Living Grace Assisted Living and Memory Care

Allegation investigated: Staff do not prevent the spread of gastrointestinal illness

Unannounced complaint visit made out to this facility on 07/30/2026 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Farial Shokoor. A brief interview was conducted with the facility designated Administrator at this time. Current census was 68 residents. The purpose of this visit was to deliver the findings from this complaint investigation to this facility, and it's representative, at this time. Based on a review of the forms and documents gathered during the course of this investigation, it was learned that there were a total of 12 facility residents affected with some sort of gastrointestinal illness. It was learned that the first case appeared on Mother's Day weekend but symptoms and the effects of the illness would only last for 24 hours. It was learned that the resident would experience the illness and recover after isolation, proper hydration, and minimal medication. It was learned that the issue for containment came about with the spread of the illness since it was rampant for about 8 days from the initial case. Unsubstantiated It was learned that a resident with the illness would be isolated and recover after 24 hours but somehow another resident, or staff person, would then contract the gastrointestinal illness and repeat the whole cycle for another 24 hours. It was learned that this facility, and it's personnel, did follow their Infection Control Plan and utilized universal precautions and deployed Personal Protective Equipment (PPE) during this time period. It was learned that masks, gloves, and gowns were made available and used by facility personnel while dealing with infected residents. It was learned that notifications in regards to this facility wide illness were reported to the appropriate agencies with corresponding documentation of facility staff, residents, and policies and procedures that were being deployed to mitigate this illness. As a result of this investigation, this Department found the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegation may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jul 30, 2026 · control 27-AS-20260619085615

Allegation investigated: Staff is handling residents in a rough manner

Unannounced complaint visit made out to this facility on 05/29/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Farial Shokoor, who was briefly interviewed at this time. Current census was 67 residents. The purpose of this visit was to deliver the findings from this complaint investigation to this facility, and it's representative, at this time. Based on interviews that were conducted during the course of this investigation, it was learned that staff person, S1, has been observed by facility staff to be aggressive and handled residents in a rough manner while attempting to provide adequate care and supervision. It was learned that on several occasions, S1 was observed to grab and pull residents by their wrists in S1's attempts to redirect them to the restroom or to their designated rooms. It was learned that on other occasions, S1 was observed to forcefully grab residents by their wrists and clothing while pulling them up when attempting to transfer them to their chairs. Substantiated It was learned that staff person S1 was observed by other facility staff persons to push and shove residents in care while attempting to redirect them or while attempting to assist them. It was learned that staff person S1 disregarded personal safety for a facility resident who required the use of a wheelchair and was pushing this resident by only using the back two wheels of the wheelchair while the front wheels were suspended in the air. Based on the statements and information gathered during the course of these interviews conducted, it was determined that staff person S1 did handle residents in a rough manner and even went so far as to jeopardize the safety and well being of the residents in care. As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Appeal rights were printed and a copy was left with the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, May 29, 2026 · control 27-AS-20260417110448

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1)(2) · Plan of correction due date: May 30, 2026

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This facility was found to be deficient as evidenced by the rough handling of facility residents and instances of putting residents in hazardous situations by facility staff. This posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.the state’s words, verbatim · CDSS document, May 29, 2026

Plan of correction: The facility designated Administrator stated that all facility staff will be in-serviced, for no less than 2 hours in duration, on the topics of proper transfer of residents and maintaining the integrity of personal rights at all times. A statement of correction, along with proof of proper training, will be completed and submitted into CCL by the due date for review by this LPA. Proper Training will include the topics of training with duration, name of trainer(s), and a list of all attendees.

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 05/06/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator Farial Shokoor. A brief interview was conducted with the facility designated Administrator at this time. Current census was 68 residents. The purpose of this visit was to follow up on the deficiencies that were cited from a prior annual visit conducted on 04/17/2026. This visit was to follow up on the Plan of Correction that was due. The following deficiencies were observed and cited on 04/17/2026: Licensees shall maintain in the personnel records verification of required staff training and orientation. Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. Plan of Correction clearance letter was printed and a copy was provided to the facility designated Administrator at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, May 6, 2026

