Merrill Gardens at Willow Glen

Allegation investigated: Facility charging services not stated on the admission agreement.

Licensing Program (LPA) Analyst Marcela Yanez conducted an unannounced complaint investigation visit to deliver findings. LPA announced the purpose of the visit and met with Brittnay Leonard, Memory Care Director MCD and Eva Reiter, Resident Care Director RCD, GM was not in the office. On January 2, 2026, the department received a complaint with the allegation that the Facility was charging for services not stated on the admission agreement. On 01/08/26 LPA Yanez conducted an initial 10-day complaint investigation visit and a continued complaint visit on 02/25/26. LPA reviewed residents file, admissions agreement, level of care plan, resident progress notes, change in service agreement, and billing ledger. Page 1 of 2 Unsubstantiated Page 2 of 2 During the investigation the department interviewed General Manager (GM) and 1 staff. Resident (R1) moved into facility on 01/29/21 and entered into agreement with a signed admissions agreement. When R1 moved into the facility he/she had a level 5 care, then on 05/24/21 it increased to level 6 then was lowered to level 2 on 8/25/21. On 10/22/21 R1 was credited for level 6 care for $6461.08 for previous months when level 2 care was to be applied. R1 was charged for level 2 care for $3341.94 on 10/22/21. On 03/17/23 R1 had an increase in level of care status to level 3 until 06/26/23 when it was reduced to level 1 care. R1s level of care increased again on 10/12/23 to level 6 until it was reduced to level 2 on 11/01/23. GM stated that R1s level of care was documented and signed every time R1 had an increase in level of care and placed in residents file. R1 also signed every level of care plan change. GM stated R1 was notified every time the level of care increased or decreased. GM stated per facility policy every level of care change is documented and signed by the GM and the Resident. LPA Yanez reviewed R1s ledger and verified all charges on the ledger were agreed upon when R1 entered into an admissions agreement dated 01/29/21. R1 was charged and credited accordingly for services when there was an increase or decrease in level of care. On 02/10/26 R1 became in agreement with the facility to pay a total final balance of $9006.10 after the facility gave a credit of $1500.00 as a courtesy to settle the final bill. Based on documentation R1 received services he/she agreed upon and paid for according to the admissions agreement. On 04/09/26 the department has completed its investigation. Based on investigation, interviews conducted, and records reviewed, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. This report was reviewed with MCD and RCD, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 9, 2026 · control 26-AS-20260102141149

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Case Management - Other visit to deliver an amended report to the facility. LPA met with Administrator, Ida Gemignani and stated the purpose of the visit. During visit, LPA Rai provided a copy of the original and amended report from 3/10/2026 visit was provided for Administrator, Ida Gemignani to review and sign the amended report. LPAs reviewed the Plan of Correction submitted on 03/17/2026. Administrator Ida submitted a Letter of Understanding the regulations and provided training to staff on 03/10/2026 regarding e-call system and procedures. During visit, LPAs provided letter of the Deficiency Citations cleared. This report was reviewed with Administrator, Ida Gemignani and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 24, 2026

Allegation investigated: Staff do not ensure residents’ call buttons are answered in a timely manner.

