Laurel Haven

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Malou Holmes, Lead Staff LS, and Merle Laurel, Administrator who had to leave for prior appointment during visit. LPA announced the purpose of the visit. During visit, LPA toured the facility inside and out. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA toured 10 resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. LPA toured 1 staff room and storage room. LS tested the smoke detector in the hallway and found the smoke detector to function properly when tested. LPA toured 3 resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 107-114 degrees F. LPA toured the outside area and found the exits to be clear of obstructions. LPA observed fire extinguisher was last serviced on 01/06/26. LPA reviewed Fire and Earthquake log, last disaster drill on 02/02/26. LPA reviewed resident records for 5 residents and centrally stored medication record. LPA reviewed 4 staff records. No deficiency were cited as per California Code of Regulations Title 22. This report was reviewed with Malou Holmes and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 6, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Merle Laurel. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and food storage areas. LPA observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA reviewed the first aid kit and found it to be complete. LPA toured the facility and tested the smoke detectors in the hallways and each resident room. All smoke detectors functioned properly when tested. The carbon monoxide detector functioned properly when tested. LPA toured each resident room and found each room to have functioning lights and available bedding and clothing storage areas. LPA toured three out of three resident bedrooms. Each bedroom had available soap and hand drying machines as well as working lights. The water temperatures in the bathroom sinks were 116 F - 118 F. LPA toured the outside area and found the exits to be clear of obstructions. LPA reviewed six resident records and six Centrally Stored Medication and Destruction Records and found them all to be complete. LPA reviewed five staff records and found them to be compete. The Disaster Drill Log indicates the last drill was conducted on February 1st, 2025. No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Merle Laurel and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 13, 2025

Allegation investigated: Staff physically abused resident Staff neglected resident

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Staff Alex Ignacio and explained the reason for the visit. Administrator Merle Laurel could not make the visit today and gave permission for staff Alex Ignacio to sign the required paperwork. Census: 14 Staff physically abused resident - LPA Lund reviewed facility records, San Jose Police report-SJ 2023-232160140, interviewed staff, and residents in care. Based on facility records review, San Jose Police report-SJ 2023-232160140, interviews with staff, and residents in care. According to San Jose Police report-SJ 2023-232160140 on 8/2/2023 Resident (R1) was pushed by a suspect (Staff) from the back, into the residents’ room. R1 was pushed approximately 20 times from the back supposed staff. Unsubstantiated On 8/2/2023 R1 called 911 to go to the ER. On 8/4/2023 San Jose police officer interviewed R1 regarding the incident on 8/2/2023. San Jose police officer interviewed case manager, Administrator Merle Laurel, and care staff from the facility. Case manager for R1 stated to the officer that R1 would not be going back to the facility and would find new housing. Functional Capability Assessment dated 7/14/2023 states that R1 loses balance easily which leads to R1 falling. Doctor recommended that R1 use a walker to help with walking. Staff stated to LPA Lund that R1 would refuse to use the walker. San Jose Police report-SJ 2023-232160140- States that no injuries completed. Based on facility records review, San Jose Police Report-SJ 2023-232160140, interviews with staff, and residents in care on the information provided, it was unclear if staff physically abused resident, therefore the allegation was deemed UNSUBSTANTIATED. Staff neglected resident - LPA Lund reviewed facility records, San Jose Police report-SJ 2023-232160140, interviewed staff, and residents in care. Based on facility records review, San Jose Police report-SJ 2023-232160140, interviews with staff, and residents in care. Resident (R1) was placed at the facility on 7/14/2023 and Functional Capability Assessment dated 7/14/2023 states that R1 loses balance easily which leads to R1 falling. Staff interviewed stated that they would continually remind R1 to use walker and on 8/2/203 R1 called 911 to go to the ER. On 8/4/2023 San Jose police officer interviewed R1 regarding the incident on 8/2/2023. San Jose police officer interviewed case manager, Administrator Merle Laurel, and care staff from the facility. Case manager for R1 stated to the officer that R1 would not be going back to the facility and would find new housing. Residents interviewed stated that staff treat well and here to help them when needed. San Jose Police report-SJ 2023-232160140- States that no injuries completed. Based on facility records review, San Jose Police report-SJ 2023-232160140, interviews with staff, and residents in care on the information provided, it was unclear if staff neglected resident, therefore the allegation was deemed UNSUBSTANTIATED. As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Nov 9, 2024 · control 26-AS-20230808145034

