Ivy Park at Seal Beach

Type of visit: Required - 1 Year

On May 21, 2026, at 12:45 PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (ADMIN) Tami Ojwang and explained the purpose of the visit. The facility is licensed to operate for fifty-three ambulatory residents and two hundred and eight (208) non-ambulatory, of which eight (8) may be bedridden, and have a hospice waiver for twenty (20) residents. The facility has two buildings with three stories each, which consists of the following: one hundred forty-six (146) resident bedrooms, seven (7) offices, three medication rooms, one hundred and fifty (150) bathrooms, two waiting areas, seven activity areas, exercise room, two bistro areas, theater, three dining areas, kitchen, and two outdoor covered patio areas. LPA Kim toured indoor and outdoor of the physical plant. There are no bodies of water or obstructions on the premises. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The following bedrooms were inspected in Building A: Resident Room 106, Resident Room 117, Resident Room 127, Resident Room 211, Resident Room 225, Resident Room 303, and Resident Room 312. The following bedrooms were inspected in Building B: Resident Room 106, Resident Room 125, Resident Room 202, Resident Room 215, Resident Room 309, and Resident Room 321. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 111.9 degrees F and 115.3 degrees F. A comfortable temperature of 75 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. During the visit, LPA Kim observed the facility's infection control practices. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Emergency water is stored outside by the kitchen exit. Emergency food and emergency supplies were stored in a storage shed in the back of the facility. A working telephone (562-594-5788) remains available. LPA Kim reviewed the facility’s plan of operation, emergency and disaster plan, and fire/safety drill log. The facility conducts a Fire/Safety Drill quarterly and was last conducted on April 4, 2026. All facility fire extinguishers were charged, and they were all serviced on October 7, 2025. All smoke detectors and carbon monoxide detectors were operable and were last inspected on December 29, 2025, by Cal Building Systems. Certificate of Liability insurance is effective May 1, 2026, and expires on May 1, 2027. \ LPA conducted nine (9) resident interviews and four(4) staff interviews. Due to time constraints a continuation inspection will be conducted on a later date and the following will be done: 1) an audit of resident files, 2) An audit of staff files, and 3) An audit of medication and medication administration record). An exit interview was conducted, and a copy of this report was provided to Administrator Tami Ojwang.the state’s words, verbatim · CDSS document, May 21, 2026

Allegation investigated: Staff are screaming at the residents. Staff mishandles the residents. Staff do not provide adequate care and supervision to the residents. Staff do not respond timely to the residents alerts.