Allegation investigated: Facility is not financially solvent

On 04/27/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA Pascua met with Facility Designated Administrator (FDA), Farial Shokoor and explained the purpose of the visit. The purpose of the visit was to deliver complaint findings for the allegation above. Current census was 69. A brief interview with FDA Shokoor was conducted. It was alleged that the facility is not financially solvent. Based on information gathered during this investigation, it was learned that the September sample month Profit and Loss statement shows a net loss. The licensee did not provide documents to identify or support the actual revenues generated. The mortgage document and bank statement support that rent was paid, and it appears the licensee had control over the facility during the sample month reviewed. Substantiated The utility billing statements provided for PG&E, water, and Comcast show that the licensee made full payments consistently for the months reviewed. However, utility billing statements were not provided to determine the electricity payment history for the same period or to support the electricity expense listed on the operating statement. A working capital analysis performed for the sample month showed positive working capital. However, this is not considered reliable because the licensee did not report all current liabilities, including credit cards, and did not provide supporting documentation for current assets such as short-term receivables and notes. The review of the bank statements provided did not indicate that the licensee maintained, as required by law, the equivalent of at least one month of operating expenses. The liability insurance certificate provided during the audit period shows that the facility met the required coverage per occurrence and aggregate per facility, as required by the Health and Safety Code. However, the liability insurance policy has since expired. The Certificate of Workers’ Compensation has also expired. Overall, based on the records provided and reviewed, there is sufficient evidence to conclude that the facility is not financially solvent. As a result of this investigation, the department found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. An exit interview was conducted, a copy of this report and appeals rights were provided to the facility at the end of this visit.the state’s words, verbatim · CDSS document, Apr 27, 2026 · control 27-AS-20251016124621

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(b) · Plan of correction due date: May 7, 2026

(b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. This is not met as evidenced by: Based on record review, the licensee did not ensure that the facility administrator had the responsibility and authority to ensure that the facility was financially solvent. This poses a potential health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 27, 2026

Plan of correction: The facility has been placed on quarterly financial audit monitoring for 6 months. The Licensee will send the department documentation including: bank statements, profit & loss statements, balance sheets, utility bills, gas bills, worker’s compensation insurance. Documentation for the first quarter of the year will be sent to the LPA by 05/07/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87205(a) · Plan of correction due date: May 7, 2026

(a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This is not met as evidenced by: Based on record review, the licensee did ensure that the facility was financially solvent. This poses a potential health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 27, 2026

Plan of correction: The facility has been placed on quarterly financial audit monitoring for 6 months. The Licensee will send the department documentation including: bank statements, profit & loss statements, balance sheets, utility bills, gas bills, worker’s compensation insurance. Documentation for the first quarter of the year will be sent to the LPA by 05/07/2026.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87213 · Plan of correction due date: May 7, 2026

The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency. Such request shall explain the need for disclosure. The licensing agency reserves the right to reject any financial report and to request additional information or examination including interim financial statements. This is not met as evidenced by: Based on record review, the licensee did not ensure that the licensee had a financial plan and sufficient resources to meet operating costs for the facility, this poses a potential health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Apr 27, 2026

Plan of correction: The facility has been placed on quarterly financial audit monitoring for 6 months. The Licensee will send the department documentation including: bank statements, profit & loss statements, balance sheets, utility bills, gas bills, worker’s compensation insurance. Documentation for the first quarter of the year will be sent to the LPA by 05/07/2026.

Type of visit: Office

An office meeting was held today to discuss solvency audit findings regarding Living Grace Assisted Living and Memory Care. Present in today's meeting was Community Care Licensing (CCL), Regional Manager (RM), Stephenie Doub, Licensing Program Manager (LPM)Liza King and Lisa Rios, Licensing Program Analysts (LPAs) Arielle Pascua, Kesha Lewis, and Charlie Yang . Living Grace Assisted Living and Memory Care Licensee Shelly Cha and Christine Soriano , Living Grace and Assisted Living and Memory Care Administrator Farial Shokoor and Legal Counsel Jake Reinhardt. The solvency audit was conducted by Audit Investigator, Benjamin Banahene. During today's meeting reviewed the audit report finding summary. Based on the audit report findings, the licensee is in violation of the following Title 22 regulations: 1. Section 87405 – Administrator Qualifications and Duties. 2. CCR, Title 22, Division 6, Chapter 8, Section 87205, Accountability of Licensee 3. CCR, Title 22, Division 6, Chapter 8, Section 87213 - Finance; Records However, these deficiencies will be cited on Complaint # 27-AS-20251016124621 The facility will be placed on quarterly Financial Monitoring for a total of six (6) months. An exit interview was held during the Office meeting. A report will be delivered via email. Licensee to review, sign, and send report back to LPA Pascua.the state’s words, verbatim · CDSS document, Apr 23, 2026

