Lakeview Lodge

Type of visit: Case Management - Health Checks

On 7/14/2026, LPA Grace Donato arrived at the facility to conduct a Case Management visit-Health Check. LPA met with Co-Administrator Adilene Klink & Maria Boulangger and explained the purpose of the visit. LPA toured the facility. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. All exit doors have working alarms. Grocery has been observed to have been delivered. No accessible bodies of water or hazards were observed. Residents are currently resting in different areas of the facility. More caregivers are scheduled. LPA observed that the medication room has been updated. All medications are sorted in the medication cart. Medication room is locked at all times. No deficiencies cited during today's visit. Report is reviewed and copy is providedthe state’s words, verbatim · CDSS document, Aug 21, 2026

Type of visit: Case Management - Health Checks

On 7/14/2026, LPA Grace Donato arrived at the facility to conduct a Case Management visit-Health Check. LPA met with Administrators Zach Pilkerton and explained the purpose of the visit. LPA toured the facility. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. All exit doors have working alarms. No accessible bodies of water or hazards were observed. Residents are currently resting in the activities area. LPA observed that the medication room has been updated. All medications are sorted in the medication cart. Medication room is locked at all times. Supplies for hospice and doctor visits are separate. No deficiencies cited during today's visit. Report is reviewed and copy is providedthe state’s words, verbatim · CDSS document, Jul 14, 2026

Type of visit: Case Management - Health Checks

On 5/28/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit-Health Check. LPA Calandra was greeted by Fe Arnaiz, Co-Administrator and Zach Pilkerton, Administrator and explained the purpose of the visit. LPA Calandra toured the physical plant. This is a 1-story building. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. No accessible bodies of water or hazards were observed. The facility had the required 7 days of non perishables and 2 days of perishables. No food was expired. The facility's carbon monoxide detectors and fire alarm were observed to be in working order. There were 14 staff members and 17 residents were present during the visit. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy provided.the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Case Management - Health Checks

On 4/3/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management Health and Safety Check. LPA Calandra was greeted by Zach Pilkerton, Administrator and Fe Arnaiz, Co-Administrator and explained the purpose of the visit. LPA Calandra toured the physical plant. This is a 1-story building. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. No accessible bodies of water or hazards were observed. LPA observed 2 days of perishables and 7 days of non perishables. No food was expired. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies were cited during today's visit. An exit interview was conducted. A copy of the report was provided to the facility representative.the state’s words, verbatim · CDSS document, Apr 3, 2026

Type of visit: Case Management - Health Checks

On 3/24/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Health and Safety Case Management visit. LPA Calandra was greeted by Zach Pilkerton, Administrator and Fe Arnaiz, Co-Administrator and explained the purpose of the visit. LPA Calandra toured the physical plant. This is a 1-story building. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. No accessible bodies of water or hazards were observed. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy provided.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Case Management - Health Checks

On 2/18/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management-Health and Safety Check. LPA Calandra was greeted by Eileen Doyle, Consultant and Fe Arnaiz, Co-Administrator and explained the purpose of the visit. Zach Pilkerton, Co-Administrator joined the visit later. LPA Calandra toured the facility with the Co-Administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Ten staff members including the Administrators were observed throughout the facility. Twenty-two residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA also reviewed 3 resident files. All were observed to be complete. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report was emailed to the facility representative.the state’s words, verbatim · CDSS document, Feb 18, 2026

Type of visit: Case Management - Other

On 1/30/2026, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Co- Administrator(ADM), Fe Arnaiz and explained the purpose of the visit. LPA Calandra toured the facility with the Co-Administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Ten staff members including the Administrators were observed throughout the facility. Sixteen residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA also reviewed 3 resident files. All were observed to be complete. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report was emailed to the facility representative.the state’s words, verbatim · CDSS document, Jan 30, 2026

Type of visit: Required - 1 Year

On 12/10/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Fe Arnaiz, Co-Administrator and explained the purpose of the visit. Eileen Doyle, Consultant and Zach Pilkerton, Administrator arrived later during the visit. LPA Calandra toured the physical plant. This is a 1-story building with 25 bedrooms and 21 bathrooms, kitchen, dining room, TV room, Nurses Lounge, Office, Beauty Salon, Patio, and back yard. No accessible bodies of water or hazards were observed. All bedrooms had the required furniture and sufficient lighting. All bathrooms had anti-skid flooring and grab bars. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility was maintained at a comfortable temperature. The facility's smoke alarms and Carbon Monoxide detectors were observed to be functioning properly based on observation of the facility's fire panel. The facility had the required 7 days of non perishables and 2 days of perishables on hand. No food was expired. The facility's first aid kit had the required items. LPA reviewed 5 resident files and 6 staff files. All were observed to be complete. During record review, LPA observed that the facility did not have documentation of their latest emergency drill. A Technical Violation was provided for this deficiency. A Technical Violation was also provided for not recording the hours of trainings conducted by the Licensee. Technical Assistance was provided as the Administrator on paper's certificate is pending renewal. It is a best practice to have someone listed as Administrator who has an active Administrator Certificate. In addition, Technical Assistance was provided as the facility did not have their policy regarding retention or prohibition of firearms in their Admission Agreement. This is a best practice. During file/record review, LPA observed that staff had not received eight hours of dementia care training and four hours of training specific to postural supports, restricted health condition, and hospice care. A Type B citation was provided for this deficiency. Deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the POC due date may result in Civil Penalties. LPA received copies of the facility's Liability Insurance and requested a copy of their current LIC 500 by end of business on Wednesday, December 17th, 2025. An exit interview was conducted. This report along with Appeal Rights were provided to facility representatives.the state’s words, verbatim · CDSS document, Dec 10, 2025

Type of visit: Case Management - Health Checks

On 11/07/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Co- Administrator(ADM), Fe Arnaiz and explained the purpose of the visit. LPA Calandra toured the facility with the Co-Administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Eight staff members including the Administrators were observed throughout the facility. Nineteen residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 7, 2025