On May 19, 2026, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced subsequent complaint visit to deliver findings at the facility for the above allegations. LPA Kim met with Administrator Tami Ojwang and explained the purpose of the visit. The investigation consisted of the following: LPA Kim conducted a physical plant tour inside and outside of the facility and no concerns were observed. LPA Kim reviewed twelve resident record, which include: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, and other pertinent records. The investigation revealed the following: Continued on LIC9099C Unsubstantiated Allegation: Staff are screaming at the residents. It is alleged that care providers are screaming at residents in the residents’ rooms. It is alleged that staff #1 (S1) and staff #2 (S2) are screaming at residents. Based on interviews conducted, twelve out of twelve residents interviewed stated they do not recall any staff that screamed at a resident in their room or in the facility. They stated they do not recall S1 and S2 are yelling at any residents. All staff stated they have not observed any staff yelling at any resident inside of the facility. Based on observations, on July 31, 2025, August, 28, 2025, and May 19, 2026, LPA did not observe any staff yelling at any residents in their rooms or in common areas. Based on record review, LPA requested records from the facility about disciplinary actions or any incidents where staff yelled at residents, but the facility did not have any record of such incidents. Based on the information gathered, there is no sufficient evidence to confirm the above allegation. Allegation: Staff mishandles the residents. It is alleged that S3 is being too rough with residents. It is alleged residents are abandoned at the dining room and the residents are crying in pain. Based on interviews conducted, twelve of twelve residents and five out of five staff denied the allegation. All residents and all staff stated they do not recall S3 being too rough with residents. Residents did not observed or hear about a time they were ignored and abandoned in the dining room. Staff stated they have not heard or observed a time where residents were left abandoned and ignored in the dining room. Based on observation on July 31, 2025, August 28, 2025, and May 19, 2026, LPA did not observe any staff being too rough with any residents. LPA did not observe any staff abandon or ignore residents in the dining room. When residents needed assistance to be escorted up, staff were available and took the residents back to their rooms. Based on record review, LPA requested from the facility of any disciplinary actions or any incidents where staff were being too rough with residents, ignoring residents requests for help, or abandoning residents in the dining room. The facility did not have any record of any incidents or disciplinary actions in regard to being too rough, abandoning residents in the facility, or ignoring residents requests for help. Based on the information gathered, there is no sufficient evidence to confirm the above allegation. Continued on LIC9099C Allegation: Staff do not provide adequate care and supervision to the residents. It is alleged staff are on their phone and ignoring residents when the residents ask for help. It is alleged residents are being abandoned in the dining rooms and crying in pain because they are not being escorted back to their rooms. Based on interviews conducted, twelve out of twelve residents and five out of five staff denied the allegation. All staff and resident stated they had not observed or heard a situation where the staff were ignoring residents requests for help while using their phones. Residents stated the staff provide care and supervision to help them with their daily needs. Residents do not recall a time where they were not escorted back or crying in plain because they are not being escorted back to their rooms. Staff stated they have not observed staff ignoring residents or abandoning residents in the dining room. Based on observations on July 31, 2025, August 28, 2025, and May 19, 2026, LPA Kim did not observe staff abandon or ignore residents when they needed assistance or requested for any help. Based on record review, LPA requested a record of any incidents or disciplinary actions from staff for ignoring residents request for help, not escorting residents to their rooms, or abandoning residents. Facility did not have any records of any of this happening. Based on the information gathered, there is no sufficient evidence to confirm the above allegation. Allegation: Staff do not respond timely to the residents alerts. It is alleged that staff are instructed not to click pendants for pickup by care providers because it red flags the location if there are too many pendant clicks. It is alleged a pull cord is being pulled and it takes staff 45 minutes to respond. Based on interviews conducted, twelve out of twelve residents and five out five staff denied the allegation. All staff stated they were never instructed by management to not click pendants for pickup because it red flags the location. Staff stated that whenever a pendant is pressed, they get paged to what resident’s room number requested the help. They will respond within 5 to 10 minutes. Whether it is the pull cord or the pendant, the staff will reset the pull cord or the pendant once the resident’s request is met. All residents stated the facility staff respond in a timely manner. All staff and residents stated they will respond within 10 minutes and have not face a situation where they have waited over 20 minutes. Continued on LIC9099C Based on record review, LPA requested a record log for residents, but the facility was not able to provide one at the time of the visit. Based on observations on August 28, 2025, LPA tested and recorded the time the resident’s pull cord and pendant call button in the following rooms: staff arrived to Building B Room 109 in five minutes and forty-two seconds, Building B Room 219 in three minutes, Building B Room 325 in five minutes and fifty-six seconds, Building A Room 126 in one minute and eighteen seconds, and Building A Room 114 in one minute and thirty-four seconds. Based on the information gathered, there is no sufficient evidence to confirm the above allegation. Based on observations, interviews, and records review, LPA did not find sufficient evidence to support the above allegations Staff are screaming at the residents, Staff mishandles the residents, Staff do not provide adequate care and supervision to the residents, and Staff do not respond timely to the residents alerts. 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 was conducted and a copy of the report was provided to Administrator Tami Ojwang.the state’s words, verbatim · CDSS document, May 19, 2026 · control 22-AS-20250725093607

Allegation investigated: Staff stopped residents medication without a physicians order