Allegation investigated: Staff did not treat resident with dignity and respect Staff did not administer resident’s medication Staff yell at residents Staff confined resident to room Facility has rodents

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Administrator Merle Laurel and explained the reason for the visit. Census: 14 Staff did not treat resident with dignity and respect - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on facility records review, interviews with staff, and residents in care. Staff have been trained on how to recognize & report elder abuse & understanding mental illness with residents with schizophrenia. Staff interviewed stated that they would report immediately to management if they were to see any staff disrespect or mistreat any residents in care. Residents interviewed stated that they have been treated with dignity and respect. Unsubstantiated Based on facility records review, interviews with residents and staff on the information provided, it was unclear if staff did not treat resident with dignity and respect, therefore the allegation was deemed UNSUBSTANTIATED. Staff did not administer resident’s medication - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on facility records indicate that staff have had the six-hour Medication Training Program. Four hours of initial instruction & 2 hours of hands-on shadowing. LPA reviewed Medication Administration Records (MARS) from residents in care from May 2022 through August 2022 and were in compliance. Staff interviewed stated most residents take their medications when told, if not we come back to them. If a resident doesn’t take their medication, we mark in their Medication Administration Records (MARS) and notify parties involved if needed. Residents interviewed stated that they are given their medications on time and staff give it to them properly. Based on facility records review, interviews with residents and staff on the information provided, it was unclear if staff did not administer resident’s medication, therefore the allegation was deemed UNSUBSTANTIATED. Staff yell at residents - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on facility records review, interviews with staff, and residents in care. Staff have been trained on how to recognize & report elder abuse & understanding mental illness with residents with schizophrenia. Staff interviewed stated that they would report immediately to management if they were to see any staff yell at residents in care. Residents interviewed stated that they have not been yelled at by staff. Based on facility records review, interviews with residents and staff on the information provided, it was unclear if staff yell at residents, therefore the allegation was deemed UNSUBSTANTIATED. Staff confined resident to room - LPA Lund interviewed staff, and residents in care. Based on interviews with staff, and residents in care. Staff interviewed stated that they have never told any residents to staff in their rooms unless it was under if they have had COVID-19 and we would try to tell residents in care to stay in their rooms. Residents interviewed stated that they have never been forced to stay in their rooms. Based on interviews with residents and staff on the information provided, it was unclear if staff confined resident to room, therefore the allegation was deemed UNSUBSTANTIATED. Facility has rodents - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on reviewed facility records, interviews with staff, and residents in care. LPA Lund reviewed Clark Pest Control report dated 5/6/2022 states the facility is clear of rodents. LPA Lund reviewed pest control reports from 4/29/2024 through 10/24/2024 states the facility is clear of pests and rodents. Staff interviewed stated that have not seen any rodents are pests at the facility. Residents interviewed stated that have not seen any rodents are pests at the facility. Based on facility records review, interviews with residents and staff on the information provided, it was unclear if staff failed to keep facility free of pests, therefore the allegation was deemed UNSUBSTANTIATED. As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Oct 26, 2024 · control 26-AS-20220615085116

Allegation investigated: Resident has scabies Staff misplaced resident’s medication Staff failed to keep facility free of pests Facility restrains residents in their bedrooms