Type of visit: Case Management - Health Checks

On 10/06/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Co- Administrator(ADM), Fe Arnaiz and explained the purpose of the visit. LPA Calandra toured the facility with the Co-Administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Eight staff members including the Administrators were observed throughout the facility. Twenty three residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 5 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report was emailed to the facility representative.the state’s words, verbatim · CDSS document, Oct 6, 2025

Type of visit: Case Management - Other

On 10/03/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Administrator(ADM), Fe Arnaiz and explained the purpose of the visit. LPA Calandra toured the facility with the Co-Administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Six staff members including the Administrators were observed throughout the facility. Twenty-five residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report was emailed to the facility representative.the state’s words, verbatim · CDSS document, Oct 3, 2025

Type of visit: Case Management - Health Checks

On 10/01/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Administrator(ADM), Fe Arnaiz and explained the purpose of the visit. LPA Calandra toured the facility with the Co-Administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Eleven staff members including the Administrators were observed throughout the facility. Nineteen residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA reviewed 5 resident's Centrally Stored Medications Records. All medications for the 5 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report was emailed to the facility representative.the state’s words, verbatim · CDSS document, Oct 1, 2025

Type of visit: Case Management - Health Checks

On 9/25/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Administrator (ADM), Zach Pilkerton and explained the purpose of the visit. LPA Calandra toured the facility with the administrator, Zach Pilkerton. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Seven staff members including the Administrators were observed throughout the facility. Seventeen residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA reviewed 3 staff files. All were observed to be complete. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Sep 25, 2025

Type of visit: Case Management - Health Checks

On 9/24/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. Zach Pilkerton, Co-Administrator joined the visit later. LPA Calandra toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Seven staff members including the Administrators were observed throughout the facility. Eleven residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA reviewed 5 resident's Centrally Stored Medications Records. All medications for the 5 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Sep 24, 2025

Type of visit: Case Management - Health Checks

On 9/16/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. Zach Pilkerton, Co-Administrator joined the visit later. LPA Calandra toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Ten staff members including the Administrators were observed throughout the facility. Nineteen residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA reviewed 5 resident's Centrally Stored Medications Records. All medications for the 5 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Sep 16, 2025

Type of visit: Case Management - Health Checks

On 9/10/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. Zach Pilkerton, Co-Administrator joined the visit later. LPA Calandra toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Nine staff members including the Administrators were observed throughout the facility. Twenty six residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. All soap, detergent, and sharp objects were observed to be locked and in-accessible to persons in care. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted. This report was reviewed with facility representatives and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Sep 10, 2025

Type of visit: Case Management - Health Checks

On 9/8/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. LPA Calandra toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Nine staff members including the Administrators were observed throughout the facility. Twenty residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. An exit interview was conducted. A copy of the report was provided to the facility representative.the state’s words, verbatim · CDSS document, Sep 8, 2025

Type of visit: Case Management - Health Checks

On 9/5/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. Administrator, Zach Pilkerton arrived later during the visit. LPA Calandra toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Eight staff members including the Administrators were observed throughout the facility. Twelve residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA requested the following document by 9/15/2025: Copy of facility sketch showing where surveillance cameras are in the facility No deficiencies cited during today's visit. A copy of the report was provided to the facility representatives.the state’s words, verbatim · CDSS document, Sep 5, 2025

Type of visit: Case Management - Health Checks

On 9/4/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. LPA toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Eight staff members including the Administrators were observed throughout the facility. Seventeen residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. All door alarms were functioning. LPA reviewed 3 resident files. All were observed to be complete. No deficiencies cited during today's visit. A copy of the report was provided to the facility representatives.the state’s words, verbatim · CDSS document, Sep 4, 2025

Type of visit: Case Management - Health Checks

On 8/29/2025, Licensing Program Analyst (LPA) John Calandra and Golden Gate Regional Center(GGRC) Quality Assurance Program Manager, Jennifer Smith arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA Calandra and Jennifer met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. Administrator, Zach Pilkerton arrived later during the visit. LPA Calandra and Jennifer Smith toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Eight staff members including the Administrators were observed throughout the facility. Twenty residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. The facility's call button system was observed to be functioning. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. A copy of the report was provided to the facility representatives.the state’s words, verbatim · CDSS document, Aug 29, 2025

Type of visit: Case Management - Health Checks

On 8/26/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. LPA toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Eight staff members including the Administrators were observed throughout the facility. Five residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. All door alarms were functioning and the facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility's call button system was observed to be functioning. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. A copy of the report was provided to the facility representatives.the state’s words, verbatim · CDSS document, Aug 26, 2025

Type of visit: Case Management - Health Checks

On 8/22/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. LPA toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Seven staff members including the Administrators were observed throughout the facility. Eighteen residents were observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. All door alarms were functioning and the facility's first aid kit was observed to be complete. LPA reviewed 3 staff files. All were observed to be complete. No deficiencies cited during today's visit. A copy of the report was provided to the facility representatives.the state’s words, verbatim · CDSS document, Aug 22, 2025

Type of visit: Case Management - Health Checks

On 8/19/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Co-Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. Administrator, Zach Pilkerton arrived later during the visit. LPA toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Staff were in the dining room serving lunch to the residents and observed throughout the facility. LPA inspected random resident bedrooms and resident common spaces. LPA observed a tv monitor in the admission area showing views of hallways in the facility. LPA also observed all alarms in exit doors to be in good working order. All of the facility's fire extinguishers were observed to be fully charged and Carbon Monoxide detector was observed to be in working order. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. A copy of the report was provided to the facility representatives.the state’s words, verbatim · CDSS document, Aug 19, 2025

Type of visit: Case Management - Health Checks

On 8/15/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. Administrator, Zach Pilkerton arrived later during the visit. LPA toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature of 72 degrees Fahrenheit. No accessible bodies of water or hazards were observed in hallways or the property. Staff are currently cleaning the facility and some residents are in the living rooms watching TV. LPA inspected resident bedrooms 21, 20, 12, 14 and resident common spaces. LPA also observed all alarms in exit doors to be in good working order. LPA reviewed 3 resident files. All were observed to be complete. No deficiencies cited during today's visit. A copy of the report was provided to the facility representatives.the state’s words, verbatim · CDSS document, Aug 15, 2025