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced visit to conclude the complaint investigation. LPA Rai met with the Administrator, Ida Gemignani-Stearns and stated the purpose of today’s visit. The complaint investigation closed on January 9th, 2026 is being amended due to new information provided to the Department. On 7/21/2025, the Department received a complaint with the above allegations. On 7/29/2025, the Department conducted an initial investigation at the facility. On 7/29/2025, the Department interviewed six staff (S1-S6). One out of six staff does not work with residents with call buttons/pendants and does not have information about call button/pendants response times. Two out of five staff stated there have been issues with the sensors, but the battery or resident’s call button/pendant will be replaced. Continuation on LIC 9099-C, Page 1 of 2. Substantiated Page 2 of 2. Three out of five staff stated there are issues with system not clearing the resident’s call button/pendent which will be documented on the call button/pendent report as not answered. Two out of five staff stated there have been issues where residents pushed the call button and the notification is not logged into the system. Three out of five staff stated there haven’t been issues with responding to residents in a timely manner but they are aware that emergencies do exist like responding to a medical intervention or paramedics reporting to the facility which will delay in responding to resident’s call button. Five out of five staff stated the staff will routinely check on the residents throughout the day, so they are able to address their concerns in a timely manner without relying on the call button/pendent. On 8/19/2025, the Department interviewed three residents (R1-R3). Two out of three residents refused to be interviewed. Resident (R2) stated there are no issues with staff responding to the resident’s call buttons. R2 stated he/she knows how to use the call button pendant and stated the staff will respond within approximately 10 minutes. During the interview, R2 pressed the call button, and LPA Rai observed the response time as 9 minutes, within 10 minutes time frame. Based on review of the response times of call bell pendants for the month of July 2025, the average wait time was within 20 minutes, from when the call button/pendant was pressed to when the call button/pendant was cleared. Based on interviews conducted of the 9 residents whose wait time on average was over 20 minutes, 5 out of 9 residents had moved out of the facility during the investigation. LPA Rai interviewed 4 residents (R4-R7) and 4 out of 4 residents stated there were issues of call buttons being answered over 20 minutes in July 2025 wherein the residents required assistance with ADLs and not medical assistance. All 4 residents stated there were issues with staff not responding to the call bell pendents for over 20 minutes but the staff have improved and they are answering the call bell/pendents more quickly. LPA Rai reviewed no requirement stated in the facility’s Admissions Agreement or Resident Handbook in regard to staff response time for resident’s call buttons/pendent. Based on interviews and observation/inspection of the facility, the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Administrator and a copy of the report was provided. Appeal Rights was provided. Page 2 of 2. Six out of six staff stated the managing director did come to the facility and covered the shift. Three out of six staff members were aware there were two managing directors on the floor administering medications. Three out of six staff members stated there was a delay in residents receiving medication, but they received the medication before 11am on 7/27/2025. On 8/19/2025, the Department interviewed three residents (R1-R3). Two out of three residents refused to be interviewed. Resident (R2) stated there were no issues with medications, including the medications given on 7/27/2025. R2 stated the staff will come back if R2 is busy receiving the medication. Based on review of facility’s Program Plan on Medication Management, page 12 out of 16 states medication should be distributed based on prescriber orders. LPA Rai reviewed no requirement stated in the facility’s Admissions Agreement or Resident Handbook in regard to time response for distributing medications. Based on review of the Time Variance Report at 5 random residents Medication Administration, LPA Rai reviewed the medication administered on 7/27/2025. LPA Rai reviewed managing director’s signature on administering the mediations on 7/27/2025 to the residents and note was made that the medication was given but was charted late on the resident’s file. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Administrator, Ida Gemignani-Stearns and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 10, 2026 · control 26-AS-20250721092014

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411 · Plan of correction due date: Mar 17, 2026

87411 Personnel Requirements General -Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This was not met as evidence by: Based upon review of staff emergency call button system it was found that month of July 2025, the average wait time was within 20 minutes, from when the call button/pendant was pressed to when the call button/pendant was cleared which poses/posed a potential health, safety or personal rights risk tothe state’s words, verbatim · CDSS document, Mar 10, 2026

Plan of correction: Administrator stated to provide a written plan of action understanding regulation and will ensure call button system is reviewed in a timely manner and all active call button/pendant are addressed in timely manner. Administrator will submit staff training once completed directly to LPA. (cont') persons in care.

Allegation investigated: Staff did not prevent resident from developing a pressure injury Staff do not ensure that resident's toileting needs are met Staff do not ensure that resident has clean bedding Licensee did not ensure staff dispensing medication to residents were appropriately trained