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 04/17/2026 by Licensing Program Analyst (LPA) Charlie Yang. This LPA was met by the facility designated Administrator, Farial Shokoor, who was briefly interviewed at this time. It was learned that there were (14) residents under the care of hospice at this time. This facility does have an approved waiver to be able to accept and retain up to (25) residents at any given time. It was learned that there were residents diagnosed with dementia at this time. This facility does have an approved program to be able to accept and retain residents diagnosed with dementia at any given time. This facility does have a memory care unit on site at this time. Current census was 68 residents for all three components of this facility at this time. Tour of the facility was conducted. A tour of the facility kitchen area was conducted. Food storage units, refrigerators and freezers, were toured. It was observed that there was a sufficient supply of 2-day perishable food quantities available on site to meet the requirements at this time. Pantry area was toured. It was observed that there was a sufficient supply of 7-day nonperishable food quantities available on site to meet the requirements at this time. A sample review was conducted for the facility resident bedrooms at this time. It was observed that furniture and furnishings were observed to be functional and maintained in compliance at this time. A sample review was conducted for the facility resident restrooms at this time. Hot water temperatures were taken to make sure that they measured within the allowed range of 105-120 degrees at all times. Grab bars and non skid surfaces were observed to be present and maintained in compliance at this time. Living areas, dining areas, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Laundry room was toured. It was observed to be locked and all laundry detergents, bleach, and supplies were made inaccessible to the residents at this time. Rooms designated as supply rooms, storage rooms, and equipment rooms were observed to be locked and made inaccessible to the residents at this time. Medication carts were reviewed alongside the facility designated Administrator and present medication technician. Policies and procedures in regards to the handling, dispensing, and documentation of the resident medications were discussed at this time. This facility utilized mobile medication carts that were pushed out into the facility when it was time to dispense the medications to the residents. It was learned that this facility employed an E-MAR system as well as documented paperwork for the facility resident medications at this time. First aid kit, located in the medication carts, was observed to contain all of the required components at this time. Fire extinguishers, located throughout this facility, were observed to have been annually inspected by the local fire extinguisher company, Annual Fire and Safety, on 02/18/2026 and found to be in compliance at this time. A tour of the facility exterior grounds was conducted. A review of the perimeter fence, side gates, and all other exits was conducted at this time. A review of (6) facility resident files was conducted and noted on the following LIC 858. A review of (6) facility personnel files was conducted and noted on the following LIC 859. The following forms and documents were requested by this LPA to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Apr 17, 2026

Type of visit: Office

Office meeting conducted on 03/02/2026 via Teams meeting with the following individuals at this time: Stephenie Doub, Regional Manager Liza King, Licensing Program Manager Lisa Rios, Licensing Program Manager Charlie Yang, Licensing Program Analyst Christine Soriano, LLC Board Member Shelly Cha, LLC Board Member The purpose of this meeting was to discuss the current issues surrounding this facility at this time. It was recently learned by this licensing office that the Chief Executive Officer, CEO, Christine Soriano was removed from the board and no longer a part of operations at this time. This meeting was held to determine the course of action that the Licensee was taking in order to maintain operational stability within the governing board for this facility so as to remain in compliance at all times. The following items will need to be updated and submitted into CCL for further review: Updated LIC 500 for staff coverage and indicated days/hours for the facility designated Administrator to be present in the facility LIC 501 for the facility designated Administrator Copies of the facility utility bills for electric, water, sanitation since 01/01/2026 Letter from the Board appointing the facility designated Administrator Copy of current facility designated Administrator certificate Forms and documents for the facility designated Administrator to show that he/she does meet all educational and experience requirements Documentation that the facility designated Administrator is fingerprint cleared and properly associated to this facility Updated LIC 200 signed by the Licensee or board resolved representative Staffing projections for the next (2) weeks specifically for caregivers and medication technicians for all (3) shifts of AM, PM, and NOC Proof of current liability insurance and workman's compensation Updated LIC 610 Board resolution denoting any changes to the representative at this time All requested forms and documents are to be updated, completed, and submitted into CCL by COB of 03/04/2026 for further review by this LPA. There were no deficiencies observed or cited during today's office meeting. A copy of this report will be emailed to the address for the Licensee at shellycha81@gmail.com and a request was made by this LPA for the appointed representative to go ahead and sign the documents and scan a copy back to this LPA. Exit Interviewthe state’s words, verbatim · CDSS document, Mar 2, 2026

