clients, victim, and witnesses. The interviews conducted provided insufficient corroborating information regarding the allegation of staff stealing/removing money from R1’s possessions or bedroom. More importantly, the information provided did not allow to identify any individual staff that may have had direct involvement in the theft of cash. There is therefore insufficient evidence to support the allegation of staff stealing money from the resident. CONTINUED ON FORM LIC9099-C CONTINUED FROM FORM LIC9099-C Regarding the allegation that Staff pushed resident causing injury, the following has been concluded: During the investigation, licensing staff conducted interviews with facility staff, clients, alleged victim, and witnesses. The interviews conducted provided insufficient corroborating information regarding the allegation of staff pushing or intentionally causing victim to fall. No specific alleged perpetrator was also identified based on the interviews. There is therefore insufficient evidence to support the allegation of staff intentionally pushing or causing the resident to sustain injury. Based on the evidence gathered, the allegations that Staff did not seek timely medical care for resident, Staff financially abused resident and that Staff pushed resident causing injury are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, Oct 3, 2025 · control 22-AS-20250418135127

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Oct 4, 2025

Per CCR87468.1(a)(2) Personal Rights of Residents in All Facilities: "Residents (...) 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 evidence reviewed, facility did not prevent S1 from stealing R1’s property while on duty at the facility. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Oct 3, 2025

Plan of correction: Staff member was terminated and is no longer associated to the facility. Licensee stated they would conduct an updated training regarding the theft and loss policy directed to care staff. Proof of training to be provided to the Department.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 878464(f)(1) · Plan of correction due date: Oct 4, 2025

Per CCR 878464(f)(1) on 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 records reviewed and interviews conducted, excessive response time was corroborated in at least one instance after R1 sustained a fall. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, Oct 3, 2025

Plan of correction: Licensee stated that all staff members would receive follow-up training on appropriate response to call system activations.

Type of visit: Case Management - Incident

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Ruth Martinez to follow up on an incident reported to Community Care Licensing. LPA arrived at the facility was greeted by receptionist and granted entry. LPA met with Zehra Syed, Executive Director and explained the purpose of today’s visit. Incidents were self-reported on August 25, 2025, regarding resident (R1’s) incidents on August 15, 2025. During today’s visit, LPA completed resident file review, toured the physical plant of facility, and obtained copies of pertinent documents. On August 15, 2025, resident (R1) was in their apartment when they called for assistance. Upon arrival staff was advised by R1 that they were having severe chest pain and difficult breathing. R1 explained pain might be due to the fall they had on August 13, 2025, in which staff were aware of. Staff were aware of the fall that occurred on August 13, 2025, and at the time of fall R1 did not complain of pain or discomfort. R1 was placed on monitoring and R1 did not complain of pain till two days later. Staff called paramedics immediately and resident was sent out for further evaluation. R1 was noted to be doing well and recovering. R1 has had no further incident since the date of the incident. LPA found that the facility acted appropriately and in a timely manner to address the incident and all other immediate attention to injuries in question. LPA did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with Executive Director, and a copy of the report was furnished to the facility.the state’s words, verbatim · CDSS document, Sep 22, 2025