On May 19, 2026, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced subsequent complaint visit to deliver findings at the facility for the above allegation. LPA Kim met with Administrator Tami Ojwang and explained the purpose of the visit. The investigation consisted of the following: LPA Kim conducted a physical plant tour inside and outside of the facility and no concerns were observed. LPA Kim reviewed one resident record, which include: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, charting notes, Medication Administration Record, and other pertinent records. The investigation revealed the following: Continued on LIC9099C Unsubstantiated Allegation: Staff stopped residents medication without a physicians order. It is alleged when a resident’s medication was in low supply that it was canceled by facility staff due to a blood test being necessary without physician approval. It is alleged that the prescription was not refilled due to this incident. Based on record review, R1’s physician report dated October 1, 2025, diagnosed R1 with vascular dementia. R1’s Charting notes dated August 7, 2025, that R1’s family notified the facility a medication needs to be placed on hold. Staff notified R1’s family that an official hold order is needed from the doctor. Staff attempted to contact the doctor to receive the hold order. Medication Administration Record dated October 2025, stated the doctor placed the medication on hold from August 7, 2025, to October 9, 2025. Starting from October 9, 2025, the medication was administered to R1 because the medication was placed off hold. Charting Notes dated October 9, 2025, states the letter of clearance signed by the doctors was received by the facility. Based on interviews conducted, S1 and S3 stated that R1 had only one medication placed on hold. This was done because the family stated the doctor placed the medication on hold. S1 and S3 stated once the order was received to place it on hold, the facility would have withheld the medicine from R1. Once the Physician’s Order was received for R1 to receive the medication, the facility would administer the medication. Based on the information gathered, there is no sufficient evidence to confirm the above allegation. Based on interviews and records review, LPA did not find sufficient evidence to support the above allegation Staff stopped residents medication without a physicians order. 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 was conducted and a copy of the report was provided to Administrator Tami Ojwang.the state’s words, verbatim · CDSS document, May 19, 2026 · control 22-AS-20251023162755

Allegation investigated: Licensee is not ensuring that communications to staff from resident's representative are answered promptly.

On May 13, 2026, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced subsequent complaint visit at the facility for the above allegation. LPA Kim met with Administrator Tami Ojwang and explained the purpose of the visit. The investigation consisted of the following: LPA Kim conducted a physical plant tour inside and outside of the facility and no concerns were observed. LPA Kim reviewed one resident record, which include: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, email correspondence, and other pertinent records. The investigation revealed the following: Continued on LIC9099C Unsubstantiated Allegation: Licensee is not ensuring that communications to staff from resident's representative are answered promptly. It is alleged the facility lacked communication by not informing resident or resident’s responsible party of when medications ran out or when doses were missed. Ivy Park did not answer phone calls or have not responded to inquiries and questions. Based on interviews, LPA interviewed two staff and attempted to interview additional three staff. Staff #1 (S1) and S2 stated that whenever a staff member is contacted directly through email or over the phone it can take up to 72 hours for response based on their schedule. When they are working and receive a phone call or email, they will respond in a timely manner. S1 and S2 stated that they have not heard complaints from residents, resident’s family, and others about the lack of communication and about not responding in a timely manner for phone calls and email. S1 and S2 stated that staff notify resident, resident’s family, and/or responsible party if the resident’s medication is about to run out or if there is a medication error. Based on record review, email correspondence from Witness #1 (W1) to S1 were done in a timely manner. In an email correspondence dated March 11, 2025, S1 responded on the same day. On March 12, 2025, S1 responded to the email sent by W1 on the same day. In an email correspondence dated from July 29, 2025, S1 responded on the same day. An email correspondence dated August 24, 2025, to August 27, 2025, S1 responded to each email within the same day. An email correspondence dated November 4, 2025, S1 responded to the email the same day. LPA requested the facility for a call log, but the facility does not contain a call log record. Based on the information gathered, there is no sufficient evidence to confirm the above allegation. Based on observations, interviews, and records review, LPA did not find sufficient evidence to support the above allegation Licensee is not ensuring that communications to staff from resident's representative are answered promptly. 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 was conducted and a copy of the report was provided to Administrator Tami Ojwang.the state’s words, verbatim · CDSS document, May 13, 2026 · control 22-AS-20250826120248

Allegation investigated: Staff did not give resident medication as prescribed.