On 02/25/26 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit. LPA announced the purpose of the visit and met with Ida Gemignani-Sterns, General Manager (GM). LPA interviewed GM. On 08/18/25 the department received a complaint with the allegations of Staff did not prevent resident from developing a pressure injury, Staff do not ensure that resident's toileting needs are met, Staff do not ensure that resident has clean bedding, and Licensee did not ensure staff dispensing medication to residents were appropriately trained. On 09/29/26 LPA Yanez conducted a complaint investigation visit During visit LPA requested copies of hospice notes, medication orders, Emergency contact information, Hospice log sheet, Visit log, and email communication. LPA interviewed 8 staff and 2 residents. Page 1 of 3 Unsubstantiated Hospice care plan and progress notes stated that the facility monitored R1 every two hours and repositioned R1 every hour. Hospice staff also visited 2–3 times a week. Facility staff would also check on R1 every 2 to 3 hours for incontinence care. During visits by hospice care staff, R1 was cleaned after a bowel movement. R1 was not left in soiled briefs when hospice care staff visited. 8 out of 8 staff stated that the facility staff checked on residents with incontinence care every 2 hours and that the residents who are bedridden are repositioned every hour. 3 out of 8 staff stated that any resident on hospice services has hospice care staff visit 2 to 3 times a week and has Hospice caregivers visit and sit with resident 2 to 3 times a week. GM stated that the staff followed R1s care plan and R1 was repositioned every hour and briefs changed every 2 to 3 hours. 1 out 8 staff stated that the R1s responsible party placed a white board in R1s room and wanted the date and time written when R1 was changed or when a caregiver entered the room and what services were done. S1 stated that Witness (W1) also took a lot of pictures and asked staff questions regarding policy and procedure. S7 stated that the facility was in constant communication with W1 about the care R1 was being provided. S7 stated W1 wanted to have more transparency regarding R1s care and have documentation provided when services were done. S7 accommodated W1s request anytime he/she questioned R1s care that was being provided by staff and hospice services. W1 and POA of R1 had a meeting with Memory care director, hospice services and GM on 09/02/25 where R1s care was discussed and any concerns were addressed at that time. On August 18, 2025 Hospice notes states for facility staff to monitor R1s heels that showed redness. On 10/10/25 LPA Yanez conducted another complaint investigation visit and interviewed 5 residents. LPA toured random rooms and observed beds with clean sheets and residents rooms to be clean. LPA obtained Medication Technician training records which showed Medication Technicians are trained prior to dispensing medication. S5 stated the staff are trained on the computer and then will shadow the medication technician to get hands on training and are not left alone to dispense medication without competency exam. Page 2 of 3 Page 3 of 3 LPA interviewed Staff S4 who stated he/she provided medication on time and does not give any type of injections to residents. S4 stated residents’ medication is ordered and given to them according to doctor’s order. S4 states the only injection medication is in liquid form that is packaged and pre-filled and given to residents orally. GM stated that the Medication Technicians are trained via Brainer and provided a copy of training and are not left alone until they pass a competency exam. S7 stated that the facility changes the resident’s sheets at least once per week or more if the resident’s sheets get soiled. S7 stated that R1s sheets were changed every 2 or 3 days and more often if R1 soiled the sheets. S7 stated that R1 wanted to eat without staff assistance and he/she would soil their sheets and the sheets were changed more often than usual approximately 2 to 3 times a day. 5 out of 5 residents stated that the facility staff maintains their rooms clean and sanitary by conducting housekeeping visits every week. 5 out of 5 residents stated that the facility staff will come and help them with toileting and changing if necessary. 1 out of 5 residents stated he/she has a hospice caregiver that visits a few days a week and assists with Activities of Daily Living (ADLs). On 02/25/26 the department has concluded its investigation. Based on observations, interviews conducted and records reviewed, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur. No citations noted at today’s compliant investigation visit. Exit interview conducted with Ida Gemignani-Sterns. This report was provided to review and for signature. A copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 25, 2026 · control 26-AS-20250818163511

Allegation investigated: Staff do not ensure facility is kept free from pests for residents in care. Staff do not ensure residents are kept free from being malodorous.