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Administrator Merle Laurel and explained the reason for the visit. Census: 14 Resident has scabies - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on reviewed facility records, interviews with staff, and residents in care. LPA Lund reviewed Residents (R1) Medication Administration Records (MARS) from 5/1/2022 through 8/30/2022. In 6/1/2022 through 6/18/2022 R1 was prescribed a cream but never used it. Staff interviewed stated that the facility never had scabies. Residents interviewed stated that they have never had scabies. On 7/22/2022 LPA David Marrufo observed that the facility didn't have scabies. Unsubstantiated Based on facility records review, interviews with residents and staff on the information provided, it was unclear if resident has scabies, therefore the allegation was deemed UNSUBSTANTIATED. Staff misplaced resident’s medication - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on facility records indicate that staff have had the six-hour Medication Training Program. Four hours of initial instruction & 2 hours of hands-on shadowing. LPA reviewed Medication Administration Records (MARS) from residents in care from May 2022 through August 2022 and were in compliance. Staff interviewed stated most residents take their medications when told, if not we come back to them. If a resident doesn’t take their medication, we mark in their Medication Administration Records (MARS) and notify parties involved if needed. Residents interviewed stated that they are given their medications on time and staff give it to them properly. On 7/22/2022 LPA David Marrufo interviewed ten residents and three staff who stated they staff have never misplaced residents medication. Based on facility records review, interviews with residents and staff on the information provided, it was unclear if staff misplaced resident’s medication., therefore the allegation was deemed UNSUBSTANTIATED. Staff failed to keep facility free of pests - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on reviewed facility records, interviews with staff, and residents in care. LPA Lund reviewed Clark Pest Control report dated 5/6/2022 states the facility is clear of rodents. LPA Lund reviewed pest control reports from 4/29/2024 through 10/24/2024 states the facility is clear of pests and rodents. Staff interviewed stated that have not seen any rodents are pests at the facility. Residents interviewed stated that have not seen any rodents are pests at the facility. On 7/22/2022 LPA David Marrufo interviewed ten residents and three staff who stated the facility is free of pests. Based on facility records review, interviews with residents and staff on the information provided, it was unclear if staff failed to keep facility free of pests, therefore the allegation was deemed UNSUBSTANTIATED. Facility restrains residents in their bedrooms - LPA Lund interviewed staff, and residents in care. Based on interviews with staff, and residents in care. Staff interviewed stated that they have never told any residents to staff in their rooms unless it was under if they have had COVID-19 and we would try to tell residents in care to stay in their rooms. Residents interviewed stated that they have never been forced to stay in their rooms. On 7/22/2022 LPA David Marrufo interviewed ten residents and three staff who stated the facility has never forced residents to stay in their rooms. Based on interviews with residents and staff on the information provided, it was unclear if facility restrains residents in their bedrooms, therefore the allegation was deemed UNSUBSTANTIATED. As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Oct 26, 2024 · control 26-AS-20220714111842

Allegation investigated: Staff does not treat resident with dignity and respect Administrator threatened resident Staff did not let resident use the facility's telephone

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegations. LPA Lund met with Administrator Merle Laurel and explained the reason for the visit. Census: 14 Staff does not treat resident with dignity and respect - LPA Lund reviewed facility records, interviewed staff, and residents in care. Based on facility records review, interviews with staff, and residents in care. Staff have been trained on how to recognize & report elder abuse & understanding mental illness with residents with schizophrenia. Staff interviewed stated that they would report immediately to management if they were to see any staff yell at residents in care. Residents interviewed stated that they have not been yelled at by staff. On 10/10/2022 LPA David Marrufo interviewed six residents and three staff who stated they have never seen staff disrespect any residents in care. Unsubstantiated Based on facility records review, interviews with residents and staff on the information provided, it was unclear if staff does not treat resident with dignity and respect, therefore the allegation was deemed UNSUBSTANTIATED. Administrator threatened resident - LPA Lund interviewed staff, and residents in care. Based on interviews with staff, and residents in care. Staff interviewed stated that they would notify management or call 1-844-LET-US-NO if they where to see the Administrator threatened a resident. Residents interviewed stated that they have never seen Administrator threatened any residents in care. On 10/10/2022 LPA David Marrufo interviewed six residents and three staff who stated they have never seen a administrator threaten an resident. Based on interviews with residents and staff on the information provided, it was unclear if administrator threatened resident, therefore the allegation was deemed UNSUBSTANTIATED. Staff did not let resident use the facility's telephone - LPA Lund interviewed staff, and residents in care. Based on interviews with staff and residents. Staff interviewed that resident have always been able to use the phone. Residents interviewed stated that they have been able to use the phone. On 10/10/2022 LPA David Marrufo interviewed six residents and three staff who stated they have been able to use the phone. Based on interviews with residents and staff on the information provided, it was unclear if staff did not let resident use the facility's telephone, therefore the allegation was deemed UNSUBSTANTIATED. As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and report left.the state’s words, verbatim · CDSS document, Oct 26, 2024 · control 26-AS-20221004141551