Allegation investigated: - Staff are not following residents dietary plan

On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conclude the investigation and to deliver findings for the allegation mentioned above. LPA Tea was greeted and granted entry by Executive Director (ED) Zehra Syed and explained the reason for the visit. The department received a complaint on February 6, 2025 and LPA Tea conducted the initial 10-day visit the next day on February 7, 2025. It was alleged that staff are not following residents dietary plan. LPA Tea interviewed facility staff and residents and collected pertinent documents such as staff and resident rosters, copies of Resident 1 (R1)’s file, facility menu schedule, and information sheets of residents that were interviewed. The investigation determined the following: LPA Tea received a list of residents who had special diets, food allergies and preferences and interviewed those who were present at the facility. Eight out of nine residents interviewed agree that staff are following or accommodating to most of their diet plans and restrictions. A lot of the residents also agree that due to Report continued on LIC9099-C Unsubstantiated the numbers of residents living here, they understand that it’s hard to meet all of the residents different food preferences and diets because of the population’s diversity and different upbringing and preferences. At the time of the initial investigation the facility had a norovirus outbreak and had two menus. The first one had the daily specials, and the second one was an “always available” a la cart menu that had the same items for residents to order throughout the day. Eight out the nine residents felt the second menu gave them a lot of options or alternatives to get around their diet restrictions and they are not limited to choices. Some of the residents said that staff try their best and never denied their choices or requests. One resident interviewed, R1, said there are no options for their diet restrictions or preferences. R1 said they had a letter from their doctor about their diet restrictions and had given it to the facility. The previous executive director, ED Jennifer Turgeon has said she has never received the resident’s diet restrictions from the doctor. The Health Service Director (HSD) Jazzmyne Jefferies had also never received R1’s diet plan or restrictions and that residents can be on special diets, which they do honor when given to the facility. Based on records review, R1 has no diet restrictions on file. Most of the records, like the physician’s report, reflect no special diet from the doctor. The most recent Diet Clarification Request form indicates no dietary restrictions currently. The current executive director, ED Zehra Syed has never received from R1 any diet restrictions or doctor’s order regarding diet plans as of today since she has been here at the facility. LPA spoke to the facility dietician and nutritionist. The dietician staff said she did speak to R1 regarding their diet concerns specifically their GERD. It’s her job to provide nutritional information and counseling and it is up to the residents to address their dietary preferences to the executive chef or facility. LPA spoke to the facility nutritionist who conducts mainly kitchen audits and checks food compliance for the facility. She said the facility is very flexible with the resident’s food preferences, whether they are dietary or not. If they wanted lower sodium, sugar free, the facility would accommodate them. She stated that residents can order lots of food based on their food preferences. One staff interviewed said they are not saying no to the residents’ diet and food preferences. She makes sure the facility servers provide options to the residents. Therefore, based on LPA Tea's observations and interviews conducted and records reviewed the allegation that staff are not following residents dietary plan has been determined to be unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Complaint investigation continued on LIC9099-C No deficiencies cited at this time and an exit interview was conducted with Executive Director Zehra Syed. A copy of the report and confidential names list were provided to the facilitythe state’s words, verbatim · CDSS document, Jul 17, 2025 · control 22-AS-20250206120944

