Ivy Park at Pleasanton

Allegation investigated: Due to neglect/ lack of supervision resulting in resident sustaining a fractured elbow

On 06/02/2026 at 9:52 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to to deliver findings in regard to the allegation above.LPA met with Executive Director in training Erica Glynn and explained the purpose of the visit. The Department conducted interviews and reviewed facility records, EMS records, and medical records regarding the allegation. Records revealed that on 11/18/2025, R1 was observed chasing an unknown staff person when R1 tripped and fell. EMS responded and assessed R1 following the fall. EMS records indicated R1 denied pain and did not exhibit signs of injury at that time. Records further indicated that R1's responsible party declined transportation to the hospital following the assessment. ***CONTINUE ON 9099C*** Unsubstantiated ***CONTINUE FROM 9099*** S1 informed the Department during an interview that R1 did not exhibit any signs or complaints of pain in her left arm following the reported fall and did not experience any additional falls between 11/19/2025 and 11/27/2025. S1 further stated that R1 was away from the facility with family for the Thanksgiving holiday from 11/27/2025 through 11/30/2025. Records reviewed indicated that on 11/30/2025, at approximately 8:50 a.m., R1 was admitted to an emergency room with complaints of left wrist pain related to an unspecified fall. Medical records documented a diagnosis of a nondisplaced fracture of the radial head (elbow fracture). The Department interviewed S1 and S2, who reported that R1 remained at baseline following the incident, continued to ambulate independently, participated in normal daily activities, and did not complain of pain or discomfort. Records reviewed by the Department indicated that facility staff monitored R1 following the fall and documented R1's condition. This agency has investigated the allegation above. We have found that the complaint was unfounded. Exit interview conducted and a copy of this report was provided to the Executive Director. ***CONTINUE FROM 9099*** The Department interviewed S1 and S2, who reported that R1 was ambulatory, independent with walking, and was not considered a fall risk prior to the incident. S1 and S2 stated that following the fall, R1 continued to ambulate throughout the facility, participated in activities, and did not complain of pain or display signs of injury. Records reviewed by the Department showed that R1 left the facility with family on 11/27/2025 and returned on 11/30/2025. Hospital records reviewed by the Department revealed that on 11/30/2025, R1 was diagnosed with a nondisplaced fracture of the radial head. However, the records did not identify when or where the injury occurred. This agency has investigated the allegation. We have found that the complaint was 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 allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 2, 2026 · control 15-AS-20251204162751

Type of visit: Case Management - Health Checks

On 04/16/2026 at 1:00 PM, Licensing Program Analyst (LPA), Ardalan Gharachorloo conducted a health and safety check as a result of the department receiving a complaint with the control number (#15-AS-20260415082542). LPA met with Jeffrey Brenner, Regional Operation Specialist and explained the purpose for the visit. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, memory care unit and outdoor area. Hot water temperature was measured at 113.2 degrees F in the hallway bathroom. The room temperature in the hallway was measured at 73 Degrees F.LPA checked medication room. Resident's medications were kept locked in the medication room. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 16, 2026

Type of visit: Case Management - Incident

On 01/29/2026 at 12:00 PM, Licensing Program Analysts (LPA), Ardalan Gharachorloo arrived unannounced to conduct a case management visit in response to an incident report received on 01/27/2026. LPA met with Health services director, Vernica Herrera and explained the purpose for the visit. On 01/23/2026 at approximately 8:30 PM, LPA interviewed S1 who stated that staff heard a door alarm wile immediately checked the nearby exit and stairwell but did not observe anyone exiting the building. A headcount of residents was initiated, during which it which discovered R1 was not in her room. Staff continued to search and promptly located R1 outside the building walking toward the parking lot with a family member of another resident. R1 was safely redirected back to the facility. No injuries were observed or reported, and the responsible party was notified of the incident. S1 stated that "R1 was redirected back to the building with a staff member immediately after leaving". LPA reviewed R1's file. No deficiencies cited during the visit. Exit interview conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jan 29, 2026

Type of visit: Case Management - Health Checks

On 12/05/2025 at 12:00 PM, Licensing Program Analysts (LPA), Ardalan Gharachorloo arrived unannounced to conduct a health and safety check as a result of the department receiving a complaint with the control number (#15-AS-20251204162751). LPA met with Executive Director, Patricia Holguin and explained the purpose for the visit. LPA toured the memory care unit with Executive Director Patricia Holguin ,and observed residents sitting in common area, backyard, and dining area. LPA toured 3 resident rooms, bathrooms, bedrooms and outdoor area. LPA measured the water temperature at 112 degrees Fahrenheit. The room temperature in common area was measured at 71 degrees Fahrenheit. No deficiencies were cited today. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 5, 2025