Type of visit: Case Management - Health Checks

On 8/13/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Co-Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. Administrator, Zach Pilkerton arrived later during the visit. LPA toured the facility with the administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Staff are currently cleaning the facility and some residents are in the living rooms watching tv. LPA inspected resident bedrooms, 2,10,18,19,21,16, and 9 and resident common spaces. LPA observed a tv monitor in the admission area showing views of hallways in the facility. LPA also observed all alarms in exit doors to be in good working order. LPA reviewed 3 resident's Centrally Stored Medications Records. All medications for the 3 residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. No deficiencies cited during today's visit. A copy of the report was provided to the facility representatives.the state’s words, verbatim · CDSS document, Aug 13, 2025

Type of visit: Case Management - Health Checks

On 8/8/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Co-Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. Administrator, Zach Pilkerton arrived later during the visit. LPA toured the facility. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Staff are currently cleaning the facility. LPA observed 22 residents throughout the facility, watching television in the front room and tv room located towards the back of the facility. LPA observed 8 staff members including a cook, caregivers, and two administrators on site. LPA inspected random resident bedrooms and resident common spaces were inspected. LPA requested and received copies of the facility's Administrators' certificates at the facility. LPA observed a tv monitor in the admission area showing views of hallways in the facility. The medications room was observed to be locked and medications in-accessible to persons in care. LPA also observed all alarms in exit doors to be in good working order. No deficiencies cited during today's visit. A copy of the report was provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 8, 2025

Type of visit: Case Management - Health Checks

On 8/6/2025, Licensing Program Analyst (LPA) John Calandra arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Co-Administrator (ADM), Fe Arnaiz and explained the purpose of the visit. LPA toured the facility. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Staff are currently cleaning the facility. There were 10 residents in the front room near the dining room and 6 residents in the tv room watching tv. LPA observed 8 staff members on site. LPA inspected resident rooms 5,8,7,20,15,24, and 6 and resident common spaces were inspected. LPA observed a tv monitor in the admission area showing views of hallways in the facility. The medications room was observed to be locked and medications in-accessible to persons in care. LPA also observed all alarms in exit doors to be in good working order. No deficiencies cited during today's visit. A copy of the report was provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 6, 2025

Type of visit: Case Management - Health Checks

On 7/31/2025, Licensing Program Analysts (LPAs) Grace Donato arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Co-Administrator (ADM), Zach Pinkerton and explained the purpose of the visit. LPA toured the facility with the other administrator, Fe Arnaiz. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Staff are currently cleaning the facility and some residents are in the living rooms watching tv. Random resident’s bedrooms and resident common spaces were inspected. LPA observed a tv monitor in the admission area showing views of hallways in the facility. LPA also observed all alarms in exit doors to be in good working order. No deficiencies cited during today's visit. A copy of the report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jul 31, 2025

Type of visit: Case Management - Health Checks

On 7/22/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct an unnanounced Case Management Health Check. LPA Calandra was greeted by Zach Pilkerton and Fe Arnaiz, Administrators and explained the purpose of the visit. LPA toured the physical plant. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Resident’s bedrooms, memory care unit and resident common spaces were inspected. A majority of residents were observed in the common areas with multiple staff present. LPA observed 10 staff on shift including the Administrators and a Medtech. LPA observed 19 residents in common spaces and walking around the facility. LPA toured the outside parameters of the facility and found the area to be free from any hazards. All sharp objects, soap, detergents, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 33 resident files. No deficiencies were cited during the visit. An exit interview was conducted. This report was reviewed with facility representative and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jul 22, 2025

Type of visit: Case Management - Health Checks

On 7/21/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct an unnanounced Case Management Health Check. LPA Calandra was greeted by Zach Pilkerton and Fe Arnaiz, Administrators and explained the purpose of the visit. LPA toured the physical plant. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Resident’s bedrooms, memory care unit and resident common spaces were inspected. A majority of residents were observed in the common areas with multiple staff present. LPA observed 8 staff on shift including the Administrators. According to Administrator, Zach Pilkerton, there were 10 staff working. LPA observed 24 residents in common spaces and walking around the facility. According to the Administrator, 9-11 staff stay at the facility. LPA toured the outside parameters of the facility and found the area to be free from any hazards. The facility's smoke alarms were observed to be fully charged and last serviced on 9/7/2024. No deficiencies were cited during the visit. An exit interview was conducted. This report was reviewed with facility representative and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jul 21, 2025

Type of visit: Case Management - Other

On 7/21/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit for the purpose of delivering an Amended report for a visit conducted on 7/19/2025. LPA Calandra was greeted by Fe Arnaiz and Zach Pilkerton, Administrators and explained the purpose of the visit. LPA reviewed the 809 and explained the reason for the Amendment. An exit interview was conducted. This report was reviewed with facility representative and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jul 21, 2025

Type of visit: Case Management - Health Checks

On 7/20/2025, Licensing Program Analysts (LPAs) John Calandra and Jaime Vado arrived at the facility to conduct an unnanounced Case Management-Health and Safety Check. LPAs Calandra and Vado, were greeted by Clarence Balios, Administrator and explained the purpose of the visit. Administrator, Fe Arnaiz arrived later during the visit. LPA toured the physical plant. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Resident’s bedrooms, memory care unit and resident common spaces were inspected. A majority of residents were observed in the common areas with multiple staff present. Upon LPA's arrival, there were 7 staff on shift including the Administrators. LPAs observed 26 residents in common spaces and walking around the facility. According to the Administrator, 9-10 staff live at the facility. LPA toured the outside parameters of the facility and found the area to be free from any hazards. LPAs asked for the personal email address of the Licensee however, the Administrator did not know it and provided the facility's main email address as a means of reaching her. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed and a copy of the report left at the facility with Clarence Balios, Administrator.the state’s words, verbatim · CDSS document, Jul 20, 2025