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by receptionist. LPA met with Zehra Syed, Executie Director and Jessica Hernandez, Business Office Director and LPA explained the nature of the visit. Facility is licensed for 75 ambulatory, 158 non-ambulatory residents, of which 8 may be bedridden. Facility has an approved hospice waiver for 15 residents. The facility currently has 155 residents, and 6 residents are on hospice during today's visit. LPA Martinez along with Business Office Director toured the inside and outside of the physical plant of the facility. LPA observed a bistro on the first floor where residents can obtain different snacks and beverages selections than in the main dining area. The bistro offers snacks all day so residents may dine when convenient. LPA observed menus and the food offered is varied and healthful. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Maintenance records were observed in the main kitchen. Facility has in storage the emergency food and water supply. Food supply delivery is done twice a week. During the tour LPA observed residents involved in an activity as well as a posted activity schedule including games, exercise, and outings at the facility. LPA inspected that medication is centrally stored in a safe locked location; facility has a medication room on the first floor. LPA observed and inspected medication carts that are used to dispense meds to residents and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the first aid kit and manual stored in the medication room. There are first aid kits mounted on the walls throughout the Continued on LIC809-C facility. Facility has apartment style bedroom for residents. LPA inspected apartments; all required components were observed in inspected apartments. Each apartment has their own bathroom, LPA inspected resident bathrooms. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Resident bathrooms were tested for hot water temperature and water temperature measured between 106.8 – 112.6 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPA observed the restrooms are equipped with a call button in various resident rooms. Call button when pulled calls to caregiver tablet as well as the front desk/med room for response accuracy. LPA tested the pull cord system and received an accurate response time by a staff member. LPA observe caregiver receive a call button notification. LPA observed several residents throughout the facility who appeared clean, and happy. LPA observed several courtyards with shaded seating areas for residents’ enjoyment. LPA observed a swimming pool with a fence around it. LPA observed the pool gate has a self-latching entry door which opens away from the pool and there is only one entry way. The fence has a key lock at the gate door for inaccessibility. LPA measured the pool fence which measured 5.25ft from base of the floor to the top of the fence and it was observed to enclose the entire pool area. Toxic chemicals, cleaning solutions and disinfectants are stored locked in the housekeeping storage closet and kitchen toxins are stored in kitchen storage closet. Carbon monoxide detectors tested and noted to be operational. LPA observed fire extinguishers throughout the facility that are fully charged. Fire extinguisher has a service date of December 12, 2024. Smoke detectors and sprinkler system are tested yearly by an outside agency, and LPA was provided with testing information, last testing was done June 26, 2025. Emergency drills are being conducted quarterly on every shift and the last drill conducted was May 6, 2025. Facility has five stairwells and there are evacuation chairs in those stairwells. LPA began review of facility records. LPA reviewed ten resident files, all resident files contained required documentation including updated physician reports and care plans. LPA reviewed six staff files. Staff files contained required documentation including health screens, first aid, and fingerprint clearance. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Facility Representative and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 9, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced case management visit to follow up on an incident report received by the department on 03/27/25. LPA was greeted and granted entry into the facility and explained the reason for the visit. LPA spoke with Brenda Myers, Interim Executive Director. On 3/21/25 Executive Director received a report from family of resident (R1) about a theft at residents apartment. Family had video footage of a staff rummaging through a closet at R1's apartment and holding items that belonged to R1. Upon received information Executive Director immediately called OC Sheriff to the facility and identified staff. Executive Director and Health Services Director interviewed and began an internal investigation with identified staff and staff was place on suspension pending investigation. R1's decided to move out of the community and provided a vacate notice to facility and requested a refund. Executive Director informed R1 that a refund would be processed and provided to resident. Executive Director is still awaiting information from OC Sheriff and since resident moved out on 4/13/25. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 14, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced case management visit to follow up on an incident report received by the department on 04/03/25. LPA was greeted and granted entry into the facility and explained the reason for the visit. LPA spoke with Brenda Myers, Interim Executive Director. On 4/2/25 Executive Director received a report that Residents (R1, R2), had a dispute in the community dinning room. R1 and R2 are husband and wife residing at the facility. R1 was slapped in the face by R2 while eating dinner. R1 was evaluated and removed from the area, law enforcement was called to the facility and no physical injuries were noted on R1. R1 had no complaints it pain and refused medical treatment. Residents representative were notified and arrived to the facility after the call. R2 was removed from the premises and upon return R2 was provided with 1:1 care while R1 was provided with increased services and support. R2 was evaluated at the hospital and authorized representative informed Executive Director that R2 would be moving out and place in a memory care unit. R2 moved out of the facility on the weekend of 4/12/25, R1 still resided at the facility and has had no issues. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 14, 2025

Allegation investigated: -Staff left resident in soiled diapers/linin for an extra period of time -Staff will not provide resident with water -Staff are not taking universal precautions to prevent spread of illness