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced visit to deliver the findings of the complaint received by the Department on 09/02/2025. LPA met with administrator/general manager (ADM/GM) Ida Gemignani-Stearns and stated the purpose of the visit. The investigation included physical inspections, interviews with residents, staff, and hospice personnel, and review of submitted evidence. On 09/05/25, the Department inspected five memory care rooms (R1–R5) with ADM present, checking floors, bathrooms, walls, and areas around beds for pests. No ants or foul odors were observed. During the visit, staff were serving snacks to ambulatory residents, and one resident was having a meal in their room assisted by a staff. page 1 of 3 - see LIC 9099C Unsubstantiated During the visit on 09/05/25, LPA interviewed 5 residents (R1 to R5) in memory care and 3 out of 5 residents stated they have not seen or experienced ants crawling on them, nor have they seen an infestation of ants in their room. 2 Out of 5 were asleep and resting at the time of the visit and could not be interviewed. All other residents were busy with the activity at the time of the visit. On 09/09/25, the Department interviewed Witness 1 (W1) by phone. W1 stated he /she is an independent advocate for residents, not affiliated with Long Term Care Ombudsman (LTCO), any non-profit organization, church, or the facility. W1 is a friend of Resident 1 (R1) and does not hold power of attorney (POA). Witness 1 (W1) stated that on 09/02/25 at about 07:15, he/she visited R1 and found a “huge trail of ants” around the bathroom sink. W1 cleaned the area and notified staff. Around 07:25, hospice arrived, and W1 helped wake R1. W1 noticed a foul odor (feces) and ants along the wall. W1 cleaned ants with Windex and paper towels, removed R1’s sheet, and saw ants starting on the bed. W1 attempted to take a photo but it was unclear. Ants were on the sheet and bed chucks according to W1, and ants were attracted to feces that staff had not cleaned, as stated by W1. Based on video clips sent to the department by W1, ants can be seen on the video clip and 1 (one) ant on the leg of a person, there was 1 (one) ant on the bed sheet crawling and several ants on the base of a wall. Several ants on the bathroom sink can also be seen. Which according to W1 was expeditiously cleaned and eliminated. On 10/07/25, the Department continued with the investigation and interviewed staff 1 to 3 (S1 to S3), Administrator (ADM) and hospice care staff (HCS). ADM stated R1 recently passed away with R1s POA and W1 at bedside. R1 was moved to memory care due to declining health, hospice was initiated by medical providers and per POLST the primary goal is comfort focus treatment signed by the POA. ADM confirmed staff addressed ants reported in R1’s room. page 2 of 3 HCS stated that the facility monitored R1 every two hours. HCS visited 2–3 times weekly, with a Home Health Aide (HHA) staff also involved. During visits, R1 was attended to, and no ants were observed on bedding or body. R1 received hospice comfort care due to end-of-life status. On one occasion, staff promptly cleaned R1 after a bowel movement. HCS stated R1 was not left in soiled conditions during visits. Photos submitted by W1 to HCS showed no ants. R1 remained alert and able to express needs. S1, S2, and S3 confirmed ants were only found in a room near the kitchen due to stored chocolates; the area was cleaned and fumigated, and no ants were observed in R1’s room, bedding, or body. Staff reposition R1 every 1.5–2 hours, conduct rounds every 45 minutes, and change incontinence products regularly, documenting each change. R1 was not left soiled. Staff stated that W1 visits around 7:00 a.m., and closes the door of R1s room. Staff stated that W1 can call staff anytime R1 needs cleaning or changing. Housekeeping addressed W1’s ant report cleaned and treated the area. The memory care unit was odor-free, and staff responded to hygiene needs. Based on document review, the facility is non-medical. Hospice care and a home health aide were ordered by R1’s medical providers focusing on comfort care. Due to declining health. R1 was transferred from Assisted Living to the Memory Care unit for a higher level of care. On 12/04/25, LPA conducted a second inspection of the memory care unit, including rooms #1, 5, 9, and 10, bathrooms, shower areas, walls, floors, storage, and beds. No foul odor was detected. The exterior perimeter was clear of ants and trash. The kitchen was sanitary and organized, with no ants observed on counters, floors, or cabinets. Based on maintenance records the facility has a contract with Banner Pest Services. The company conducts fumigation each month as a preventive measure or extra services if needed. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations(s) did or did not occur, therefore the allegations are unsubstantiated. No deficiencies were cited during today's visit based on CCR Title 22. An exit interview was conducted with ADM/GM Ida Gemignani-Stearns. A copy of the report was provided. page 3 of 3 end of reportthe state’s words, verbatim · CDSS document, Jan 6, 2026 · control 26-AS-20250902112832

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced case management - annual continuation for the required 1 year inspection and met with General Manager Ida Stearns and stated the purpose of the visit. Physical inspection was conducted and completed on 11/26/2025. Today's inspection, 12/04/2025 is for file and record review. LPA reviewed 6 staff record and 10 resident records. Based on record review 10 out of 10 resident file record are complete and up to date including but not limited to the centrally stored medication and destruction record (CSMDR), Admission agreement, Physician's report (LIC 602), appraisal needs and services plan (LIC 625) and personal rights. Based on record review 6 Out of 6 staff have cleared fingerprint and criminal background. 6 Out 6 have the required training according to their duties and responsibilities. 6 out of 6 have were given emergency and disaster training and 1st/aid CPR for 5 out of 6 staff. A technical assistance to keep records updated was provided to ensure that all records are complete when file is reviewed by CCLD during inspections. No citations were issued during today's visit based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with General Manager, Ida Stearns and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 4, 2025

Allegation investigated: Facility did not notify CCL within 5 days of the initiation of hospice care.