Type of visit: Case Management - Health Checks

*** This is an amended document *** On 7/19/2025, Licensing Program Analysts (LPAs) Grace Donato and Jaime Vado arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPAs met with Co-Administrator (ADM), Fe Arnaiz explained the purpose of the visit. Upon arrival, ADM was dispensing medications to residents. LPAs toured the facility with the ADM. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Random resident’s bedrooms and resident common spaces were inspected. 4 residents in the TV room located lower than the front living. New hand rails and painting of hallways are observed. New reception area is observed in the main administration area as well. There are currently 2 care staff scheduled and the ADM. Letter for scheduled NCC was given to ADM and an email was also sent. No deficiencies cited during today's visit. A copy of the report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jul 19, 2025

Type of visit: Case Management - Health Checks

On 7/15/2025, Licensing Program Analyst LPA) John Calandra arrived at the facility to conduct an unnanounced Case Management-Health and Safety Check. LPA Calandra was greeted by Zach Pilkerton and Fe Arnaiz, Administrators and explained the purpose of the visit. LPA toured the physical plant. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Resident’s bedrooms, memory care unit and resident common spaces were inspected. A majority of residents were observed in the common areas with multiple staff present. Upon LPA's arrival, there were 7 staff on shift including the Administrators. LPA toured the outside parameters of the facility and found the area to be free from any hazards. LPA conducted a spot check of medication and found the reviewed Centrally Stored medication records to be in order. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: POC

On 7/15/2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Plan of Correction(POC) visit in regards to the citations provided on 6/24/2025 . LPA Calandra was greeted by Zach Pilkerton, Administrator and explained the purpose of the visit. On 6/24/2025, LPA Calandra cited the facility for California code of regulations(CCR) 87463(i) Reappraisals. On 6/24/2025, LPA reviewed a resident record and found that a care meeting had not been held to discuss the resident’s most recent reappraisal. On 7/15/2025, LPA observed that the facility had a meeting with the responsible party on 6/24/2025 and the reappraisal was signed by the responsible party. On 6/24/2025, LPA Calandra cited the facility for California code of regulations(CCR) 87468.1(a)(6) Personal Rights of Residents in All Facilities. During an investigation of a complaint received by the Department on 4/17/2025, it was found that two residents were being locked in their rooms by staff using a bed sheet tied to the door. On 7/15/2025, LPA Calandra observed that no resident rooms were tied shut/locked. On 6/24/2024, LPA Calandra cited the facility for California code of Regulations 87405(d)(2) Administrator - Qualifications and Duties. During an investigation of a complaint on 4/17/2025, the facility could not locate a Do Not Resuscitate(DNR) order for a resident. On 7/15/2025, LPA Calandra observed Physician Orders for Life Sustaining Treatments(POLST) for 9 residents. All other residents per interview with Administrator are full code. No deficiencies were cited during today’s visit. An exit interview was conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: POC

On 7/15/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Plan of Correction(POC) visit in regards to a citation issued during a visit on 6/26/2025. LPA Calandra was greeted by Zach Pilkerton, Administrator and explained the purpose of the visit. During a Case Management visit on 6/26/2025, LPA Calandra cited the facility for California Code of Regulations(CCR) 87207 False Claims. On 7/15/2025, the Department received a copy of a document all staff are being required to sign known as a Integrity in the workplace statement. Per interview with Administrator, this was drafted by the Licensee on 6/27/2025. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with the facility representative and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jul 15, 2025

Type of visit: Case Management - Health Checks

On 7/10/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct an unnanounced Case Management health and safety check. LPA Calandra was greeted by Fe Arnaiz, Administrator and explained the purpose of the visit. LPA toured the physical plant. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Resident’s bedrooms, memory care unit and resident common spaces were inspected. A majority of residents were observed in the common areas with multiple staff present. Upon LPA's arrival, there were 6 staff on shift including the Administrators. LPA toured the outside parameters of the facility and found the area to be free from any hazards. During LPA's tour of the physical plant, LPA observed that R1 had half bed rails on their bed. LPA reviewed R1's file and did not observe a physician's order for the half bed rail. In the presence of the LPA, the bed rail was removed. A Type A citation was issued for this deficiency. LPA reviewed 14 resident files. All were observed to be complete. Deficiency is cited under the California Code of Regulations, Title 22. Failure to correct the deficiency by the due date may result in civil penalties. An exit interview was conducted. This report was reviewed with facility representative, and a copy of the report along with Appeal Rights left at the facility.the state’s words, verbatim · CDSS document, Jul 10, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(3) · Plan of correction due date: Jul 18, 2025

87608(a)(3) Postural Supports: (a) Postural supports may be used under the following conditions...A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. This requirement is not met as evidenced by: Based on observation and record review, facility does not have written orders from a physician indicating the need for half bed rails in the rooms of R1, which is an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: Licensee removed bed rail in presence of LPA. Deficiency cleared during visit.

Type of visit: POC

On 7/10/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Plan of Correction(POC) visit in regards to the deficiency cited on 7/10/2025. LPA Calandra was greeted by Zach Pilkerton, Administrator and explained the purpose of the visit. During the visit on 7/10/2025, LPA observed half bed rails in R1's bedroom. LPA reviewed R1's file but could not locate any written order from the physician indicating the need for the half bed rail. During the visit, LPA Calandra observed Administrator, Zach Pilkerton remove the half bed rail from R1's bed. No deficiencies were cited during today's visit. An exit interview was conducted and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jul 10, 2025

Type of visit: Case Management - Health Checks

On 7/8/2025, Licensing Program Analyst LPA) John Calandra arrived at the facility to conduct an unnanounced Case Management-Health and Safety Check. LPA Calandra was greeted by Zach Pilkerton and Fe Arnaiz, Administrators and explained the purpose of the visit. LPA toured the physical plant. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Resident’s bedrooms, memory care unit and resident common spaces were inspected. A majority of residents were observed in the common areas with multiple staff present. Upon LPA's arrival, there were 6 staff on shift including the Administrators. LPA toured the outside parameters of the facility and found the area to be free from any hazards. LPA conducted a spot check of medication and found the reviewed Centrally Stored medication records to be in order. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jul 8, 2025