Allegation investigated: Staff do not follow infection control protocols. Staff did not report a facility outbreak as required. Emergency gate is locked

On 2/10/2026, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA Pascua met with Facility Designated Administrator (FDA), Farial Shokoor and explained the purpose of the visit. Current census was 68. A brief interview with FDA Shokoor was conducted. Allegation: Staff do not follow infection control protocols It was alleged that staff do not follow infection control protocols. During the course of the investigation, the department conducted interviews, observations, and reviewed facility records. Based on the information gathered was determined that on December 30, 2025, facility staff identified two residents with red, itchy rashes. On January 8, 2026, an additional six residents residing in the same area of the facility were identified with similar symptoms. On January 8, 2026, the facility physician evaluated the affected residents and identified the condition as suspected scabies, issuing prescription treatment orders. However, treatment was not initiated until approximately January 11, 2026. Substantiated The facility did not promptly implement environmental infection control measures, as deep cleaning of the affected area was not conducted until January 9, 2026. Facility staff reported this delay was due to a lack of sufficient cleaning supplies. On January 25, 2026, an unannounced visit was conducted by Licensing Program Analyst (LPA) Pascua. During the visit, no signage was observed indicating a suspected outbreak or isolation precautions within the affected area of the facility. Interviews with staff and management revealed the facility did not maintain or follow a definitive infection control protocol. Staff reported reliance on general infection prevention knowledge from trainings received years prior and not specific to facility policies. Facility management acknowledged they were unaware of which infection control procedures to implement and stated they had not been provided with guidance. In addition, facility staff were given a copy of the facilities infection control protocol and facility staff stated they have never seen the infection control protocol during their time at the facility. However, a review of the facilities LIC9282 EMERGENCY INFECTION CONTROL PLAN states that a review was conducted by the Facility Administrator on 09/30/2025. Further interviews revealed the facility did not notify Local Public Health and Licensing of the suspected outbreak, citing the absence of a confirmed diagnosis. However, per the Facility Regional Nurse, infection control protocols are to be initiated immediately upon identification of suspected cases, and notification to Local Public Health and Licensing is required upon medical diagnosis. Additional interviews confirmed the facility did not implement infection control protocols until additional residents developed rashes. Based on the information gathered, the facility did not follow infection control protocols. As a result of this investigation, the department found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. Allegation: Staff did not report a facility outbreak as required. It was alleged that staff do not report a facility outbreak as required. During the investigation, it was determined that on December 30, 2025, facility staff identified two residents with red, itchy rashes. On January 8, 2026, an additional six residents residing in the same area of the facility were identified with similar symptoms. On that same date, the facility physician evaluated the affected residents, identified the condition as suspected scabies, and issued prescription treatment orders. On January 14, 2026, LPA Pascua received an email from the facility reporting a skin outbreak. However, subsequent interviews revealed that the facility had not reported the suspected cases to state licensing or local public health, as the cases had not been confirmed. Further interviews with facility management indicated they were unaware of the requirement to report suspected cases. A review of the facility’s Plan of Operation states that any suspected cases must be reported to local public health in accordance with Title 22 regulations.Based on the information gathered, the facility staff did not report a facility outbreak as required. As a result of this investigation, the department found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. Allegation: Emergency gate is locked It was alleged that the emergency gate is locked. During the course of this investigation, the department conducted interviews and conducted a facility tour. Based on interviews conducted, it was admitted by the facility staff that the emergency gate was held by a pad lock and chain to prohibit the residents from leaving the facility. In addition, the facility staff stated that the Local Fire Department inspector did come to the facility and stated that they need to remove the lock on the gate and was not permitted to be locked. A tour of the facility was conducted which confirmed that there was a chain and lock on the facility gate. Based on the information gathered, the emergency gate was locked. As a result of this investigation, the department found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. An immediate civil penalty was issued for Section 87203 Fire Safety. An exit interview was conducted and a copy of this report and appeals rights was provided to the facility at the end of this visit. Based on statements obtained, records review and observations during the investigation process, LPA was unable to corroborate the allegations. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.the state’s words, verbatim · CDSS document, Feb 10, 2026 · control 27-AS-20260109150634