Type of visit: Case Management - Other

On 12/02/2025 at 10:10 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct a case management visit. LPA met with Patricia Holguin, Executive Director and explained the purpose of the visit. LPA went to the facility to deliver an Immediate Exclusion letter for S1. It was confirmed S1 was not present at the facility. Immediate Exclusion letter was delivered for S1 and notification of the exclusion letter was given to the Executive Director. LPA has advised the Executive Director to disassociate the individual from their roster and submit an updated LIC 500. Exit interview conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Dec 2, 2025

Type of visit: POC

On 09/30/2025 at 12:30 PM Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Proof of Correction (POC) visit and met with Regional Operations Specialist, Jessica Pryor. LPA explained the purpose of the visit to Jessica. LPA obtained the following documents: copy of R2’s Resident Assessment (dated 09/01/24) and Service Plan Reports (dated 02/05/23 and 09/03/23). On 09/24/2025, LPA L. Alexander conducted a case management visit and cited the facility for not having R1’s and R2’s files available, including but not limited to documents from 2024. The facility was previously licensed under License #19200722, with Welltower OPCO Group LLC as the owner and Oakmont Management Group LLC as the operator at the time Complaint #15-AS-20240520111558 was opened on 05/22/2024. The Change of Ownership became effective on 09/06/2024. Staff 1 (S1) stated that Welltower remains the owner while Oakmont manages daily operations. At the time of the ownership change, R2 was still a resident at the facility until 10/01/2024 and R1 moved out 05/31/2024. LIC809-C Continued... LIC809-C (Page 2) Deficiency Not Cleared: CCR 87506(d) $100.00 x's 1 day = $100.00 Civil Penalties in the amount of $100.00 is assessed today for the period of 09/30/2025 for failure to meet POC due date for deficiency CCR 87506(d). Facility is subject to ongoing penalties until citation is corrected. Exit interview conducted. A copy of this report, LIC421FC and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 30, 2025

Allegation investigated: Staff behavior poses as a risk to residents Staff did not prevent a resident from assaulting another resident Staff left a resident outside in extreme heat for an extended period of time Staff does not communicate effectively Staff did not properly report incidents involving the residents

On 09/24/2025 at 12:15 PM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver findings in regard to the allegations above. LPA met with Executive Director, Gilbert Castro and explained the purpose of the visit. During the course of the investigation, LPA conducted interviews with 4 staff (S1-S4), two residents (R3,R4) ,and obtained the following documents: a copy the residents roster in the memory care unit, staff roster and schedule, and incident reports. LPA also obtained the files of R1, and R2 including admission agreement, invividualzed service plan, Physician's report, Charting Notes, Assessments and med records.During visit, LPA also toured the memory care unit. Allegation: Staff behavior poses a risk to residents - Unsubstantiated W1 expressed concern management and oversight of the memory care unit.LPA interviewed staff (S1–S4) who did not report any issues related to staff behavior or administrative oversight. ***CONTINUE ON 9099C*** Unsubstantiated ***CONTINUE FROM 9099*** Resident interviews were also consistent, with R3 stating, “the staff are very nice and take good care of us,” while R4 shared, “I don’t have problems with the staff.” LPA’s observation during the tour showed staff engaged in scheduled care responsibilities. Review of staff schedule, resident files, including charting notes and individualized service plans, indicated that care delivery and monitoring were consistent with residents’ needs. No documentation supported that staff behavior created a risk or led to lapses in care. Allegation: Staff did not prevent a resident from assaulting another resident - Unsubstantiated W1 reported that “two incidents occurred where R1 was hospitalized after being assaulted by another resident,” and stated "staff failed to intervene". Staff interviews confirmed an altercation occurred between residents; however, S1 stated, “both responsible parties were notified right away and both residents were sent for medical assessment.” S2 similarly reported that staff “reacted quickly and ensured the facility protocols are being followed.” A review of R1’s file, including charting notes, and incident reports and LPA's interview with S1, revealed that R1 was taken to Urgent care by the responsible party at W1's request ,and follow-up steps were documented. S3 stated " I notified the nurse immediately when the altercation happened we made calls and left voicemail". Based on staff statements and file reviews, staff responded and documented the incident as required. ***CONTINUE ON 9099C*** ***CONTINUE FROM 9099C*** Allegation: Staff left a resident outside in extreme heat for an extended period of time- Unsubstantiated W1 stated that “a resident was left outside in extreme heat for over an hour” and found by her daughter showing signs of overheating. Interviews with S3 and S4 did not confirm this incident, and both stated they “are attentive when residents are outdoors, especially in hot weather.” LPA interviewed R3 who stated, “I usually see one or two staff outside checking in if a resident is outside".Review of daily charting notes and assessments for residents did not show any documentation of a resident experiencing heat related issues. During the tour, LPA observed shaded areas in the outdoor space. Allegation: Staff does not communicate effectively - Unsubstantiated W1 reported that “communication was hindered as the caregiver did not speak English” during an incident. Interviews with S1–S4 revealed that some staff speak English as a second language, but all were able to effectively communicate with residents and facility leadership. S4 stated, “I can explain care needs in English, and if needed, I ask another staff to help.” R3 confirmed, “the staff understand what I want,” while R4 shared, “I never had problems talking to them.” Additionally, during the visit, LPA was able to communicate directly with all staff and confirm they understood questions and responded to questions asked. A review of resident service plans and charting notes showed that care instructions were being followed. ***CONTINUE ON 9099C*** ***CONTINUE FROM 9099C*** Allegation: Staff did not properly report incidents involving the residents - Unsubstantiated W1 stated there “should be unusual incident reports on file” regarding the resident altercations. A review of R1’s and R2’s files revealed that incident report was sent to CCL and a copy of the incident report was reviewed by LPA. Documentation also showed charting notes for both residents aligned with the reported timelines and follow-up care. This agency has investigated the above allegations. We have found that the allegations were unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 24, 2025 · control 15-AS-20250608233141