Type of visit: Case Management - Health Checks

On 7/4/2025, Licensing Program Analyst (LPA) Grace Donato arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Administrator, Fe Arnaiz explained the purpose of the visit. LPA toured with the ground with the Administrator. The facility is currently serving breakfast to residents in the dining area. During the tour LPA observed how Med Tech is dispensing and assisting residents with medication. LPA also reviewed 5 resident medication records and everything was up to date and accounted for. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Random resident’s bedrooms and resident common spaces were inspected. There are currently 7 staff scheduled. LPA also delivered an amended report from 6/29/2024 visit. No deficiencies cited during today's visit. A copy of the report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jul 4, 2025

Type of visit: Case Management - Health Checks

On July 03, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a unannounced Case Management – Health Check inspection visit. LPA met with the Administrators (ADM1) Zach Pilkerton and (ADM2) Fe Arnaiz and disclosed the purpose of the inspection. There were 33 residents in care and 10 staff members present at the time of the inspection. LPA initiated a walk-through of the facility, accompanied by the ADM1. LPA inspected a centrally stored medication cart in the medication room. Med tech was preparing for the med pass at that time. Centrally Stored Medication Records were reviewed for random residents. Narcotics medication count was performed for two (2) residents (R1 and R2), and the count was found to be complete. LPA inspected common areas and observed two (2) residents sitting in the dining room with their visiting families. LPA observed residents watching TV in the TV room. LPA toured the outside areas and observed two (2) residents sitting on the front deck. LPA observed that the facility didn’t have any auditory devices to monitor exits on the exterior doors of the facility building. LPA observed a delayed egress rolling iron gate controlling the driveway entrance / exit, next to the perimeter fence. This gate was the only way cars and people can come in and out of the facility. An auditory alarm was observed in the front office / lobby area when this gate was opened. The exterior perimeter of the facility was observed to be fenced. No deficiencies were cited during today's visit. An exit interview was conducted with the Administrator. A copy of this report was provided to the Administrator, Zach Pilkerton, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Jul 3, 2025

Type of visit: Office

On 7/3/2025, Regional Manager (RM) Isaac Taggart, Licensing Program Manager (LPM April Cowan and Licensing Program Analyst (LPA) Grace Donato conducted an Informal Meeting via Teams tele-conference in regards to the Health and Safety issues in Lakeview Lodge with facility #415600864 with Lawyers John Chow and Felix Hu representing the facility. It was discussed how a Non-Compliance Conference (NCC) is conducted per Licensing process. Issues will be addressed during the NCC, plans will be developed. Reports will be provided. During this meeting, the transparency website was provided It was agreed upon that by July 8, 2025, end of business day, a proposed scheduled date and time for the meeting will be provided by the Licensee/Lawyers. Proposed scheduled will be no later than July 18, 2025. This report is reviewed and provided to the Lawyers via email.the state’s words, verbatim · CDSS document, Jul 3, 2025

Type of visit: Case Management - Health Checks

On July 02, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a unannounced Case Management – Health Check inspection visit. LPA met with the Administrator (ADM) Zach Pilkerton and disclosed the purpose of the inspection. There were 33 residents in care and 11 staff members present at the time of the inspection. LPA initiated a walk-through of the facility, accompanied by the Administrator. LPA inspected random resident rooms. LPA inspected attached bathrooms in these random rooms. The hot water temperature at the sink faucets measured between 112.3°F and 112.6°F. LPA inspected common areas and observed eight (8) residents sitting in the front room, seven (7) residents watching TV in the TV room, and one (1) resident in the dining room. LPA inspected the kitchen next to the front lobby area. The refrigerator and freezer were checked, and there was a sufficient supply of fresh perishable food for two (2) days and nonperishable staples for seven (7) days. LPA inspected the pantry storage and laundry area in the basement, one level below the main floor. LPA toured the outside areas and found passageways free of obstructions, and without any blocking or tripping hazards. No accessible bodies of water were observed. LPA observed locked centrally stored medication cart in the medication room. Medications were organized separately for each resident. At 09:10 AM, Centrally Stored Medication Records were reviewed, and a medication count check was performed. LPA observed that the medication count for one (1) bedtime + dinner narcotic medication for one resident (R1) was found to be inaccurate and one less day of medication was administered to R1 for this medicine. Continued on LIC809-C The start date of this medication was 06/22/2025 and today’s date is 07/02/2025. Ten (10) days of medication should have been administered to R1 but only 9 days of medication were administered to R1. The MAR for this medication was reviewed and the entry for 06/29/2025 was not initialized. The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, and Plans of Correction were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and provided to the Administrator, Zach Pilkerton, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jul 2, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Jul 3, 2025

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated…facility staff designated… (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on observation, interview, and record review, the Administrator did not ensure one medication Lorazepam was administered correctly to resident (R1), which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 2, 2025

Plan of correction: The Administrator will submit the plan for POC to CCLD by 07/03/2025.

Type of visit: Case Management - Health Checks

On July 1, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit. LPA met with Administrators, Fe Arnaiz and Zach Pilkerton and explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms, common areas & kitchen. The indoor and outdoor passageway was free of obstruction. No accessible bodies of water of fire safety hazards observed. Residents were observed in the dining area eating lunch or sitting in the communal area. Residents were observed comfortable. Lighting was sufficient for comfort. LPA toured a random sample of resident rooms and observed them to have all required furnishings. LPA observed 2-day perishable and 7-days non-perishables. During the visit, LPA observed medication bottles unlocked and accessible to residents in the lobby area. In addition, LPA observed the med-cart locked in the office room, however the keys to the med-cart was on the side of the cart. There are currently 11 staff at the facility. All staff were observed to be fingerprint cleared. The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency may result in civil penalties. Report is reviewed with Administrators and a copy is provided with appeal rights.the state’s words, verbatim · CDSS document, Jul 1, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jul 2, 2025

87465 Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This regulation is not met as evidenced by: Based on observations, LPA observed prescription medications unlocked and accessible on the desk in the lobby area and no staff present. In addition, LPA observed the med-cart keys on the side of the med-cart accessible.the state’s words, verbatim · CDSS document, Jul 1, 2025

Plan of correction: Licensee/administrator shall conduct an in-service training with med-techs to ensure all medications are locked and inaccessible to residents in care. In addition, to ensure med-cart keys are not left in the med cart where it's accessible to residents in care.