On May 13, 2026, at 8:30 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced subsequent complaint visit at the facility for the above allegation. LPA Kim met with Administrator Tami Ojwang and explained the purpose of the visit. The investigation consisted of the following: LPA Kim conducted a physical plant tour inside and outside of the facility and no concerns were observed. LPA Kim reviewed one resident record, which includes: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, Medication Administration Records, Centrally Stored Medication Destruction Records, and other pertinent records. The investigation revealed the following: Continued on LIC9099C Unsubstantiated Allegation: Staff did not give resident medication as prescribed It is alleged that resident has been administered the wrong medication. The staff have given the wrong number of pills and the resident has gone to the medication office to get the medication. It is alleged that the facility received antibiotics but was not given it until the next day. Based on record review, R1 was admitted to the facility on July 31, 2023. R1’s physician report dated August 25, 2025, diagnoses the resident with hypertension, type 2 diabetes, and being nonambulatory. A Resident Assessment was performed on March 21, 2025, because there was a change of condition that stated the resident need assistance with medication, assistance with showers/bathing, and meal time reminders. R1’s Charting Notes dated August 19, 2025, to August 23, 2025, stated R1 waw administered their antibiotic medication for five days. Charting notes stated the resident did not express any pain or discomfort. On an email correspondence dated August 25, 2025, W1 stated R1 was given two blood pressure pills instead of one pill. S2 explained that the two pills totaled the same dosage as the prescribed single pill. Centrally Stored Medication Destruction Record (CSMDR) dated August 18, 2025, that the inhaler and the antibiotic were received and was started on August 19, 2025 at 11:00 AM. Physician’s order stated the antibiotics were take one pill for two times a day. There is no specific time of day when it needs to be taken. CSMDR dated August 24, 2025, the blood pressure medication was filled and given on the next day. Based on interviews conducted, S7 stated that R1 was administered their blood pressure medication on August 25, 2025. S1 and S2 stated the facility administered their antibiotic medication from August 19, 2025, to August 23, 2025, as prescribed. S2 and S7 stated the process for the medication being received is to firsts verify the medication was received then administer as soon as possible. Based on the information gathered, there is no sufficient evidence to confirm the above allegation. Based on interviews, and records review, LPA did not find sufficient evidence to support the above allegation Staff did not give resident medication as prescribed. 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 was conducted and a copy of the report was provided to Administrator Tami Ojwang.the state’s words, verbatim · CDSS document, May 13, 2026 · control 22-AS-20250821153955

Allegation investigated: Staff did not provide services as agreed in resident's Admission Agreement. Staff confined resident to a wheelchair.

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to complete the complaint investigation and deliver the findings. LPA Haley explained the reason for the visit upon entry. The complaint investigation consisted of interviews with facility staff, resident family members, and document review. A total of ten interviews were conducted, and two more interviews were attempted. Regarding the allegation: Staff did not provide services as agreed in resident's Admission Agreement. 8 of 10 individuals interviewed provided information that contradicts the complaint allegation. Document review also revealed information that contradicts the complaint allegation. A review of Resident 1 (R1) initial Assessment and Service Plan dated August 5, 2023, under #14.) Bathing - the selection made was marked (a.) requires no assistance with showering/bathing. Under SP14 Service Plan: Bathing - The selected goal: Will remain independent with bathing. Continued on LIC9099C Unfounded During interviews Staff 1 (S1) stated, I think the resident (R1) needed it, but we were not charging them for it. It was like 10-days or 2-weeks and we were appeasing them, but the resident could not shower independently. According to S2, R1 would refuse showers due to sun downing behavior. The facility attempted to change the time of R1’s showers but that did not work. During a review of an updated Service Plan for R1 dated January 3, 2024, due to a change in condition a change was made to R1’s care and the service plan was updated. R1 bathing needs changed. #14.) Bathing: The selection was changed to: (e.) requires hands on assistance for all showering/bathing needs (1-2x/week). The goal was also changed as well. On the updated service plan, under SP14 Service Plan: Bathing - The selected goal: Will be able to meet bathing needs with assistance. According to S2, R1’s family only wanted one shower a week, but the facility staff said they encourage two showers a week. Regarding the allegation: Staff confined resident to a wheelchair. 8 of 10 individuals denied the allegation. S7 denied the allegation and said they never seen anyone do anything bad to R1. S7 also denied hearing any complaints about S5 from R1. S5 says they only worked with R1 one time. S5 explained that they would observe R1 using a walker, then S5 saw R1 using a wheelchair. According to S5, when the staff was working with the R1, the resident complained of leg pain so S5 said they took R1 out in a wheelchair because they were scared R1 would fall. S3 also denied the allegation, and stated R1 started complaining of pain and was struggling with ambulating. S3 says R1's mobility decreased and R1 began using a wheelchair. S3 also added there have been no complaints about S5 and most of the residents love S5. A review of a R1’s physicians report with an exam date of March 18, 2024, reveal R1 suffered from muscle weakness, and difficulty walking. Further, an inventory list from a Skilled Nursing Facility (SNF) signed by a family member of R1, dated January 8, 2024, reveal R1 had a black wheelchair cushion on their inventory list upon admission to the SNF and when discharged from the SNF. Based on the information gathered during interviews, and document review, both allegations are deemed unfounded, meaning the allegations are false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 19, 2026 · control 22-AS-20240812165107