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegation. LPA arrive at facility was greeted and granted entry. LPA spoke with Jessica Hernandez, Business Office Manager and explained the purpose of the visit. Findings are based upon this investigation which included resident file review, facility file review, tour of the physical plant of the facility and interviews conducted. It is alleged staff left resident in soiled diapers/linin for an extended period of time. Record review for resident (R1) individualized service plan and assessment do not reflect R1 has any bladder and/or bladder impairment that would require R1 to use diapers. Charting notes reflect that R1 has private caregivers and on February 3, 2025, when doing resident check in R1 was found being assisted by R1’s private caregiver in Continued on LIC9099-C Unsubstantiated the shower due to R1 not feeling well and soiling clothes. Interview with staff stated that when they checked in on R1 and found soiled clothing on the floor and R1 in shower assisted by private caregiver, staff immediately called 911 to have R1 evaluated and R1 was taken to hospital for further evaluation due to not feeling well. R1 stated that they had been sick and got the care and treatment by both private care giver and by facility staff and R1 had no complaints. It is alleged staff will not provide resident with water. LPA toured R1’s apartment on February 4, 2025, and on today’s date and it was observed there was ample supply of water in throughout the apartment for R1’s consumption. Water bottles were observed in the kitchen, refrigerator, bedroom, living room, night stand next to the bed and in bathroom. R1 stated that the get the water they need by both private caregiver and facility staff, they have enough water in their apartment and if they don’t, they can request more by calling the front desk. It is alleged staff are not taking universal precaution to prevent the spread of illness. On February 3, 2025, LPA Martinez received a call from Executive Director informing LPA of various resident were ill. Executive Director called the Health Department and was advised to stop all activities and close the dining hall until it had been 48 hours free of no new residents being sick. Executive Director stated on call that facility was being sanitized continuously and doing room services for residents until dining hall is open, dining hall was only open for walk in’s if residents wanted to get water or request food to take to their apartment. LPA toured the facility on February 4, 2025, and observed that staff were cleaning, sanitizing, and disinfecting the common spaces and residents’ apartments. Record review reflected that on February 3, 2025, a notice was sent to residents informing them of residents having GI symptoms throughout the community and advising them of the temporary closure of the dining, and meals being served by room service to individual resident apartments. LPA observed contact precaution carts outside of affected residents’ apartments with a contact precaution notice on the door of the apartment with precaution measures to take for entering the apartment such as wearing gloves, gowns, sanitizing and touching precaution. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with facility representative and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Mar 19, 2025 · control 22-AS-20250203141522

Allegation investigated: Facility did not issue refund

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Brandon Lopez made an unannounced visit to the facility for the purpose of following up on the investigation of the allegation listed above as well as to deliver findings to the licensee. LPAs were greeted and granted entry by the facility’s front desk staff after introducing themselves and stating the purpose of the visit. Executive Director Jennifer Turgeon was present on the premises and assisted with the visit. The initial complaint investigation visit was conducted on November 4, 2024. During the visit, LPA requested and obtained the current facility census in addition to admission paperwork for residents R1 and R2, as well as a final account statement dated October 12, 2024. Additional witness interviews conducted via telephone following the visit. CONTINUED ON FORM LIC9099-C Substantiated CONTINUED ON FORM LIC9099 Regarding the allegation that Facility failed to issue a refund, the following has been concluded: Residents R1 and R2 signed up as prospective residents of the facility on August 31, 2024 and assumed tenant status of a unit at the facility on that day. They received their move-in binder on September 9, 2024. On September 12, 2024, R1 and R2 gave notice to facility staff of their intent to not move forward with their admission at the facility. Following the terms of the notice, R1 and R2 were charged for one full month and 12 days of residency fees which were deducted from the 80% refund of their community fee which they were owed after terminated their admission after admission and conducting of their respective needs assessments. However, upon review of the residents records maintained at the facility, LPA Kevin Saborit-Guasch observed that the admission agreement signed by both residents on August 31, 2024 did not bear a signature made by a facility representative within seven days of the admission. The facility therefore was not in possession of a binding agreement to establish residence in exchange for payment of a monthly residency fee. Residents R1 and R2 additionally never physically moved into their unit at the facility. As a result, the allegation is found to be Substantiated, meaning that the preponderance of evidence standard has been met. One violations is being cited per California Code of Regulations Title 22. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.the state’s words, verbatim · CDSS document, Dec 16, 2024 · control 22-AS-20241029144756

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87507(c) · Plan of correction due date: Dec 17, 2024

Per CCR 87507(c) :" Admission agreements shall be signed and dated, (...), by the resident (...) and the licensee (...) no later than seven days following admission." This requirement is not met as evidenced by: Based on records review and staff interviews, the admission agreement for residents R1 and R2 was not signed by the licensee or its representative within seven days of admission. This constitutes an immediate risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: Licensee to issue all residency and community fees paid by residents R1 and R2.