On 12/01/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit to deliver findings and met with Ida Gemignani-Stearns. LPA announced the purpose of the visit. On 10/11/24 the department received a complaint with the above allegation During the investigation the department interviewed 5 staff. 5 out of 5 staff stated that the department reports special incidents to the department within 7 days and notification of hospice services within 5 days. 1 out of 5 staff stated that the facility had issues with their fax machine in the month of December 2024 and January 2025 where faxes were taking up to an hour to transmit. The facility could not provide documentation informing the department of R1s admittance to Hospice services on 09/06/24. Page 1 of 2 Substantiated Page 2 of 2 On 12/01/25 the department completed its investigation and determined the facility did not submit a hospice notification for R1 who began hospice services on 09/06/24. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Citations noted today. Please see LIC9099-D. Exit interview was conducted with Ida Gemignani-Stearns, ADM. A copy of the report and appeals rights were provided.the state’s words, verbatim · CDSS document, Dec 1, 2025 · control 26-AS-20241011112030

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87632(d)(2) · Plan of correction due date: Dec 12, 2025

87632 Hospice Care Waiver (d)(2) The licensee shall notify the Department... initiation of hospice care services... five working days of admitting a resident already receiving hospice care services... This requirement was not met as evidenced by; Based on record review and interview, facility ADM stated she did not notifiy the deparment of the initiation of hospice care services for R1. This poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 1, 2025

Plan of correction: ADM stated she will send a letter of understanding regarding the hospice waiver stipualtions, such as notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days... admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice agency. ADM stated she will send the plan of correction by POC date 12/12/25

Allegation investigated: Facility staff are not treating residents with dignity and respect. Facility staff did not to seek timely medical attention to a resident who sustained an injury resulted in death. Facility medication cart was left unattended and accessible to residents. Facility staff did not adhere to residents' medication as per physician's order. Facility did not submit an incident/death report to licensing.

On 12/01/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit to deliver the findings. LPA announced the purpose of the visit and met with Administrator (ADM) Ida Gemignani-Stearns. On 10/11/24 the department received a complaint with the above allegations. On 10/14/24 LPA Marrufo conducted a 10-day initial complaint investigation visit and obtained copies of pertinent resident files, staff, and facility records. On 07/11/25 LPA Yanez conducted a follow-up complaint investigation visit. LPA interviewed ADM, 3 staff and 5 residents. Page 1 of 3 Unsubstantiated Page 2 of 2 LPA obtained documents including but not limited to death report and incident report for 1 resident and reviewed Centrally Stored Medication Records for 3 residents. On 09/29/25 LPA Yanez conducted a follow up complaint investigation visit and interviewed 1 staff and obtained pertinent resident documentation. On 10/10/25 LPA Yanez conducted a follow up complaint investigation visit and interviewed 5 additional residents. During the investigation the department interviewed 10 Residents (R1-R10) and 5 Staff (S1-S5). 9 out of 10 residents stated the facility staff have not been disrespectful or rude and have always treated them with dignity and respect. 1 out of 10 residents stated that the previous facility general manager was difficult to work with. During the investigation Resident (R1s) death report was reviewed and determined resident passed away from underline ailments and the death certificate states that the residents time interval between the onset and death was listed as years. 7 out of 7 staff stated they have not seen the medication cart unattended, the only time is when a Med-Tech is handing out medication, but it is locked when left unattended. 7 out of 10 residents stated that they get there medication on time and according to doctors order. 3 out of 10 resident stated they administer their own medication. During visit LPA Yanez observed staff administering medication to residents and 2 of 2 residents visited the Medication Room to get there noon medication, and Med Tech stated residents are diligent when its time for their medication to be administered. Page 3 of 3 LPA audited 6 residents Centrally Stored Medication Record and found all medication was administered according to doctors order. During the investigation the department reviewed an incident report with R1s fall dated 10/01/24 and fax cover sheet stating 3 pages that were faxed to the department on 10/01/24. On 12/01/25 the department has completed its investigation and found the above allegations Based on these observations, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time. This report was reviewed with ADM Ida Gemignani-Stearns and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 1, 2025 · control 26-AS-20241011112030