Type of visit: Case Management - Other

On 09/24/2025 at 2:30 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced at the facility to conduct a Case Management visit. Upon arrival, LPA met with Executive Director (ED) Gilbert Castro and explained the purpose of the visit. On 09/18/2025, LPA L. Alexander requested residents' file documents related to Complaint #15-AS-20240520111558 for Resident 1 (R1) and Resident 2 (R2) from Staff 1 (S1). Staff 2 (S2) subsequently responded to LPA’s request and asked for an extension until 09/23/2025 to provide the requested documents. During visit, LPA obtained copies of R1's MC Assessment & Service Plan (dated 05/21/24) and Service Plan Reports (dated 09/12/21, 03/11/22, 09/15/22, 03/15/23 and 08/07/23). In addition, LPA obtained copies of R2's Order Summary Report for medication (dated 05/25/23) and Service Plan (dated 02/05/23). S1 stated that records for year 2024 was not available for R1 and R2. S1 stated that their Health Services Regional will request access to Point Click Care (PCC) liaison through the former software in order to obtain documents. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Sep 24, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(d) · Plan of correction due date: Sep 29, 2025

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying.... This requirement is not met as evidenced by: Based on record review and staff interviews,the licensee did not comply with the section cited above in by not ensuring that complete and former resident records were maintained and available for review as required. Specifically, records for R1 and R2 for the year 2024 were not available during the visit on 09/24/2025. In which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 24, 2025

Plan of correction: The licensee shall ensure that R1 and R2’s 2024 records are retrieved and maintained in the facility files. The Executive Director shall submit proof of record retrieval (copies or verification of access through Point Click Care) to the Department by due date.

Type of visit: Required - 1 Year

On 09/09/2025 at 10:00 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Gilbert Castro and explained the purpose of the visit. LPA toured the facility including but not limited to 5 residents’ units, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 75 degrees F. The hot water temperature in 5 residents’ bathrooms were measured at 117 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 01/22/2025. Emergency Disaster Plan was last updated and posted on 06/18/2025. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 06/18/2025. LPA reviewed 5 residents records and 6 staff records, and all were complete. LPA also reviewed a sample of resident’s medications. The following documents were reviewed during the visit: LIC 500 Personnel Report LIC 610E Emergency Disaster Plan, Liability Insurance, and Current Administrator’s Certificate. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 9, 2025