Type of visit: Case Management - Health Checks

On 6/30/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Administrator, Fe Arnaiz and explained the purpose of the visit. LPA toured with the ground with the Administrator. Residents are in living rooms watching television. Some residents are out on Day Program. LPA observed the residents to be happy and smiling and are comfortable. LPA checked random rooms and everything was good. Beds were made up, bathrooms are clean. All the residents personal belongings are in tact. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. There are currently 9 staff scheduled. No deficiencies cited during today's visit. A copy of the report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 30, 2025

Type of visit: Case Management - Health Checks

*** This is an Amended Report *** On 6/29/2025, Licensing Program Analyst (LPA) Grace Donato arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA met with Administrator, Fe Arnaiz and explained the purpose of the visit. LPA toured with the ground with the Administrator. The facility is currently prepping for dinner. Residents were at 2 different living rooms watching television. During the tour when LPA visited one of the TV rooms, LPA observed the residents to be happy and smiling and are comfortable. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Resident’s bedrooms, memory care unit and resident common spaces were inspected. There are currently 7 staff scheduled. LPA reviewed 3 resident records and everything is updated. No deficiencies cited during today's visit. A copy of the report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 29, 2025

Type of visit: Case Management - Health Checks

On 6/28/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of conducting a Case Management, Health & Safety visit. LPA was greeted by Administrator, Fe Arnaiz and conducted a tour of the facility. The facility currently provides care for 32 residents, 1 of which was out of the community due to medical center admission. The facility was found to be clean and at a comfortable temperature with all exits and doorways free from obstruction. Resident’s bedrooms, memory care unit and resident common spaces were inspected. A majority of residents were observed in the two common areas with multiple staff present. Upon LPA's arrival, there were 6 staff on shift including the Administrator. LPA toured the outside parameters of the facility and found the area to be free from any hazards. LPA conducted a spot check of medication and medication records of 3 residents and found the reviewed medication records to be in order. LPA reviewed staff schedule and confirmed coverage for overnight shifts. No deficiencies cited during today's visit. A copy of the report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 28, 2025

Type of visit: Case Management - Health Checks

On 6/27/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management Health and Safety check. LPA Calandra was greeted by Fe Arnaiz, Administrator. Zach Pilkerton, Administrator arrived later during the visit. LPA toured the physical plant inside and outside. No accessible bodies of water or hazards were observed in the hallways or throughout the facility. LPA conducted 3 resident interviews and reviewed 3 files. All files were observed to be complete. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Zach Pilkerton, Administrator and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jun 27, 2025

Type of visit: Case Management - Deficiencies

On 6/26/2025, Licensing Program Analysts(LPAs) John Calandra, Simi Rai, and Manuel Monter, arrived at the facility to conduct a Case Management visit to cite additional deficiencies discovered during the Department's investigation of a complaint #14-AS-20250417161453 received on 4/17/2025. LPAs were greeted by Fe Arnaiz (ADM1) and William Zach Pilkerton (ADM2), and explained the purpose of the visit. During the visit, LPAs toured the physical plant inside and outside. LPAs reviewed 32 resident files (R1-R32) including Centrally Stored Medication Records, Medication Administration Record (MAR) for January 2025 - March 2025 and centrally stored medications at the facility. Based on the review of R1's Physician's report dated 9/3/2024 which stated R1 has a dual diagnosis of Mental Illness and neurocognitive disorder. Based on review of the facility's plan of operation page 16, "residents determined by their physicians to have a primary diagnosis of mental disorder unrelated to Dementia shall not be accepted or retained." R1 was admitted to the facility on 11/11/2024. On 3/6/2025, Staff S4 was interviewed. Staff S4 stated, he/she conducted a routine check at 4:00am where he/she observed R1 to be in his/her room lying on his/her bed. Based on evidenced reviewed, resident R1 was observed outside of the facility at 1:38am-4:47am. Staff did not observe resident during this time frame. A Type A citation was issued for this violation during today's visit. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. Based on interview of Administrator, Administrator did not have the knowledge to provide appropriate care and supervision to residents. Administrator denied having knowledge that staff are locking resident door for over 12 hours and denied seeing the door secured with a bedsheet. On 5/14/25 ADM 2 was interviewed and admitted he has remote access to facility cameras to redirect staff. However during investigation, ADM2 denied having knowledge of staff's actions at night. A Type A citation was issued for this violation. During today's visit, LPAs requested and received copies of the following documents: All Resident records - Identification Emergency Contact, Appraisal Needs and Services Plan, LIC602A Physicians Report Centrally Stored Medication logs and Medication Administration Records form January- March 2025. LIC 500 Personnel Summary Report During today's visit, 809-D page from 6/24/2025, Case Management was Amended to update the language in the deficiency statement. Changes were discussed with facility representative. The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. An exit interview was conducted. This report was reviewed with facility administrator and a copy of the report along with Appeal Rights was provided.the state’s words, verbatim · CDSS document, Jun 26, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87208(a) · Plan of correction due date: Jun 27, 2025

87208 Plan of Operation (a)The licensee shall have and maintain....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 met as evidenced by Based on record review, the facility did not follow their plan of operation. The facility's program description states “Residents determined to have their physician diagnosis of mental disorder, unrelated to dementia shall not be accepted or retained. R1s primary diagnosisthe state’s words, verbatim · CDSS document, Jun 26, 2025

Plan of correction: The Licensee will submit a written plan of action on how they will ensure they are following their plan of operation. (con't) was schizophrenia, dementia, confusion, aggressive behavior and harm to self and will require supervision, which pose/poses an immediate health, safety and personal rights risk to residents in care.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87207 · Plan of correction due date: Jun 27, 2025

87207 False Claims No licensee, officer or employee of a licensee shall make…any false or misleading statement regarding the facility…This requirement is not met as evidenced by: Based on interview, S2 stated he/she checked R1 at 4:00am and later admitted that he/she lied. S1 was interviewed & stated CPR was administered prior to 911 call, however, S1 stated to SMCSO deputies he/she did not perform CPR. Administrator denied knowledge and witnessing that staff ties the door shut. On 5/14/25 ADM 2 was interviewed and admitted he has remotethe state’s words, verbatim · CDSS document, Jun 26, 2025

Plan of correction: The Licensee will submit a plan of action on how false statements are not made regarding care that is being provided at the facility. (con't) access to facility cameras to redirect staff. However during investigation, ADM2 denied having knowledge of staff's actions at night. which pose/poses an immediate health, safety and personal rights risk to persons in care.