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87370(a) · Plan of correction due date: Feb 11, 2026

(a) A licensee shall ensure that infection control practices are maintained as follows: This is not met as evidenced by: Based on observation, interview, and record review, the facility did not ensure that infection control practices were followed as stated in the facilities infection control plan.the state’s words, verbatim · CDSS document, Feb 10, 2026

Plan of correction: A statement of correction, along with proof of staff training from an outside vendor for no less than (1) hour in duration, for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date. Information submitted must include attendees, trainers, and information discussed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(2) · Plan of correction due date: Feb 11, 2026

(2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This is not met as evidenced by: Based on observation, interview, and record review, the facility did not ensure that the facility outbreak was reported to licensing within 24 hours upon notification of suspected scabies outbreak. This poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Feb 10, 2026

Plan of correction: A statement of correction, along with proof of staff training from an outside vendor for no less than (1) hour in duration, for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date. Information submitted must include attendees, trainers, and information discussed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Feb 11, 2026

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This is not met as evidenced by: Based on observation, interview and record review the licensee did not maintain proper fire clearance by padlocking the outside emergency gate near the parking lot. This poses an immediate health, safety, and personal rigths risks to persons in care.the state’s words, verbatim · CDSS document, Feb 10, 2026

Plan of correction: Administrator shall provide a statement of acknowledgement to this LPA by POC date. LPA Pascua acknowledged that the padlock was removed prior to this visit.

Type of visit: Office

On 1/27/2026 an announced office visit was conducted by Licensing Program Manger (LPM), Lisa Rios and Licensing Program Analyst (LPA) Arielle Pascua. In attendance from Living Grace Assisted Living and Memory Care and California Department of Social Services (DSS) representatives: Cristina Wong: DSS Nurse Evaluator Farial Shokoor: Facility Designated Administrator to Living Grace Assisted Living Christine Soriano: Licensee Carolyn Appeal: Regional Health and Wellness Director Ricki Henderson: Resident Care Coordinator Erika Archie: Medication Room Coordinator The purpose of this office visit, conducted via Microsoft teams, was to discuss a recent suspected Scabies outbreak at the facility. Some topics of discussed were, pass scabies outbreaks, contact tracing, ensuring staff are using proper PPE, disinfecting, staff monitoring, and visitation. If warranted, the department will call another meeting to discuss further interventions. Per California Code of Regulations (CCRs) - Title 22 no deficiencies are being cited during this visit. An exit interview was conducted with Farial Shokoor, and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documentsthe state’s words, verbatim · CDSS document, Jan 27, 2026

Allegation investigated: Facility staff are not following admission agreement

On 11/17/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Farial Shokoor and explained the purpose of the visit. The purpose of this visit was to inform the facility and its representative that a complaint has been filed against it at this time. Current census was 63. A brief interview with FDA Shokoor was conducted. It was alleged that the facility staff do not follow the facility admission agreement. During the course of this investigation, LPA conducted interviews and reviewed facility records. Based on interviews conducted, it was denied that the facility staff are not following the admissions agreement regarding transportation services. It was stated by facility staff that all resident's are welcome to obtain transportation services through the facility. In addition, the facility staff responsible for driving the residents state that they are able to transport both ambulatory and non-ambulatory residents. Futhermore, a review of the facilities records show that the facility does provide the facility transportation. Unsubstantiated Based on statements obtained, records review and observations during the investigation process, LPA was unable to corroborate the allegations. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.the state’s words, verbatim · CDSS document, Nov 17, 2025 · control 27-AS-20251114134240

Allegation investigated: Staff is smoking marijuana inside the facility. Staff does not provide a safe environment for residents