Allegation investigated: Facility staff did not address resident's fall risk Facility staff did not address resident's change in condition

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit regarding a complaint received in our Regional Office. LPA was greeted and granted entry and explained the purpose of the visit. LPA met with Tami Ojwang, Executive Director. LPA obtained and reviewed the following documents: Unusual Incident Reports for the past six months, Resident #1 (R1's) facesheet, Physician's Report, Preplacement Appraisal, Appraisal and Needs and Services Plan. LPA reviewed hospital discharge paperwork and Home Health Agency notes. LPA requested and reviewed facility notes regarding each of the fall incidents for R1. R1 moved in July 25, 2024 and began to have falls on December 12, 2024, February 7, 2025, March 8, 2025, May 24, 2025 and June 4, 2025. Resident received Home Health (HH) services and LPA obtained (Continued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) HH notes. Each of the dates were documented by HH, who provided wound care and mental assessment and worked with facility staff to prevent falls and to observe any changes in condition. Facility also documented on Unusual Incident Reports to the Department regarding R1's falls and the medical services received. On June 16, 2025 LPA interviewed three of three residents regarding care received. Three of three residents did not have issues with care and that staff arrived in a timely manner and would check on them throughout the day. LPA toured R1's apartment and did not observe any immediate fall risks and spoke with Resident #2 (R2) who is R1's spouse, regarding any care issues. R2 stated everything was fine. It is alleged the: Facility staff did not address resident's fall risk. LPA interviewed two of two staff members regarding Resident #1 (R1) and both felt staff constantly checked on R1 and Resident #2 (R2) due to R2's higher level of care. Staff reported R1 had access to a pendant at all times and had frequent checks. The Responsible Party (RP) was notified of R1's falls and does not have any concerns other than the resident has falls due to becoming weaker. Both the facility and Home Health continued to monitor R1's fall risk and were in communication with the RP. It was alleged the Facility staff did not address resident's change in condition. Unusual Incident Reports and Home Health notes both documented that if R1 had any systemic infections; facility and home health were to follow-up with physician if any changes of condition were observed. Both facility and HH continued to monitor R1's falls and assess R1. Home Health notes on March 10, 2025 documented R1, who was initially independent, was no longer able to leave the community and that facility staff and RP were informed. Two of two staff reported R1 continued to have frequent checks and that R1 would not press pendant for assistance. On May 24, 2025 R1 was sent for further evaluation after a fall and returned to the community with no new orders. R1 fell on June 4, 2025 and was admitted at the hospital and Skilled Nursing for rehabilitation. R1 will return to the community on August 12, 2025. Based on LPA record review and interviews, 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 (Continued on LIC 9099C1) (Continued from LIC 9099C) allegations that: Facility staff did not address resident's fall risk and Facility staff did not address resident's change in condition are Unsubstantiated. An exit interview was conducted with Executive Director Tami Ojwang and a copy of the report was provided to the facility.the state’s words, verbatim · CDSS document, Aug 11, 2025 · control 22-AS-20250609111614