Allegation investigated: Facility staff did not seek timely medical attention for resident

On December 6, 2024, Licensing program Analyst (LPA) Jenifer Tirre met with Executive Director (ED) Jennifer Turgeon to deliver findings for the above allegation. The investigation consisted of observations, interviews, and record review. The investigation revealed the following: Regarding allegation Facility Staff did not seek timely medical attention for resident: On September 18, 2024, the Department received an allegation that facility staff did not seek timely medical attention for resident. During the course of this investigation, LPA Tirre conducted an unannounced initial visit on September 23, 2024, and subsequent visits on November 8, 2024, November 26, 2024, and November 27, 2024 related to complaint investigation. On September 12, 2024, per Call Device Activity Report, resident 1 (R1) pressed their medical alert pendant at 1:09 PM. Caregiver responded at 1:21 PM, twelve (12) minutes after the call. R1 asked for their blood pressure to be checked after they did their own blood pressure reading measuring at 63/39. CONTINUED ON 9099C Substantiated . Per facility policy, caregivers are not trained to check blood pressure, therefore the caregiver called a Medication Technician (Med Tech). Resident did not want a Med Tech and asked for a Wellness Nurse. In the time while waiting for Wellness Nurse to respond, R1 called 911 themself. Med Tech and Wellness Nurse responded at 1:35 PM just before EMT arrival. Med Tech measured R1’s blood pressure at 95/50. EMT registered two readings, the first at 109/60 pulse 79 and second at 116/63 pulse 79. R1 felt dizzy & clammy and was transported to the hospital. Per R1’s Hospital After Summary Report, resident was diagnosed with Pneumonia, COPD Exacerbation, Gerd, CAR, history of lung cancer and Iron deficiency anemia. On September 13, 2024, resident was discharged back to facility. Interview with R1 stated that on September 12, 2024, when R1 pressed their medical alert pendant, they claimed it took 20 minutes for staff to respond. R1 claims that a female caregiver arrived at room and didn’t seem to know what to do, R1 asked for a nurse and caregiver to step out of room. R1 stated it took another 15 minutes for Med Tech to arrive. LPA conducted Interviews with residents and staff and the following was revealed, five (5) of nine (9) residents stated that they don’t use facility pull cord/ call buttons for assistance. Four (4) of nine (9) residents stated they have used pull cords/ call buttons for assistance and stated the average response time is between 10 to 15 minutes. During investigation, LPA made the following observations when pulling call button in Resident 3’s bedroom to test facility response time and observed staff responded to call eight minutes later. LPA pulled call cord in common area restroom located on first floor and staff responded in seven minutes. Based on observations, interviews, and record review, it took the facility staff 26 minutes to address residents’ concerns, therefore the preponderance of evidence has been met, therefore the allegations, “Facility staff did not seek timely medical attention for resident” is deemed SUBSTANTIATED. The following is being cited on attached LIC 9099D. An exit interview was conducted with Executive Director and copies of this report along with Appeals Rights was provided. R1 did not make a copy of order as they thought it was not needed. ED stated no physician’s order was received. Per interviews with eight (8) out of (14) fourteen staff, residents have status checks done every 2 hours when resident has change in condition, returning from hospital or if resident is a fall risk. LPA conducted a record review regarding R1’s special orders, during initial visit on September 23, 2024. LPA did not observe any physician’s orders inside R1’s medical file regarding follow up regarding procedure. LPA observed R1’s Hospital After Visit Summary dated September 12, 2024, to September 13, 2024, which stated reason for R1’s visit, list of medications to be picked up, referrals to Transitional Medical clinic & Home Health Outpatient and follow up with internal medicine physician. LPA observed facility charting notes dated from September 12, 2024, to September 16, 2024 which states the following: on September 13, 2024, R1 returned to the facility at 4:00 PM, alert charting was conducted same day by staff member at 9:02 PM; on September 14, 2024, R1 was checked on twice at 1:38 PM and 9:47 PM; and on September 15, 2024 R1 was checked on twice at 2:49 PM and 9:55 PM. Based on the information provided for the investigation, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation, “Facility staff did not follow physician’s orders”, did or did not occur, therefore the allegations are deemed UNSUBSTANTIATED. LPA observed the facility’s total daily diet is of quality and quantity necessary to meet the needs of the residents and facility is following the Regulatory Standard. LPA observed facility menu located near entrance of dining area. LPA reviewed the facility’s Everyday Menu which has customized meal options available every day. Menu has options for breakfast, lunch & dinner. Menu shows options for entrees with choice of proteins, sides and sauces for resident’s choosing. The facility offers different types of seafoods such as Swai, Shrimp, Pollock, Crab, Tuna, Salmon, and Cod. Facility has options of sauces available for base of foods such as Marinara sauce, Marsala sauce, Lemon Butter sauce, Alfredo sauce and Mushroom gravy. Per Facility Health Services Policies & Procedures, residents are provided with choices at mealtimes and modified diet standards are available such as No Added Salt, Consistent Carbohydrate, and modified texture. Facility has dietician available to meet with residents as needed. LPA conducted interviews with nine residents (R1-R9) regarding meals. Eight (8) of nine (9) residents stated food is good and they like the food provided. Resident interviews also mentioned that there’s a variety of choices and residents can order what they wish. One (1) resident alleges that meals have too much salt and they serve low quality fish such as catfish and tilapia. Facility Cook explained per facility policy, food is cooked with no salt and no concentrated sweets. This agency has investigated the complaint alleging “Facility staff did not provide quality meals”. We have found that the complaint was UNFOUNDED, meaning the allegation was false, could not have happened and or is without a reasonable basis. An exit interview was conducted with Executive Director Jennifer Turgeon and copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 6, 2024 · control 22-AS-20240918134343