Type of visit: Case Management - Other

On 6/25/2025, Licensing Program Analysts(LPAs) John Calandra and Jaime Vado arrived at the facility to conduct a Case Management visit in regards to a complaint received by the Department on 4/17/2025. LPAs Calandra and Vado were greeted by Fe Arnaiz, Administrator and explained the purpose of the visit. LPAs toured the physical plant. This is a 1-story building with 25 bedrooms, a tv room, dining area, lobby, receiving room, etc. LPAs observed no residents in common spaces. All were in their bedrooms at time of visit. No rooms or bathrooms were observed to be locked from the outside hallway with any type of restraint device. Two staff members were observed going into resident rooms to take care of residents. No deficiencies were cited during today's visit. An exit interview was conducted. This report was reviewed with Fe Arnaiz, Administrator and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Jun 25, 2025

Type of visit: Case Management - Other

On 6/24/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit to deliver additional deficiencies in regards to a complaint received by the Department on 4/17/2025. LPA Calandra was greeted by Faye Arnaiz, Administrator and explained the purpose of the visit. Administrator, Zach Pilkerton arrived later during the visit. Complaint was regarding the death of resident (R1) who wandered away from their room in the early morning hours and was later found outside non responsive. The facility Administrator at the time thought R1 had a Do Not Resuscitate(DNR) order but could not locate it. This is an immediate health, safety, or personal rights risk to persons in care. A Type A citation is issued this day for this violation. The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. An exit interview was conducted. This report was reviewed with facility representative, and a copy of the report along with appeal rights left at the facility.the state’s words, verbatim · CDSS document, Jun 24, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d)(2) · Plan of correction due date: Jun 25, 2025

87405(d)(2) Administrator - Qualifications and Duties... The administrator shall have the qualifications..(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requrement is not met as evidenced by: Based on interview, ADM denied having knowledge that staff are locking resident door. for over 12 hours and denied seeing the tie before. ADM stated that he/she did not know if S2 was interviewed and did not speak to S2 about the incident. S2 was written up/cited by law enforcement. ADM did not know what S2the state’s words, verbatim · CDSS document, Jun 24, 2025

Plan of correction: The Licensee will ensure that all residents will have a POLST on file. Licensee shall submit a plan to the Department stating how they will ensure this deficiency does not occur again in the future. (Continued) was doing majority of the night. Based on document review 4 staff’s CPR/first aid was expired on 3/2024. Which pose/poses an immediate health, safety and personal rights risk to persons in care.

Type of visit: Case Management - Deficiencies

On 6/24/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to a secondary investigation by the Department. LPA Calandra was greeted by Zach Pilkerton, Administrator and explained the purpose of the visit. Through the course of the Department’s investigation into the death of a resident, R1, it was determined that staff were locking resident,(R2) in their room during the evening as they were a wander risk. However, the Needs and Services plan of R2 was not formalized and signed by resident's responsible party. The facility did not properly address R2's wandering needs. This poses an immediate health, safety or personal rights risk to persons in care. A Type A citation was issued for this violation. Based on interviews and observations, facility staff locked R2 by tying the door knob to the hand rail to prevent them from wandering around the facility. Video footage shows that another resident, R3 was also locked in their room using a device tied from the door knob to the hand rail. Residents in all residential care facilities for the elderly shall have the right to leave or depart the facility at any time. This is an immediate health, safety, or personal rights risk to persons in care. A Type A citation was issued for this violation. The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. An exit interview was conducted. A copy of this report along with Appeal Rights was left at the facility.the state’s words, verbatim · CDSS document, Jun 24, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87463(i) · Plan of correction due date: Jun 25, 2025

87463(i) Reappraisals: When there is significant change in condition... Definitions, or once every 12 months.., the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative... This requirement is not met as evidenced by: Based on document review, R2 had a reappraisal mentioning wandering, but it was not discussed with resident's responsible party, which is an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 24, 2025

Plan of correction: The Licensee shall notify responsible parties regarding all reappraisals going forward and document all interactions. Licensee will submit a plan to the Department stating how they will ensure this deficiency does not occur again in the future.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.1(a)(6) · Plan of correction due date: Jun 25, 2025

87468.1(a)(6) Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time... This requirement is not met as evidenced by: Based on interviews and observations, the Licensee did not ensure that R2 and R3 had the right to leave their room at night by locking them in their rooms by tying the door knob to the hand rail, which is an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 24, 2025

Plan of correction: Licensee conducted a training on May 20, 2025 regarding personal rights. Licensee shall submit a roster of staff who attended the training, information on the trainer, and content of the training.

Type of visit: Case Management - Other

On 6/24/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit to deliver an Amended report for a visit on 6/18/2025. LPA Calandra was greeted by Zach Pilkerton, Administrator and explained the purpose of the visit. During today's visit, LPA Calandra reviewed the amended report with the Administrator and provided a copy of the report. No deficiencies cited during today's visit. An exit interview was conducted and a copy of this report was reviewed and left with facility representative.the state’s words, verbatim · CDSS document, Jun 24, 2025

Allegation investigated: Neglect/lack of supervision by facility staff led to the death of a resident. Facility failed to seek timely medical attention for R1