Type of visit: Case Management - Deficiencies

On 08/05/2025 at 11:25 am Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with Executive Director, Gilbert Castro. LPA informed of LPA obtained the following documents regarding Complaint #15-AS-20240520111558 investigation. Documents obtained: Residents (R) R1's Progress Notes and R2's Physician's Report (dated 07/12/24), Kaiser Palliative Care (dated 04/05/24), home health notes (dated 04/01/24) and resident ledger. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 5, 2025

Allegation investigated: Staff are interfering with resident's visitation

On 07/02/2025 at 10:05 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver findings regarding the allegation above. LPA met with the Executive Director, Gilbert Castro and explained the purpose of the visit. Allegation: Staff are interfering with resident’s visitation – Unsubstantiated. During the course of the investigation, LPA interviewed four staff members (S1–S4), three residents (R1–R3), and (W1). LPA also reviewed R1’s file including the admission agreement, physician’s report, care plan, charting notes, communication logs, and Power of Attorney documents. The review of records revealed that, the admission agreement contained no provisions authorizing restrictions on visitation such as requiring staff presence, location limitations, or advance notice. Charting notes and communication logs did not reflect any instructions to restrict access to R1. ***CONTINUE ON 9099C*** Unsubstantiated ***CONTINUE FROM 9099*** S1 stated that all guests check in with the front desk and residents are notified immediately. S2 indicated that while staff were made aware of some family conflict, no formal or informal restriction on R1’s visitation was enforced. W1 stated that R1’s daughter was informed of several visitation rules, including providing 24-hour notice, limiting visits to public areas, being accompanied by staff, not bringing a cell phone or guests, and not taking R1 off premises. S3 and S4 stated that on limited occasions, they were asked to be present during visits as a precautionary measure at the POA’s request, but that visits were not prohibited. R2 and R3 both stated they receive visits regularly and had not witnessed staff restricting residents from meeting with family or guests. R1’s care plan and medical assessments did not identify any behavioral, cognitive, or safety concerns that would require limiting or monitoring visits. W1 also reported that R1 had not seen her daughter for an extended period, and when they did reunite, R1 appeared visibly distressed and expressed that she had been told her daughter no longer wished to see her. W1 stated that during this visit, R1 became emotional, and a staff member approached and asked if she felt safe, to which R1 responded that she did. W1 expressed concern that staff never communicated directly with the daughter about these reported conditions and believes R1 may have received incorrect information that caused confusion. LPA's review of communication logs and admission agreement did not produce evidence that facility staff conveyed inaccurate information to R1 or that they imposed or enforced restrictions in violation of visitation rights. This agency has investigated the above allegation. We have found that the complaint was 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 allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 2, 2025 · control 15-AS-20250409151315

Allegation investigated: Licensee does not ensure facility is adequately staffed to meet residents needs Staff are not properly supervising residents who may be a fall risk Staff are not properly notifying resident responsible parties of incidents in a timely manner Staff are not providing residents with clean linen Staff are not assisting residents with meeting their bathing needs