Type of visit: Case Management - Annual Continuation

On August 7, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted a continuation visit for a required 1-year annual visit. LPA Kim met with Administrator Tami Ojwang and explained the purpose of the visit. LPA Kim conducted a record review on resident files (R1-R19), staff files (S1-S12), and medications and medication administration record. LPA Kim observed R1, R2, and R3 were diagnosed with dementia. R1's physician's report dated July 22, 2024, R2's physician's report dated August 5, 2024, and R3's physician's report dated June 30, 2023. LPA Kim conducted interviews with eight staff. First Aid was maintained and contained all the necessary elements. A Technical Violation was assessed during the visit. LPA observed R1, R2, and R3 with a dementia diagnosis. R1's physician's report dated July 22, 2024, R2's physician's report dated August 5, 2024, and R3's physician's report dated June 30, 2023. An exit interview was conducted and a copy of this report, LIC811, and LIC9102 were provided to Administrator Tami Ojwang.the state’s words, verbatim · CDSS document, Aug 7, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On July 31, 2025, at 8:30 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Executive Director (ED) Tami Ojwang and explained the purpose of the visit. ED Tami Ojwang explained to LPA Kim that Maintenance Director (MD) Armando Galvan would conduct a physical tour with the LPA. The facility is licensed to operate for fifty-three ambulatory residents and two hundred and eight (208) non-ambulatory, of which eight (8) may be bedridden, and have a hospice waiver for twenty (20) residents. The facility has two buildings with three stories each, which consists of the following: one hundred forty-six (146) resident bedrooms, seven (7) office rooms, three medication rooms, one hundred and fifty (150) bathrooms, two waiting area, seven activity areas, exercise room, theater, three dining areas, kitchen, and outdoor covered patio areas. LPA Kim toured indoor and outdoor of the physical plant with MD Galvan. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The following bedrooms were inspected in Building A: Resident Room 104, Resident Room 113, Resident Room 116, Resident Room 130, Resident Room 203A, Resident Room 213, Resident Room 228, Resident Room 301A, Resident Room 304B, Resident Room 310, Resident Room 317, Resident Room 326, and Resident Room 334. The following bedrooms were inspected in Building B: Resident Room 106, Resident Room 123, Resident Room 205, Resident Room 218, Resident Room 305, and Resident Room 323. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 112.6 degrees F and 117.5 degrees F. A comfortable temperature of 77 degrees F was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. During the visit, LPA Kim observed the facility's infection control practices. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Emergency water is stored outside by the kitchen exit. Emergency food and emergency supplies were stored in a storage shed in the back of the facility. A working telephone (562-594-5788) remains available. LPA Kim reviewed the facility’s plan of operation, emergency and disaster plan, and fire/safety drill log. The facility conducts a Fire/Safety Drill quarterly and was last conducted on June 25, 2025. All facility fire extinguishers were charged, and they were all serviced on October 10, 2024. All smoke detectors and carbon monoxide detectors were operable and were last inspected on January 23, 2025, by Cal Building Systems. Certificate of Liability insurance is effective May 1, 2025, and expires on May 1, 2026. LPA conducted eight (8) resident interviews and one (1) staff interview. Due to time constraints a continuation inspection will be conducted on a later date: 1) an audit of resident files, 2) An audit of staff files, 3) An audit of medication and medication administration record, 4) staff interviews, and 5) an audit of first aid kit. An exit interview was conducted, and a copy of this report was provided to Executive Director Tami Ojwang.the state’s words, verbatim · CDSS document, Jul 31, 2025