********************************************THIS IS AN AMENDED REPORT********************************************** On 6/18/2025, Licensing Program Analyst (LPA) John Calandra arrived at the facility to deliver conclusionary findings for this complaint received by the Department on 4/17/2025. LPA Calandra was greeted by Administrator, Fe Arnaiz and explained the purpose of the visit. Complaint alleged that neglect/lack of supervision by facility staff led to the death of a resident. Based on interviews, around 12AM, facility staff conducted a nighttime check on R1. At around 1:38 AM, R1 left their room and was later found deceased outside the facility at 4:47 AM. Based on the Department’s review of documents and interviews conducted, it was found that facility staff did not check in on R1 every hour per the facility’s policy, resulting in them being able to leave the facility unassisted and being found outside hours after staff’s last check-in to be deceased. Substantiated ***********************************************This is an Amended Report************************************************* Complaint alleged that the facility failed to seek timely medical attention for R1. Based on interviews, staff found R1 outside of the facility and carried R1 inside. Based on interviews conducted, the Department determined that facility staff were aware that R1 was not breathing when found outside and waited to perform CPR until 911 was called which was approximately 40 minutes after R1 was found unresponsive and not breathing as staff were attempting to locate R1’s Do Not Resuscitate(DNR) order which R1 did not have. The Allegations above are found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegations are valid because the preponderance of evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. An immediate $500 civil penalty was assessed due to the deficiencies resulting in the death of a resident. Additional Civil Penalties may be assessed at a later date. An exit interview was conducted. This report was reviewed with the Administrator and a copy of the report along with Appeal Rights was left at the facility. Report sent via email to Administrator on 6/24/2025.the state’s words, verbatim · CDSS document, Jun 18, 2025 · control 14-AS-20250417161453

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jun 19, 2025

87464 Basic Services: (f)(1): Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code. This requirement is not met as evidenced by: Based on interviews, the facility failed to provide care and supervision by not checking in on R1, which is an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee to submit training plan, including roster of staff who attended training, and content of training, including information on trainer.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Jun 19, 2025

87465(g) 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.. This requirement is not met as evidenced by: Based on interviews, the licensee did not immediately telephone 911 when it was determined that R1 was not breathing, which is an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee to submit training plan, including roster of staff who attended training, and content of training, including information on trainer.

Type of visit: Case Management - Annual Continuation

On 12/23/2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 10:20 AM to complete the Annual 1-year required inspection. LPA Calandra was greeted by Zach Pilkerton, Administrator and explained the purpose of the visit. LPA Calandra reviewed 6 staff files. All were observed to be complete. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. Deficiencies are cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. An exit interview was conducted. This report was reviewed with Zach Pilkerton, Administrator and a copy of the report along with Appeal Rights was provided.the state’s words, verbatim · CDSS document, Dec 23, 2024

Type of visit: POC

On 12/23/2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Plan of Correction (POC) visit for a deficiency cited on 12/12/2024. LPA Calandra was greeted by Zach Pilkerton, Administrator and explained the purpose of the visit. LPA Calandra cleared the deficiency and provided a POC clearance letter to Zach Pilkerton, Administrator. \ No deficiencies were cited during today's visit. An exit interview was conducted and a copy of the report left at the facility.the state’s words, verbatim · CDSS document, Dec 23, 2024

Type of visit: Required - 1 Year

On December 12, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 12:33 PM to conduct the Annual 1-year required inspection. LPA Calandra was greeted by William Pilkerton, Administrator and explained the purpose of the visit. LPA Calandra toured the physical plant. This is a 1-story building with 25 bedrooms and 21 bathrooms, kitchen, dining room, TV room, Nurses Lounge, Office, Beauty Salon, Patio, and back yard. All bedrooms had the required furniture and sufficient lighting. The facility was maintained at a comfortable temperature. Per interview with the Administrator, the facility's fire alarms are connected directly to the fire department. The fire alarm panel was observed to be in working order. The facility had the required carbon monoxide detectors which were observed to be in working order. The facility had the required 7 days of non perishables and 2 days of perishables on hand. No food was expired. The following documents were gathered at the facility: Administrator certificate for William Pilkerton Certificate of Liability Insurance The following documents shall be sent to the Regional Office by 12/19/2024: Updated LIC 500 Control of Property LPA Calandra reviewed 5 resident records. All were observed to be complete. The deficiencies are cited under the California Code of Regulations, Title 22. Failure to correct the deficiencies by the due date may result in civil penalties The Annual will be completed at a later date. An exit interview was conducted. The report was reviewed with William Pilkerton, Administrator and a copy of the report along with Appeal rights left at the facility.the state’s words, verbatim · CDSS document, Dec 12, 2024

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year annual inspection visit. LPA met with administrator Rosalinda Campbell and explained the purpose of today's visit. LPA was allowed entry into the facility. The facility is considered two levels attached with a ramp and a basement level which is accessible from the parking lot or stairs located in the kitchen. Annual Fees are current. The physical plant was toured inside and outside to ensure the safety of the residents. LPA observed the facility kitchen which is locked from resident access. Knives are stored within the kitchen behind locked and closed door. Perishable and non-perishable food items are observed as in place. LPA observed the the medications as in place and current to residents reviewed. The first aid kit is maintained in the medication room and is complete with required items. LPA observed a pull alarm fire system, fire extinguishers through out the facility inspected 09/19/23, smoke detector/carbon monoxide detectors, fire sprinklers through out, and central heating in the facility as in place. PPE and additional food supplies are observed as in place. Laundry room is also observed as fully operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Water temperature was taken on two common sinks measuring at 108F. LPA observed several resident rooms at random and all rooms appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Cleaning supplies are observed behind a locked janitor's closet not accessible to residents. Additional cleaning supplies, food supplies, laundry area, COVID PPE, and resident incontinence supplies are observed in place in the basement area of the facility. LPA reviewed resident files and staff files which are all current. The facility does not handle resident money. Liability insurance is observed as in place and current as reviewed on this date. Administrator certificate is current expiring 02/07/2025 as observed in place. The following items are requested to be submitted by 12/13/2023: - Infection Control Plan (LIC9282) - Designation of Facility Responsibility (LIC308) - Personnel Report (LIC500) - Updated administrator Certificate - Emergency Disaster Plan (LIC610E) - Copy of certificate of liability insurance Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies observed or cited. Report reviewed with administrator.the state’s words, verbatim · CDSS document, Dec 6, 2023