On 05/23/2025 at 10:50 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver findings regarding the allegations above. LPA met with Executive Director,Gilbert Castro and explained the purpose of the visit. Over the course of the investigation, LPA Ardalan Gharachorloo conducted interviews with 6 staff members (S1–S6) and 3 residents (R1,R2,R3), and reviewed the resident files for R1, R2, and R3. The documentation reviewed included individualized Care plans, admission agreements, physician reports, charting notes, staff schedules, incident reports, care logs, and the staff communication logs. LPA also toured the memory care unit and inspected the rooms of R1, R2, and R3. LPA was unable to speak to W1. Allegation: Licensee does not ensure facility is adequately staffed to meet residents needs-Unsubstantiated W1 stated in her letter to the Executive Director that on several occasions she found residents, including (R1), unsupervised in the memory care common area. ***CONTINUE ON 9099C*** Unsubstantiated ***CONTINUE FROM 9099*** She expressed concern that staff may not be sufficient to monitor and care for residents safely in the memory care unit. LPA reviewed staffing schedules for January and February 2025 and observed a consistent staff-to-resident ratio. The schedules showed that the memory care unit maintained 5 caregivers and 1 med tech during daytime hours, with 4 caregiver and 1 med tech during the night shift. LPA also reviewed care plans for R1, R2, and R3. R1’s care plan included supervision in common areas, cueing for activities, and safety checks. The charting notes indicated that staff were recording observations multiple times per shift. Staff communication logs reflected shift-to-shift updates on resident behaviors and supervision needs. S1 (Executive Director) stated, “We make staffing decisions based on residents' care plans and adjust if anyone’s condition changes.” S2 added, “If we notice someone needs more one-on-one time, we increase support.” S3 said, “We’re always checking the common areas—it’s part of our routine.” S6 also stated, “Even if we’re passing meds, we’re constantly scanning the room". Allegation: Staff are not properly supervising residents who may be a fall risk- Unsubstantiated W1 reported that R1 experienced a fall during her stay. She expressed concern that residents at risk of falling were not being supervised appropriately. Charting notes reviewed by LPA identified R1 as a fall risk during nighttime hours while in her room. The care plan instructed staff to provide cueing, assist with transfers, and perform safety checks. Charting notes confirmed that staff conducted regular checks and documented her mobility daily. An incident report dated 01/30/25 detailed a fall in the common area, marked as "un-witnessed," and included follow-up actions such as vital signs monitoring and notification to the responsible party. ***CONTINUE ON 9099C*** ***CONTINUE FROM 9099C*** S2 explained, “When someone is a fall risk, we tag their chart and notify all staff to monitor them closely. R1 was being checked regularly before and after the incident.” S5, added, “We try to keep fall-risk residents in sight at all times, but they can get up quickly.” S6 stated, “We had eyes on her throughout the morning. She was fine one minute and, on the floor, the next—we responded immediately.” Allegation: Staff are not properly notifying resident responsible parties of incidents in a timely manner - Unsubstantiated W1 stated that after R1’s fall, she was not immediately informed and only learned of the incident after making her own inquiries. In the letter, she expressed frustration about not receiving prompt updates from the facility. LPA reviewed the incident reports related to R1’s fall and confirmed it included a notation of a phone call made to W1 the same day the fall happened. The facility’s internal policy requires responsible parties to be notified immediately of any significant incident. Communication logs and R1’s chart included an entry confirming that S2 spoke with W1 and provided an update on R1’s condition. S2 stated, “We make every effort to notify families within the hour. In R1’s case, Med Tech made the call that evening.” S1 added, “We train staff to report incidents immediately to management so we can handle notifications without delay.” S4 also stated, “If something happens, we write it up, radio the lead, and let them handle the family call—it’s taken seriously.” Allegation:Staff are not providing residents with clean linen - Unsubstantiated According to W1, she discovered R1’s bed with no sheets during her second week at the facility. She reported that R1 was lying on a bare mattress and was concerned that linens were not being changed or replaced as needed. ***CONTINUE ON 9099C*** ***CONTINUE FROM 9099C*** LPA inspected rooms during the visit, including R1’s former room, and found clean linens present. LPA reviewed linen logs and supply inventories, which showed that clean bedding was distributed weekly and as needed. R1’s care plan indicated that staff were to provide linen changes at least three times per week and immediately if soiled. Charting notes included entries indicating linen changes for R1 on 01/18, 01/22, and 01/29. S2 stated, “If a bed is found without sheets, that’s usually because the linens were removed for cleaning and staff hadn’t finished remaking it yet.” S3 said, “Sometimes we strip the bed, step out to grab clean sheets, and come back—but we don’t leave it for long.” S5 added, “I always change sheets if they’re dirty, and we have a full linen closet on each floor.” LPA toured R1, R2 and R3’s room during the visit and observed clean linens. Allegation: Staff are not assisting residents with meeting their bathing needs - Unsubstantiated W1 stated that R1 did not receive any baths during her stay at the facility. She stated that R1's hygiene appeared poor and her hair remained unwashed, which raised serious concerns. LPA reviewed R1’s Care Plan, which indicated she was to be assisted with bathing twice weekly and as needed. The bathing schedule showed that R1 was assigned to bathe on Tuesdays and Fridays, with logs marking bathing assistance on 01/17, 01/21, and 01/28.There were no refusals noted in the logs. S3 stated that if there is a refusal, it is noted in the charting notes. S2 explained, “We follow the care plan, and if a resident refuses a bath, we document it and try again later.” S4 added, “we also log refusals on shower skin sheet. A sample of the log was provided to LPA. S6 said, “R1 didn’t resist bathing. We assisted her per schedule, and she was always cooperative.” ***CONTINUE ON 9099C*** ***CONTINUE FROM 9099C*** This agency has investigated the above allegations. We have found that the complaint was unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, May 23, 2025 · control 15-AS-20250227120705