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted and unannounced Required 1-year inspection. LPA was met by General Manager (GM) Ida Stearns and stated the purpose of the visit. The facility serves adults age 60 and over, 150 non-ambulatory, hospice waiver for 15 and 15 bedridden. LPA toured the exterior and interior of the facility, including entryway, activity area, dining area, kitchen, food storage, laundry room, resident apartments, medication room for the Assisted Living and Memory Care area of the facility. LPA observed the emergency exits were free from obstruction, the memory care unit has a delayed egress and audible alarms. The outdoor areas were kept free from debris and tripping hazard. The exterior walkways were free from obstructions. The facility has 4 floors and LPA observed the elevator to be in good working condition, emergency exits were free from any obstruction and interior hallways were free from any tripping hazard. Residents room were organized and kept sanitary, equipped with emergency alarm with the pull cord and the equipped with Safely You electronic monitoring system. LPA observed that facility posted activity calendar for the whole month at the hallways and smaller version of the calendar is distributed to the residents. LPA observed fire extinguisher strategically placed in each floor. The system is equipped with water sprinklers. page 1 of 2 see LIC 809-C The medication room is locked and accessed only by authorized employees, the room is not accessible to residents and unauthorized staff. The prep kitchen is located below the 1st floor and the serving kitchen is on the first floor. The dining area for the assisted and independent living were clean and sanitary. The memory care unit has a community style table and a serving kitchen. No knives, sharps or chemicals were observed at inside the memory care unit. LPA inspected the facility dry food storage and observed 7 days of non-perishable food supply. LPA inspected the walk in refrigerator and freezer and observed 2 days of perishable food items. LPA inspected 9 resident apartments and observed to be sanitary and organized for the assisted living area and the memory care unit. Due to time constraint this annual inspection will be continued at a later date. No deficiency was cited during today's annual required visit. An exit interview was conducted with General Manager Ida Stearns and a copy of the report was provided. Page 2 of 2 End of Reportthe state’s words, verbatim · CDSS document, Nov 26, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct a case management – incident visit. The purpose of this visit is to deliver the final report on a case management that was initiated on 09/19/2025 regarding a death report received on 08/12/2025 for former resident (R1). LPA met with General Manager, Ida Gemignani-Stearns. On 08/12/2025, the Department received a death report stating that on 08/11/2025 at approximately 09:30am, a staff went to give R1 medications and found R1 unresponsive. In the report, it was stated that the resident was noted to have some confusion on 08/08/2025 and 911 was called but resident refused to be transferred for further evaluation. 4 staff members were interviewed. Based on staff interview, R1 was not under hospice care and resided in assisted living. R1 was only receiving medication management and housekeeping once a week but was independent for other care needs. According to the staff, the last time R1 was checked was during the night before his/her passing during bedtime medication pass. Since R1 wasn't a resident who required care, staff were not required to check R1 throughout the night unless R1 called for assistance. Staff members who observed R1 that night before his/her passing did not report anything unusual with R1’s condition. R1’s responsible party was interviewed. Based on the interview, it was stated that R1 had many health conditions which may have contributed to his/her passing. It was stated that leading up to R1’s passing, R1 was already not feeling well but refused to go to the hospital. Page 1 of 2. R1’s responsible party stated that the facility responded right away and called 911 upon discovering R1. R1’s cause of death is unknown at this time but R1’s responsible party does not feel there was any foul play or neglect from the facility. Based on record review, R1 had multiple health conditions. Facility staff noted the observation of R1 not feeling well on 08/07/2025. Staff tested R1 for COVID and the results were negative. R1 did not report any pain. The review of records show that R1 was monitored the next day and no changes of condition was noted. Based on R1’s care plan, R1 did not require any assistance with activities of daily living to include bathing, dressing, grooming, transferring and toileting. Based on R1’s responsible party, the cause of death based on the certificate is unknown as of 09/19/2025. No further follow-up needed at this time, unless new information is presented in the future that warrants this case to be re-opened. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with General Manager, Ida Gemignani-Stearns and a copy of the report was provided. Page 2 of 2.the state’s words, verbatim · CDSS document, Oct 8, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct a case management – incident visit. LPA met with General Manager, Ida Gemignani-Stearns. The purpose of the visit is to follow-up on a death report that Department received on 08/12/2025 regarding a former resident (R1). During visit, documents were obtained to include R1’s face sheet, service plan dated 02/18/2025, progress notes, and staff schedule from August 2025. A witness and 2 staff members were interviewed. This case management will be kept open pending further investigation. This report was reviewed with General Manager, Ida Gemignani-Stearns and a copy of the report was emailed to the GM due to technical difficulties.the state’s words, verbatim · CDSS document, Sep 19, 2025