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Dec 7, 2024

87465 Incidental medical and dental care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by: Based on the investigation, it took facility staff 26 minutes overall to respond to resident’s medical pendant call failing to address their concerns in a timely manner. R1 called 911 themself and was taken to hospital. This poses an immediate health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2024

Plan of correction: Executive Director agree to meet residents calls in a timely manner. Executive Director agreed to provide a written plan regarding training with all staff regarding pull cords and pendants. ED will send over plan by POC date 12/09/2024. Completed proof of training to be provided one week by 12/13/2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by receptionist. LPA met with Jessica Hernandez, Business Office Director and LPA explained the nature of the visit. Kathleen Olson, Executive Director arrived shortly after and met with LPA. Facility is licensed for 75 ambulatory, 158 non-ambulatory residents, of which 8 may be bedridden. Facility has an approved hospice waiver for 15 residents. The facility currently has 137 residents, and 6 residents are on hospice during today's visit. LPA Martinez along with Business Office Director toured the inside and outside of the physical plant of the facility. LPA observed a bistro on the first floor where residents can obtain different snacks and beverages selections than in the main dining area. The bistro offers snacks all day so residents may dine when convenient. LPA observed menus and the food offered is varied and healthful. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Maintenance records were observed in the main kitchen. During the tour LPA observed residents involved in an activity as well as a posted activity schedule including games, exercise, and outings at the facility. LPA inspected that medication is centrally stored in a safe locked location; facility has a medication room. LPA observed and inspected medication carts that are used to dispense meds to residents and observed medication was labeled and stored inaccessible to residents in care. LPA reviewed five resident files, all resident files contained required documentation including updated physician reports and care plans. Facility has apartment style bedroom for residents. LPA inspected apartments; all required components were observed in inspected apartments. Each apartment has their own bathroom, LPA inspected resident bathrooms. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Resident bathrooms were tested for hot water temperature and water temperature measured between 106.8 – 114.4 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies Continued on LIC809-C were adequately stocked. LPA observed the restrooms are equipped with a call button in various resident rooms. Call button when pulled calls to caregiver tablet as well as the front desk/med room for response accuracy. LPA observe caregiver receive a call button notification. LPA observed several residents throughout the facility who appeared clean, and happy. LPA observed several courtyards with shaded seating areas for residents’ enjoyment. LPA observed a swimming pool with a fence around it. LPA observed the pool gate has a self-latching entry door which opens away from the pool. The fence has a key lock at the gate door for inaccessibility. LPA measured the pool fence which measured 5.08ft from base of the floor to the top of the fence and it was observed to enclose the entire pool area. Toxic chemicals, cleaning solutions and disinfectants are stored locked in the housekeeping storage closet and kitchen toxins are stored in kitchen storage closet. Carbon monoxide detectors tested and noted to be operational. LPA observed fire extinguishers throughout the facility that are fully charged. Smoke detectors and sprinkler system are tested yearly by an outside agency, and LPA was provided with testing information, last testing was done May 2024. Emergency drills are being conducted monthly with a variation of shifts. Facility has five stairwells and there are evacuation chairs in those stairwells. LPA reviewed five staff files. Staff files contained required documentation including health screens, first aid, and fingerprint clearance.LPA as a reminder provided annual fee dues information. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Facility Representative and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 3, 2024

