Lavender Hills Assisted Living II

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analysts (LPAs), Marisa Chiarelli and Kayla Adkison arrived on 06/26/2026 for an unannounced inspection to follow up on a case management visit regarding a substantiated allegation as the result of an incident report investigation. On April 15, 2024, the Department concluded an investigation following an incident report regarding the elopement and unwitnessed fall of a resident (R1) who required mobility assistance. The licensee was cited for California Code of Regulations (CCR) Title 22, Section 87705(c)(4)- Care for Persons with Dementia. At the time of the case management inspection on April 15, 2024, an immediate civil penalty of $500.00 was issued and the licensee was informed that an additional civil penalty may be assessed based on Health and Safety Code § 1569.49. Continued on 809 - C The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code § 15610.67 defines serious bodily injury as "an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility failing to prevent R1 from eloping and falling, resulting in a hip fracture, hospitalization, hip surgery, and physical therapy rehabilitation. Today, 06/26/2026 the Department will be issuing a civil penalty per Health and Safety Code § 1569.49 for a violation that the Department constitutes as a serious bodily injury in the amount of $ 10,000. However, since an immediate civil penalty of $500 was previously issued on April 15, 2024, the amount of the civil penalty issued today will be $9,500. Exit interview conducted. A copy of the report issued. Appeal rights provided. Signature on this report acknowledges receipt of the appeal rights, found on page two of LIC421D.the state’s words, verbatim · CDSS document, Jun 26, 2026

Type of visit: Required - 1 Year

On 04/23/2026 Licensing Program Analyst (LPA) Marisa Chiarelli arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met administrator Jennifer Boss and explained the purpose of the visit. LPA Chiarelli and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured included but not limited to, residents bedrooms, bathrooms, and kitchen. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Medication is kept in a locked room. LPA Chiarelli reviewed three residents medications. The common area was clean, odor-free and in good repair. All bedrooms had required furniture, bedding, and lighting. The bathrooms were clean and in good repair. The kitchen was clean and in good repair. Sharps are kept in a locked drawer. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors sound directly to the fire department. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. No pools/bodies of water are on the premises. No firearms are on premises. No deficiencies are being cited on today's inspection, exit interview conducted and copy of report left with the administrator.the state’s words, verbatim · CDSS document, Apr 23, 2026

Type of visit: Case Management - Incident

On February 12, 2026, Licensing Program Analyst (LPA) Kayla Adkison arrived at the facility unannounced for a case management visit. LPA met with Jennifer Boss, Administrator and Natasha Peerman, assistant administrator and explained the purpose of the visit. During the visit, there were four (4) staff providing care and 19 residents in the facility. LPA made visual observations of the facility and interviewed Administrator and Assistant Administrator regarding an incident that occurred in April 2024. No deficiencies are being cited as a result of this visit. Exit interview conducted. A copy of this report was provided, via email, to Jennifer Boss, Administrator.the state’s words, verbatim · CDSS document, Feb 12, 2026

Type of visit: Office

An non-compliance conference was conducted at 2:00pm on June 31, 2025, with Sacramento North Regional Office via Microsoft Teams. The purpose of this non-compliance conference meeting is to address a citation issued on 4/15/2024. The following Licensing staff were present: Sacramento North Regional Manager Alycia Rayner, Licensing Program Manager Lauren Crocket, Licensing Program Analyst Sarah Benson. The following facility representatives were present: Licensee Janet Coulter, Administrator Jennifer Boss, Administrator Naitasha Peerman. The following topics were discussed during today's meeting: Summary of Complaint filed against this facility. Summary of Complaints filed against this facility. Care of Persons with Dementia, Elopement Safety issues Staff training Personal Rights of Residents in All Facilities Care for Persons with Dementia TSP offered as a resource Door chime, who answers Activities offered Continued on LIC809-C Compliance Plan: The Licensee will provide a document with the programs implemented with regards to: 1. Ensuring how staff plan to prevent eloping., 2. A list of preventative steps taken and when implemented. 3. Training's and ongoing training's, how often. 4. Quality assurance, how management is ensuring plan is actually happening, 5. Process to ensure staff are adhering to the policy. 6. List of the processes. The licensee understands and acknowledges that the Department, at its discretion, will make unannounced case management visits to monitor the licensee’s compliance with this Compliance Plan. Completing the Non-Compliance Conference does not deprive the Department of its authority to take formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager. This conference does not in any manner excuse past problems or resolve the Department’s case against the licensee if the problems are not corrected. The Non-Compliance Conference may be the last step prior to initiating administrative action following unsuccessful attempts by the Department to gain compliance. An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy must be signed and returned to the Department.the state’s words, verbatim · CDSS document, Jul 31, 2025

Type of visit: Required - 1 Year

On April 3, 2025, at 1:15 PM Licensing Program Analyst (LPA) Kayla Adkison arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met administrator Naitasha Peerman (cert #6074069740 exp.01/15/2027) and explained the purpose of the visit. Administrator certificate is current. LPA Adkison and administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to four (4) resident rooms, common areas, (5) bathrooms, kitchen, medication room and facility exterior. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Medication is kept in a locked room. The common area was clean, odor-free and in good repair. All bedrooms had required furniture, bedding, and lighting. The bathrooms were clean and in good repair. The kitchen was clean and in good repair. A 5-week menu is posted. Sharps are kept in a locked drawer. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors sound directly to the fire department. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. There is a schedule of activities posted for the clients. No pools/bodies of water are on the premises. No firearms are on premises. The last disaster drill was conducted and documented on January 18, 2025, the facility has been conducting drills every (3) three months. The facility is in compliance. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report was provided to administrator, Nataisha Peerman.the state’s words, verbatim · CDSS document, Apr 3, 2025

Allegation investigated: Insufficient staff/Lack of supervision.