Allegation investigated: Facility staff did not properly store resident's medication.

On 8/6/2025, LPA Grace Donato conducted an unannounced complaint investigation visit. LPA met with General Manager Ida Gemigani and explained the purpose of this visit. Regarding the allegation of Facility staff did not properly store resident's medication, Reporting party (RP) stated that a Med Tech (S3) recently provided resident (R1) with insulin pen for self-administration. After R1 completed the injection, S3 reportedly took the insulin pen and put it in his/her pocket before going to provide medication to another resident (R2). The next day, another Med Tech (S2) found the insulin pen on the floor of R2s, which the RP stated likely fell out of S3s pocket while assisting R2. The RP emphasized that S3 should have returned the pen to the medication cart instead of keeping it in his/her pocket. page 1 of 2 Substantiated LPA interviewed staff members. S1 mentioned that the insulin pen was given to him/her by S2 so that it will be endorsed to S3. S2 stated that during a shift, does not remember exactly when, the insulin pen was not in the med room but remembers that there was still enough shots in the pen. S2 asked S3 where the pen is and S2 mentioned that it might have fallen from his/her pocket. S2 found the insulin pen in R2s room when he/she was giving eye drops to the resident. Based on interviews, the above allegation is determined to be SUBSTANTIATED. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiency may result in civil penalties. Report is reviewed and copy of report and appeals rights are provided. page 2 of 2the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 26-AS-20250513090207

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Aug 7, 2025

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This was not met as evidenced by: Based on interviews, S2 mentioned an insulin pen, medication for R1 was found in R2s room, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2025

Plan of correction: Licensee shall conduct training with med-techs to ensure all prescribed medications are locked in place. Licensee to submit proof of in-service training to LPA by POC deadline.

Allegation investigated: Facility has cockroaches in resident room.