Allegation investigated: Facility did not accept resident back after hospitalization

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to begin the investigation into the allegations listed above. LPA met with Executive Director Elena Madsen and explained the reason for the visit. The investigation into to the allegation revealed the following. It was alleged that Resident 1 (R1) was not allowed back to the facility after the Skilled Nursing Facility (SNF) cleared R1 to return to their home. R1’s responsible party (RP) reported that they spoke to the Executive Director who informed them R1 would need medication management if they were to return to the facility based on the nurse’s assessment. RP reported that they disagreed with the assessment and provided an LIC 602A dated June 7, 2024, which stated R1 could manage their own meds with the following comments in the comments section, “PT can take own medication in the pillbox sorted by son”. The LIC 602A section 16 concerning resident medication is a yes or no question, the resident is either cable of handling every aspect of managing their own medication or they can’t. In the case of R1 the facility is correct in assessing that R1 needs medication management. The ED had a care plan meeting with RP on June 7, 2024, to discuss R1’s new care plan. Substantiated This meeting was a conference call and The Regional Health Services Director for the facility was also present. The ED reported that they presented the plan and informed RP that R1 needed medication management and they would have to agree to the new assessment and care plan in order for R1 to return to the facility. RP verified this report. The RP reported that they disagreed with the assessment and did not think R1 needed medication management, but they never received a copy of the care plan, so they didn’t have an opportunity to review the new care plan. RP stated they did not have a chance to approve or reject the care plan. The ED verified they did not send the new care plan to the RP because they were informed, they would not agree to it because it was not needed. The RP verified this report. R1 was cleared to return to the facility on or around June 7, 2024. R1 is currently at a SNF. The facility has taken no action to provide the RP with the new care plan or to contact R1 or RP. Based on the evidence gathered the preponderance of evidence standard has been met; therefore, the above allegation is substantiated. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the report along with appeal rights was provided. Based on the evidence gathered the allegation is deemed unsubstantiated, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted, and a copy of the report provided.the state’s words, verbatim · CDSS document, Jun 20, 2024 · control 22-AS-20240617153724

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Jun 21, 2024

Eviction Procedures- The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by: Based on interviews and file review, the facility did not take R1 back from the Skilled Nursing Facility. The licensee did not serve R1 with a 30 day notice to evict the resident. This poses an immediate Health and Safety and/or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 20, 2024

Plan of correction: Licensee agrees to review regulation 87224 Eviction Procedures and provide proof of understanding that a 30 day notice should be issued before a resident is evicted. Licensee to submit proof of understanding to LPA by POC due date of 6/21/2024.