On 06/18/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 01/30/24. LPA Gurriere met with Natasha Peerman, Asst. Administrator, and explained the purpose of the visit. Insufficient staff/Lack of supervision. During the interview process, the administrator and three staff persons were interviewed. Attempts were made to interview two other staff persons; however, they were not available. In addition, documents were obtained and reviewed to include the resident’s Physician’s Report and staff persons telephone numbers. continued Unsubstantiated During the investigation, it was reported that paramedics arrived at the facility to follow up on a resident and stated that the staff person working, appeared to be disheveled. It was stated by the staff that were interviewed that they were not aware of the incident and overall, it was reported that there is sufficient staff during the nighttime shift to meet the needs of the residents. Although the above allegation mentioned may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the above finding is Unsubstantiated.the state’s words, verbatim · CDSS document, Jun 18, 2024 · control 59-AS-20240130141806

Allegation investigated: Staff drugged resident in care. Staff smoke marijuana in the facility premises. Staff locked resident in care. Staff mismanaged resident's medication. Centrally stored medications are made accessible to residents in care. Staff are not following proper reporting requirements. Staff do not provide adequate supervision to residents in care.

On 06/18/24 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 03/12/24. LPA Gurriere met with , Natasha Peerman, Asst. Administrator, and explained the purpose of the visit. Staff drugged resident in care. Staff smoke marijuana in the facility premises. Staff locked resident in care. Staff mismanaged resident's medication. Centrally stored medications are made accessible to residents in care. Staff are not following proper reporting requirements. Staff do not provide adequate supervision to residents in care. continued Unsubstantiated During the interview process, the administrator and six staff persons were interviewed. Two staff persons were no longer working at the facility; however, they were still interviewed. The facility is a memory care unit; thus, the residents were not interviewed. Contact information received, included staff telephone numbers and staff work schedule. During the investigation process, it was noted that many of the allegations are in relation to specific residents; however, the names of the residents were not provided and therefore the allegations could not be thoroughly explored. Overall, it was reported that the staff were not familiar with the allegations alleged. It is noted that the exact same allegations were stated for the sister facility. Although the above allegations mentioned may have happened, or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and all of the above findings are Unsubstantiated.the state’s words, verbatim · CDSS document, Jun 18, 2024 · control 59-AS-20240312155426

Type of visit: Case Management - Deficiencies

On 4/15/2024 Licensing Program Analyst (LPA) Jaynae Boyles arrived at the facility unannounced to conduct a case management to follow up on a recent AWOL at the facility. LPA met with facility Administrator Jennifer Boss and explained the purpose of the visit. The incident occurred on 4/11/2024 where a resident, who was deemed unable to leave facility unassisted at around 4pm, had eloped in the afternoon without any staff knowing. While out the resident had an unwitnessed fall resulting in the resident sustaining a broken hip. A community member found the resident on the sidewalk and contacted 911. The facility was informed by resident's son later that afternoon at around 4:28pm. As a result of the incident, the Department is issuing a citation on the attached LIC 809-D, per Title 22 Regulations. Also attached to the deficiency is an immediate civil penalty in the amount of $500, which is assessed for a violation of California Code of Regulations Section 87705(c)(4). The licensee was informed that an Enhanced Civil Penalty is under review and may be assessed at a future date according to Health and Safety Code 1569.49. Exit interview conducted. A copy of the report has been issued. Appeal Rights provided. Jennifer Boss signature on this report acknowledges receipt of these reports. .the state’s words, verbatim · CDSS document, Apr 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4) · Plan of correction due date: Apr 16, 2024

87705(c)(4) Care of Persons with Dementia-Licensees who accept and retain residents with dementia shall be responsible for ensuring: There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs. Based upon observation and interview the Licensee failed to provide enough care staff to ensure the safety and health care needs of 1 of 1 residents who went AWOL. This poses an immediate Health, Safety and/or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2024

Plan of correction: Licensee agrees to create and implement a policy and procedure to ensure accountability of individual staff to ensure they are conducting wellness checks. Policy due to CCL no later than COB on 04/16/2024 Civil Penalty assessed in the amount of $500

Type of visit: Required - 1 Year

On 03/07/2023, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator and explained the purpose of the visit. LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, backyard, shed, and common restrooms. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the resident bedrooms to have the required furniture, light fixtures and windows with screens. LPA observed eleven (11) resident bedrooms which were clean, tidy and odor free. LPA observed resident rooms with four (4) beds to have half bed rails, LPA observed the laundry room to have locks on the toxic chemical cabinet but it was not being utilized and it was left unlocked. LPA observed the medication room to be locked and inaccessible to residents. However, the locks on the medication cabinet are not being utilized. LPA observed each bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids. Facility has a 2-day perishable and a 7-day non-perishable amount of food and sharps to be locked. Hot water temperature was measured within the required range. LPA observed several fire extinguishers, fire detectors, and carbon monoxide detectors within the facility. LPA observed the first aid kit to be complete and ready for use. LPA reviewed a total of six (6) residents' files and four (4) staff files. Staff files contained all the the required documentation. Of the six (6) resident files, two (2) residents were missing an annual physical for residents with dementia. Of the files reviewed, three resident had bed rails with no order from a physician. Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Several topics were discussed. An exit interview was conducted, and Plans of Corrections were reviewed and developed collaboratively. A copy of this report, LIC 809-D, and Appeal Rights were discussed and provided.the state’s words, verbatim · CDSS document, Mar 7, 2024

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