On 08/22/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct a complaint visit. LPA was greeted by Facility Designated Administrator (FDA), Farial Shookor and explained the purpose of the visit. The purpose of this visit was to inform the facility and its representative that a complaint has been filed it against it at this time. Current census was 60. A brief interview with FDA Shookor. Allegation: Staff is smoking marijuana inside the facility It was alleged that facility staff is smoking marijuana inside the facility. During the course of this investigation, LPA conducted interviews and observations. Based on interviews conducted with facility staff and residents, it was denied that they have ever smoked marijuana inside the facility or have seen any other facility staff smoking inside the facility. In addition, all staff and residents state that they do not smell marijuana inside the facility. It was also stated by facility staff that this community is a non-smoking community and could only smoke in the designated areas. Unsubstantiated Furthermore, LPA Pascua conducted a tour of the facility and did not any observe any smells of marijuana. It was also observed that the designated smoking area is outside of the facility at this time. Based on the information gathered, there is not a preponderance of evidence to prove that the facility staff smoke marijuana inside the facility. Allegation: Staff does not provide a safe environment for residents It was alleged that the facility staff do not provide a safe environment for the residents. During the course of this investigation, the department conducted interviews with staff and residents. Based on the interviews, 6 out of 7 residents expressed no concerns regarding the comfort of the environment. In fact, these residents stated they were content living in the facility. 5 facility staff members denied the allegations, stating that they communicate regularly regarding residents' needs and have not received any issues from family regarding this matter. Based on the information gathered, it is unclear if the facility staff do not provide a safe environment for residents. Based on statements obtained, records review and observations during the investigation process, LPA was unable to corroborate the allegations. The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.the state’s words, verbatim · CDSS document, Aug 22, 2025 · control 27-AS-20250819094431

Type of visit: Office

An informal meeting was conducted today on 08/19/25 at the Sacramento Regional Office via Microsoft Teams. The purpose of this informal meeting was to discuss the recent trends that have been observed at Legacy Oaks of Sacramento, as Living Grace Assisted Living and Memory Care is affiliated with Legacy Oaks of Sacramento. Present at this meeting were Regional Manager (RM), Stephenie Doub, Licensing Program Managers(LPMs), Stephen Richardson, Liza King, Lisa Rios, Licensing Program Analyst (LPAs) Arielle Pascua, Kimberly Viarella, and Noel WolfPetersen. Representatives from Living Grace Assisted Living included Jacob Reinhardt, Licensees Christine Soriano and Shelly Cha, Regional Quality Assurance/Performance Improvement Director, Ashley Sylve, Regional Health and Wellness Director, Carolyn Appeal, Director of Special Projects, Marlene Bremer, Balance Assisted Living Administrator, Rachelle Reyes, Facility Designated Administrator Farial Shokoor, Assisted Living Waiver Coordinator, Caroline Easton, and Ombudsman, Ron Carrera. Current census of this facility was 60. There are 27 residents on the Assisted Living Waiver Program. During this meeting it was discussed regarding current trends pertaining to a subsequent facility, Legacy Oaks of Sacramento. The following topics were discussed during the informal conference: · Reporting Requirements · Delayed Egress · Medication · Personal Rights · Facility in disrepair It was acknowledged that while Living Grace Assisted Living and Memory Care may not exhibit specific areas of concern at this time, it is expected that consistent practices and procedures are maintained across all facilities. The facility will do the following to achieve compliance: · Provide an updated plan of operation to reflect operational standards throughout all facilities highlighting the topics discussed. The regional office will do the following: Continue to collaborate and provide assistance to licensee as needed Licensees were offered and agreed to an opportunity to participate in Department's Technical support Program. These actions are not punitive, but collaborative as ways to improve on areas of concern are addressed. Per California Code of Regulations (CCR) - Title 22 - no deficiencies are being cited. An exit interview was held, and a copy of the report was sent via email and certified mail. Licensee to send a signed copy to LPA Pascua.the state’s words, verbatim · CDSS document, Aug 19, 2025

Allegation investigated: Staff do not safeguard confidential resident information

On 07/08/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA met with Facility Designated Administrator (FDA), Farial Shokoor and explained the purpose of this visit. The purpose of this visit was to deliver complaint findings. Current census was 63. A brief interview with FDA Shokoor was conducted. During the course of this visit, LPA reviewed facility records and conducted interviews. It was alleged that staff do not safeguard condifidential resident information. Based on interviews conducted with facility staff it was denied that the facility does not safeguard resident information and state that they understand the rules and regulations to ensure that resident information remains private. In addition, LPA reviewed facility communication logs through an electronic system which are not accessed to outside parties of the facility. Based on the information gathered, there is not sufficient evidence to prove that the staff do not safeguard confidential resident information. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 8, 2025 · control 27-AS-20250513114757

Allegation investigated: Facility staff do not answer call buttons on a timely manner Facility staff left resident soiled for a long period of time Resident rooms are not clean and sanitary Facility staff did not wash resident's laundry