Type of visit: Case Management - Incident

An unannounced case management visit was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding an incident report received by Community Care Licensing on July 30, 2024. LPA met with Executive Director (ED) Tami Ojwang and explained the purpose of the inspection. Per incident report, on July 25, 2024, Resident 1’s (R1’s) representative reported that Staff 1 (S1) text them a video and photographs of R1. Video depicted R1 engaged in a verbal altercation with Staff 2 (S2), whom had “previously been investigated” and “was counseled.” Photographs depicted S2 assisting R1 with changing clothes. S1 resigned their position on Jully 25, 2024, in the middle of their shift. During case management visit on August 9, 2024, interviews were conducted with staff and R1. During their interview, S1 confirmed they had taken the video of the verbal altercation between S2 and R1 and stated they provided the video and a written statement about the incident to former ED Jennifer Turgeon and Staff 3 (S3) on June 5, 2024. Per S1, they resigned their position during their shift on July 25, 2024 because the incident went unaddressed despite the video evidence. During their interview, S3 confirmed they were first notified of the incident and about the video in June, but stated they did not recall the exact date. S3 stated they had not watched the video and stated they did not have S1’s written statement as it had been provided to ED Turgeon. During their interview, former ED Turgeon refused to provide LPA with S1’s written statement and provided LPA with their own written and signed statement, which stated an investigation had been completed on June 19, 2024, regarding S1’s report about S2 arguing with R1. Per ED’s written statement, S2 was asked about the incident and confirmed they had yelled at R1 and called them a “thief”. Former ED Turgeon stated S2 is no longer working with R1, but continues working at the facility in another area. (Cont. LIC9099-C) An incident report was not submitted to CCL regarding the video, S1’s written statement, and/or “investigation” conducted by ED until July 30, 2024. Based on observations, deficiencies are being cited per Title 22, Division 6 of the California Code of regulations. An exit interview was conducted a copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Sep 4, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a) · Plan of correction due date: Sep 5, 2024

(1) a written report shall be submitted to the licensing agency.., within seven days of the occurrence of... (D) Any incident which threatens the welfare, safety or health of any resident... This requirement is not met as evidence by: Based on observations and AD admission, the Licensee did not comply with the section cited above, as incident was not reported to CCL for over 30 days, which posed an immediate personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 4, 2024

Plan of correction: ED Ojwang stated they will provide LPA with a written plan of action to ensure compliance with regulation via email by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a) · Plan of correction due date: Sep 5, 2024

(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidence by: Based on video evidence and staff interviews, the Licensee did not comply with the section cited above as S2 yelled at R1 and calling them a "thief" which poses an immediate safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 4, 2024

Plan of correction: Per ED, S2 will no longer be working with R1. ED stated staff training will be conducted regarding residents' personal rights and proof submitted to LPA via email by POC date.