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management - Annual Continuation visit and met with Merle Laurel. LPA visited the facility to continue the annual inspection visit that began on 01/30/2024. During visit, LPA Marrufo inspected the water temperatures in 3 out of 3 resident bathrooms. The water temperatures were 119 F, 118 F, and 116.5 F. LPA Marrufo reviewed Centrally Stored Medication Logs and resident records for 5 residents and found them to be complete. LPA reviewed staff records and found them to be complete. LPA Marrufo reviewed the Emergency Disaster Drill Log and found the last drill occurred on 04/03/2024. LPA Marrufo reviewed 1 out of 1 Personal and Incidental Money Log and found it to be complete. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Merle Laurel and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 25, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Mhalou Holmes. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and the other food storage areas and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least 7 days. LPA Marrufo observed locked storage areas for sharps and cleaning supplies. The facility smoke detectors functioned properly when tested. LPA Marrufo toured 3 out of 3 bathrooms and observed the bathrooms to have available soap and paper towels as well as available lighting. The outside area exit was clear of obstructions. Due to time constraints, the annual inspection will need to be continued at a further date. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Mhalou Holmes and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 30, 2024

Allegation investigated: Facility unlawfully evicted a resident

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Alex Ignacio, staff. On 12/28/2023, the Department received a complaint with the above allegation. On 01/03/2024, LPA Marrufo conducted an initial complaint investigation visit. LPA Marrufo obtained a screenshot of the text message that Licensee sent to resident R1's Case Worker on 12/28/2023. LPA Marrufo verified that the telephone number from where the text message was sent to R1's case worker is the same telephone number LPA Marrufo has used to contact the Licensee. See LIC9099-C for more information. Page 1 of 2. Substantiated The text message states, "...When I asked you for the 150 approval last September - you said it was approved. Just the email for the 55 patch in which to don't take. So pls find another place for [R1] as this is a 30 day notice. Ty" The text message did not include any of the five reasons for an eviction that a Licensee may provided as stated in Title 22 Regulation 87224 Eviction Procedures (a)(1-5). During interview, R1's Case Worker stated to have not received any other form of eviction notice. R1 stated during interview to have not received any verbal or written notice of eviction. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D for more information. This report was reviewed with Alex Ignacio and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 17, 2024 · control 26-AS-20231228114456

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Jan 24, 2024

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This requirement was not met as evidenced by: Licensee sent a text message to R1's case worker stating that R1 was being evicted for not paying the full patch amount. The text message did not include any of the legal reasons for eviction as stated in 87224(a)(1-5), which poses a potential safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 17, 2024

Plan of correction: Licensee agrees to submit a statement of understanding by POC date to CCL stating that the licensee has reviewed and understood CCL Regulation 87224 Eviction Procedures. Licensee also agrees to rescind or correct any current evictions that do not comply with CCL Regulation 87224 Eviction Procedures by POC date. Licensee shall either submit copies of rescinded or corrected eviction notices or issue a statement that there are no current non-compliant evictions by POC date.