On 07/08/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA met with Facility Designated Administrator (FDA), Farial Shokoor and explained the purpose of this visit. The purpose of this visit was to deliver complaint findings. Current census was 63. A brief interview with FDA Shokoor was conducted. During the course of this visit, LPA reviewed facility records, observations and conducted interviews. Allegation: Facility staff do not answer call buttons on a timely manner. It was alleged that the facility staff are not answering resident calls for assistance timely. During the course of this investigation, LPA conducted staff and resident interviews and reviewed facility documentation. An interview with 5 staff members were conducted. 5 out 5 staff members deny not answering resident call lights in a timely manner. 5 out 5 staff members state that the staff do a good job helping each other out and will assist a resident within 5-10 minutes. Unsubstantiated An interview with 7 residents were conducted. 6 out of 7 residents report no issues with getting assistance in a reasonable time period when using their call lights. 1 out 7 residents were unable to answer the question due to medical reasons. A review of the facilities call button log from May-June 2025 show an average time of 5 minutes and 2 seconds. Based on the information gathered, it is unclear if the facility staff are not answering residents calls for assistance timely. Allegation: Facility staff left resident soiled for a long period of time It was alleged that the facility staff left residents soiled for a long period of time. During the course of this investigation, LPA Pascua conducted interviews with staff, residents and a family member. 7 of 7 residents interviewed all stated the staff assist them their needs when required, including their incontinence needs. The family member of the residents that was interviewed had no concerns regarding the care being provided at the facility. LPA Pascua conducted unannounced inspections on 3 separate occasions and did not detect incontinence odors. Based on the information gathered, there is not sufficient evidence to show that the facility staff left the resident soiled for a long period of time. Allegation: Resident rooms are not clean and sanitary It was alleged that the staff does not keep the facility clean and sanitary. During the course of the investigation, LPA Pascua conducted site visits and inspected the facility on 4 occasions. No unsanitary conditions were observed. LPA Pascua also interviewed a family member, 7 residents and 5 staff members, all of whom felt the facility is maintained in a sanitary condition. In addition, a review of the faciities housekeeping log shows that a deep clean is conducted on the days that the resident is scheduled for a shower. Cleaning is conducted on a as needed basis and could be daily. Based on the information gathered, there is not sufficient evidence to prove that the resident rooms are not clean and sanitary. Allegation: Facility staff did not wash resident's laundry It was alleged that the staff does not wash resident's laundry. During the course of the investigation, LPA Pascua conducted interviews and reviewed facility records. Based on interview with staff conducted revealed that each residents laundry is conducted once a week or as needed. Interviews with 5 residents disclose that they do not have any issues with their laundry services and are conducted as highlighted in their care plan. A review of the facilities laundry schedule confirms this statement. Based on the information gathered, there is not sufficient evidence to prove that the facility staff do not wash resident's laundry. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. An exit interview was conducted and a copy of this report were provided to the facility at the end of this visit.the state’s words, verbatim · CDSS document, Jul 8, 2025 · control 27-AS-20250610090810

Allegation investigated: Staff does not ensure to follow doctor's prescription orders. Staff do not ensure outside patio is clean and free of debris.