Type of visit: Case Management - Other

On 04/25/2025 at 4:30 pm Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with Michelle Jauco, Business Office Director. While LPA L. Alexander was conducting a complaint investigation (15-AS-20240520111558) on 04/25/2025. During record review LPA observed Resident (R) R1's file were missing documents. LPA requested reappraisals, including but not limited to Doctor's orders, and Documentation of Support. Business office Director and Resident Care Coordinator stated documents have been moved to storage off the premises of the facility. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Apr 25, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(b)(17) · Plan of correction due date: May 2, 2025

87506 Resident Records (b) Each resident’s record shall contain at least the following information: (17) Documents and information required by the: This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in by not having complete records for R1 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 25, 2025

Plan of correction: Administrator shall send a copy of R1's reappraisals, doctor's orders, documentation of support including from physician to CCLD by POC due date.

Allegation investigated: Staff unlawfully evicted a resident Phone not in service

On 2/13/2025 at 10:15 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver findings regarding the allegations above. LPA met with Executive Director (ED), Gilbert Castro and explained the purpose of the visit. Allegation: Staff unlawfully evicted a resident. Over the course of the investigation, LPA interviewed the Executive Director. ED stated that R1 currently resides in the facility. LPA toured R1's apartment with the Executive Director, and R1 was in the apartment. R1 stated that he is "doing fine". LPA also interviewed S1, S2, S3 and S4. They all stated that phone calls from outside agencies are handled by concierge during normal business hours. If it is outside business hours, it is routed to medication technicians. S1 further stated that "calls are answered in the order received" and "as quickly as possible" to facilitate the resident's return to the facility from the hospital. ***REPORT CONTINUE ON 9099C*** Unsubstantiated ***REPORT CONTINUE FROM 9099*** Allegation: Phone not in service During the investigation, LPA checked the main phone line of the facility. The phone line was working and operational. LPA also interviewed R1, R2 and R3 and all stated that they have no issues with the phone lines at the facility. R1, R2, and R3 further stated that the facility provides them access to phone line to be able to make or receive calls. This agency has investigated the complaint regarding allegations above. We have found that the complaints were unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 13, 2025 · control 15-AS-20250128095758

Type of visit: Case Management - Deficiencies

On 10/16/2024, At 10:10 AM, Licensing Program Analysts (LPAs) Ardalan Gharachorloo and Lori Alexander arrived to conduct the investigation for the complaint received (No.15-AS-20240520111558). LPAs met with Ena Vilao, Business Office Director and explained the purpose of the visit. During the complaint visit, Licensing Program Analysts requested the resident' files, and were informed that they did not have access to those documents. THE FOLLOWING DEFICIENCY WAS OBSERVED: · At 1:30 pm LPAs requested the following documents: May 2024 shower schedule for residents, May 2024 toileting schedule for residents, Staff schedules for the month of May 2024, and home health records for R1, including but not limited the entire resident file for R1. These documents were not on file and were not available during visit. The above deficiency was observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. LIC809D, Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 16, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(d) · Plan of correction due date: Oct 25, 2024

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement is not met as evidenced by: Based on file review, the licensee did not comply with the section cited above in by not having records available, staff schedule, laundry, shower, housekeeping schedules for residents for the month of May 2024 and the resident's file including but not limited for R1 which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 16, 2024

Plan of correction: Administrator agree to submit requested documents to CCLD by POC due date.

Type of visit: Prelicensing

On 08/22/2024 at 10:25 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct pre-licensing inspection. LPA explained to Gilbert Castro, Executive Director the purpose of the visit. This pre licensing is being conducted due to a change in ownership (CHOW) of the facility. LPA inspected the facility inside and out including but not limited to the assisted living and Memory Care units, common areas, kitchen, dining and activity room. LPA also inspected the facility including but not limited to 3 resident rooms, bathrooms, common areas and backyard. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed. There is sufficient lighting throughout facility. Room temperature was maintained at 72 degrees F and hot water temperature was maintained at 106 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last serviced on 11/16/2023. LPA reviewed 5 staff files and 6 residents files and all were complete. No issues noted during inspection. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 22, 2024

Type of visit: Case Management - Other

On 08/22/2024 at 2:25 pm, Licensing Program Analyst (LPA) Ardalan Gharachorloo conducted Component lll with Executive Director (ED) Gilbert Castro. Caseload LPA Gharachorloo presented Component lll power point presentation with ED. A copy of this report was provided to ED.the state’s words, verbatim · CDSS document, Aug 22, 2024