Type of visit: Case Management - Incident

An unannounced case management visit was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding an incident report received by Community Care Licensing on July 30, 2024. LPA met with Executive Director (ED) Jennifer Turgeon and explained the purpose of the inspection. Per incident report, on July 25, 2024, Resident 1’s (R1’s) representative reported that Staff 1 (S1) text them a video and photographs of R1. Video depicted R1 engaged in a verbal altercation with Staff 2 (S2), whom had “previously been investigated” and “was counseled.” Photographs depicted S2 assisting R1 with changing clothes. S1 resigned their position on July 25, 2024. During today’s visit, interviews were conducted with staff and residents. LPA obtained a copy of resident roster and staff roster. ED refused to provided LPA with any documentation pertaining to their “internal investigation”, including staff statements and disciplinary action taken against staff. ED provided LPA with a summary regarding "internal investigation." Due to insufficient information available at this time, this incident requires further investigation. LPA informed ED that subsequent visits and document requests will be required and ED stated they understood. An exit interview was conducted a copy of this report was provided at the end of the inspection.the state’s words, verbatim · CDSS document, Aug 9, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit to follow up on a Death Report sent to the Regional Office dated July 3, 2024. During the visit, LPA Haley conducted interviews with staff and collected relevant documents. As a result of today’s case management visit and the information gathered through staff interviews, no deficiencies will be cited. An exit interview was conducted and a copy of this report was provided to Executive Director Turgeon.the state’s words, verbatim · CDSS document, Jul 8, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Rosie Quiroz conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at facility was greeted and granted entry by concierge. LPA met with Jennifer Tugeon, Executive Director/Administrator and discussed purpose of the visit. An initial application to operate an Adult Residential Facility for the Elderly, age 60 years and over, for capacity of: (261) resident capacity, (51) ambulatory residents, (210) non-ambulatory residents, of which (8) eight residents are able to be bedridden in (A) building only and Hospice waiver for (20) residents was submitted to CCL on July 01, 2023. Structure: The facility is a three-story building with a connected walkway on the first floor including A and B building with 155 resident apartment style bedrooms, first floor common spaces are: kitchen, dining room, bistro, bar, library, med room, Beauty salon, movie theater, activity room, two dining-rooms, fitness room, court yard, and seven common restrooms. Second floor common spaces are: Activity room. Third floor common spaces: Relaxation room, Activity room, kitchen, dining-room, TV room, Outdoor court yard. There are 11 laundry units all together throughout all three floors. The resident’s bedrooms are spacious and will easily accommodate the resident’s furnishings. There are two courtyards and there is ample seating areas for resident throughout both courtyards. There is a front patio with seating for residents in front of the facility on both A and B buildings. Signal system: Each apartment has a call button/pull cord to request assistance and residents also utilize pendant alert system to request assistance. CONTINUED ON LIC809-C Air/Heating:Central air/heating system installed with a central panel to control entire building. Today’s facility temperature was recorded to be 72degrees Fahrenheit. Bedrooms Residents: Bedrooms are apartment style that will be private or shared. Bedrooms Staff:There is no live in staff and there is a designated staff lounge. Bathrooms: All bathrooms have a working toilet, wash basin, walk in shower/tub. There are seven common restrooms on the first floor of the building and each apartment has its own bathroom. Linens & Hygiene Supplies:Facility has an adequate supply of linens in storage unit. Emergency Phone Numbers, Exit Plan & Menu:Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week. All day menu with substitute meals provided. Food Service: Adequate supply of seven day non-perishable and two day perishables are stored in the kitchen with surplus good stored in shed area out in the back parking lot behind the kitchen. Smoke Detectors: Smoke detectors, sprinklers and carbon monoxide alert systems are tested and maintained by an outside vendor. Fire extinguishers mounted throughout the facility charged with a date of October 03, 2023. Appliances: Residents’ apartments have small kitchen, Building B apartments have full kitchens, refrigerator, microwave, and small sink. Facility main kitchen on the first floor is equipped with ovens/ranges/microwaves, prep counters, refrigeration, freezer, grill, steam tables. Building B apartments have individual washer and dryer in each apartment. Building A has a common laundry area with operational and functional washers and dryers and a commercial washer/dryer area with functional and operational washers and dryers. Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents and stored in housekeeping and maintenance supply closets. CONTINUED ON LIC809-C Water Temperature:Tested and recorded the water temperatures measuring 106.0 – 113.4 degrees Fahrenheit in resident apartments and common bathrooms in all three floors of A and B buildings. Pool:There is no pool or any body of water in this facility. Medications, First-Aid Kit & Book: Medication, first aid and book are stored in med room inaccessible to residents. First aid kits are also located in med carts and throughout the facility in common spaces. Resident & Staff Files: Records will be kept stored in file cabinet located on the first floor in the business office. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the resident's use, commensurate with the plan of operation. Fire clearance: On October 3, 2023 Fire department granted the following: (261) resident capacity, (51) ambulatory residents, (210) non-ambulatory residents, of which (8) eight residents are able to be bedridden in (A) building only. Component III: Component III was completed with ED Turgeon during today's pre-licensing inspection. The Facility appears to be ready for licensure in the areas inspected. ED Turgeon was informed today that the facility is ready for licensure pending final approval processed by the Centralized Applications Bureau (CAB) in Sacramento. An exit interview was conducted with ED Jennifer Turgeon and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 10, 2024