On 07/08/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to deliver complaint findings. LPA met with Facility Designated Administrator (FDA), Farial Shokoor and explained the purpose of this visit. The purpose of this visit was to deliver complaint findings. Current census was 63. A brief interview with FDA Shokoor was conducted. During the course of this visit, LPA reviewed facility records, observations and conducted interviews. Allegation: Staff does not ensure to follow doctor's prescription orders It was alleged that staff does not ensure to follow doctor's prescription orders. During the course of this LPA reviewed facility records and conducted interviews. Based on interviews conducted, it was determined that Resident 1 (R1) has a prescription for a laxative to be administered every Monday, Wednesday, and Friday morning at a dosage of 17 mg for constipation. Unsubstantiated All staff members denied that the medication was not administered according to the physician’s order. The prescription specifies that 17 mg of the medication must be mixed with 4 to 8 ounces of water prior to administration. The Licensing Program Analyst (LPA) discussed and observed the process of how the medication is to be administered. During the observation, staff demonstrated that the medication is measured up to the 17 mg line on the cap and then mixed with water as instructed. A review of R1’s Medication Administration Record (MAR) confirmed that the laxative was administered as prescribed. Additionally, bowel movement logs showed that R1 experienced regular daily bowel movements. In a follow-up interview, facility management acknowledged that medication technicians were not using a full capful but confirmed that the dosage provided still met the prescribed 17 mg. Based on the information gathered, there is not sufficient evidence to prove that staff did not provide medication as directed. Allegation: Staff do not ensure outside patio is clean and free of debris. It was alleged that staff do not ensure outside patio is clean and free of debris. During the course of this investigation, LPA conducted observations of the outdoor patios on 04/22/2025 and 05/22/2025. During the visit conducted on 04/22/2025, LPA Pascua observed the patio adjacent to the main dining room in the main building was found to be littered with tree debris, including pine needle-like droppings and small, circular fruits approximately half an inch in diameter. However, on 05/22/2025 and 06/13/2025, subsequent visit was conducted by the LPA who observed that the patio areas were free of debris. Based on the information gathered, there is not sufficient evidence to prove that the staff did not ensure the outside patio was clean and free of debris. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. An exit interview was conducted and a copy of this report and appeals rights were provided to the facility at the end of this visit.the state’s words, verbatim · CDSS document, Jul 8, 2025 · control 27-AS-20250515142650

Type of visit: Prelicensing

On 04/22/2025, Licensing Program Anaysts (LPAs) Arielle Pascua and Triel Lindstrom arrived announced to this facility to conduct a Pre-Licensing visit. LPAs met with applicant, Christine Soriano and explained the purpose of the visit. Present at this visit was Facility Designated Administrator (FDA), Marlene Bremer, Regional Nurse, Carolyn Appeal, Business Office Director (BOD), Farial Shokoor, and Facility Designated Representative (FDR), Jessica Moreno. The purpose of this Pre-Licensing visit was due to a change of ownership. This facility current has residents in care. This prospective facility will serve and retain up to 88 elderly residents, of whom may be 83 non-ambulatory, and 5 bedridden residents. There is a fire clearance for bedridden residents in rooms #1,#2,#20, and #21 in the main building. The 5th bedridden bedroom is located in bedroom #41 which is housed in a separate building. Current census was 57. A brief interview with Applicant Soriano was conducted. A tour of the facility was conducted. This facility is all memory care, Delayed egress and other safety measures were observed to be functional at this time. All rooms designated as activity areas and common areas for resident use were toured. Furniture and furnishings were observed to be present and sufficient to meet the needs of the residents at this time. Office rooms and other areas intended for resident use were toured. Hot water temperatures were taken to make sure that the hot water being dispensed was within the allowed range of 105-120 degrees at this time. Fire extinguishers, placed throughout this facility, were observed to have been annually inspected on 02/14/2025 by the local fire extinguisher company, Annual Fire Company, and in compliance at this time. Kitchen area was toured. Facility freezer and refrigerator units were toured. LPAs reviewed the food storage supply to make sure that there was always a 2-day perishable and 7-day nonperishable food quantities on site at all times. Storage area for chemicals and cleaning supplies was observed to be locked and made inaccessible to the residents at this time. A tour of the facility resident bedrooms was conducted. Furniture and furnishings were observed to sufficient and able to meet the needs of the residents at this time. A review of the resident restrooms was conducted. Hot water temperatures were taken to make sure that they were within the allowed range of 105-120 degrees. 2 Medication rooms were reviewed and the policies for dispensing, storing, and documentation was discussed with facility staff responsible for the medication management at this time. This facility will be using an Electronic Medication Administration System. First aid kit was observed to be present and contained all of the required components at this time. Exterior grounds of this facility was toured. Perimeter fence and gates were observed to be functional and in good repair at this time. Call light and alarm systems such as smoke detectors and carbon monoxide were observed to be in working condition at this time. Emergency disaster plan was discussed. This facility houses a generator. This facility has been observed to be in compliance at this time. Due to the observations made during this Pre-Licensing visit, the applicant has passed this Pre-Licensing component. Comp III was waived at this time. An exit interview conducted and a copy of this report was provided to the facility and the applicant.the state’s words, verbatim · CDSS document, Apr 22, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 88 Census (if any clients in care): 52 COMP II Participants: Marlene Bremer (Administrator), Shelly Cha (CEO), Christine Soriano (Managing Member) Interview Method: Virtual interview via Microsoft Teams On March 13, 2025, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Mar 13, 2025