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator Ida Gemignani-stearns. On February 13, 2024, the Department received a complaint alleging Facility has cockroaches in resident room. On December 15, 2023, LPA Christine Dolores interviewed resident R1-R5. R1 stated he/she has observed cockroaches and fruit flies inside his/her apartment. R2-R5 stated they haven’t seen pests in their apartment. LPA Dolores interviewed staff S2-S5. Staff S2 & S4 stated they have not seen pests in residents bedrooms. Staff S3 stated resident R1’s bedroom sometimes has cockroaches. S5 stated 4 resident bedrooms have cockroaches. Page 1 Out of 3. Substantiated On May 8, 2024, LPA Simi Rai interviewed Former administrator Will Carter, referred to as S1. S1 stated he/she has reached out to Orkin since facility has an existing contract. S1 stated they have used Orkin to thoroughly cleaning of resident's apartment. S1 stated cockroaches will come back after treatment since resident leaves food out in the room. S1 stated Orkin has been 4 times for R1’s bedroom. S1 stated R1 has allowed housekeeping to come once a week to clean his/her room and he/she has not refused any service. LPA Rai interviewed facility Maintenance Director (MD) Ollie Moor Jr. MD stated the pests issues have been ongoing for a year. MD stated the facility staff always clean R1’s room and the pest control folks go into R1’s room for treatment. MD stated R1 leaves food around and had conversations about leaving food around. MD stated there is regular housekeeping once a week. MD stated they will clean the room further so the issue isn't persistent, but the issue are the days that housekeeping doesn't come into the room. LPA Rai interviewed staff S6. S6 stated there has been a long-standing issue with roaches in R1’s apartment. S6 stated R1 has not refused to have housekeeping come in the room. S1 stated there always is a bag of candy and there are always wrappers near R1’s wheelchair on the floor so the sweet candy is attracts the cockroaches. On May 28, 2025, LPA Manuel Monter interviewed residents R6-R12. Residents R6-R12 stated they haven’t seen cockroaches or pests in the facility. LPA Monter interviewed ADM. ADM stated R1’s room had cockroaches, but she hasn’t seen them. ADM stated the facility has had exterminators come out to address the issue. On May 28 and June 6, 2025 LPA Manuel Monter interviewed staff S7-S11. S7 stated he/she hasn’t seen any pests inside the facility. S8 stated he/she has seen many cockroaches and ants in the kitchen. S9 stated he/she has observed ants in the memory care kitchen. S10 stated he/she has seen cockroaches in R1’s bedroom and a bedroom adjacent to R1’s bedroom. S11 stated he/she observed cockroaches in the memory care unit. S11 stated she has brought up this issue to management, but management has not addressed it. S12 stated there was a report in November 2024, that the memory care unit of the facility had cockroaches. S12 stated they have hired pest control, which addressed the issue. Page 2 Out of 3. On July 11, 2025, LPA Manuel Monter interviewed Staff S1. S1 stated due to R1’s condition R1 had difficulty cleaning up for him/herself. S1 stated R1 did not have any behaviors that would cause his/her bedroom to become dirty. S1 stated they were aware of R1’s troubles with being able to clean up for him/herself. S1 stated they also offered additional housekeeping for R1. S1 stated R1’s family member was also informed about the infestation. S1 stated R1 declined additional housekeeping services. R1 stated he/she didn’t want to pay for additional charges. S1 stated In April 2024, they did ask orkin to treat the apartment. S1 stated this was where they needed to vacate the entire apartment, and the room had to be empty for 8 hours. Based on record review, the facility has a contract with Orkin. The service agreement states, “Orkin agree to provide Pest control service (Control means the periodic eradication of existing infestations within practical limits) for control of the following pests: Roaches, ants, silverfish, rats & mice.” Based on records reviewed, the facility has invoices for Orkin services from January 2023- December 2024. Based on the investigation, although the facility maintained a contract with Orkin for regular pest control services, it did not ensure R1’s bedroom was free of cockroaches. This posed an immediate health, safety and personal rights risk to R1 and other residents in the facility. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. An initial complaint allegation on pests was received by the Department on 12/05/2023. Although this complaint investigation was found to be substantiated, the same allegation was also reported on 02/13/2024 and 04/30/2024, while the initial complaint was still under investigation. A deficiency citation was issued in response to the initial complaint; therefore, the complaints received on 02/13/2024 and 04/30/2024 are both substantiated but considered a continuation of the same pest related allegation in 12/05/2023. Page 3 Out of 3. End of Report.the state’s words, verbatim · CDSS document, Aug 4, 2025 · control 26-AS-20240213143445

Type of visit: Case Management - Other

Licensing Program Analyst Manuel Monter and Simi Rai conducted an unannounced case management to amend two Complaint investigation, LIC9099, LIC9099-C issued on July 14, 2025. LPA met with Administrator Ida Gemignani-stearns explained the purpose of the visit. The complaints (26-AS-20240430134658 & 26-AS-202402131434450) investigations closed on July 14, 2025 are being amended and the findings regarding the pest allegations are being changed to SUBSTANTIATED due to an erroneous finding on the previous report. No deficiencies cited during todays visit. This Report was reviewed with Administrator Ida Gemignani-stearns. A signed copy was provided.the state’s words, verbatim · CDSS document, Aug 4, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Simi Rai conducted a case management visit in response to information received during a complaint investigation. LPA Rai met with Administrator Ida Gemignani-Stearns and stated the purpose of today's visit. During today's visit, LPA Rai discovered resident (R1)'s medications in a locked office, outside the medication room. LPA Rai reviewed R1's facility records and did not locate the destruction log. LPA Rai interviewed 3 staff (S1-S3) regarding R1's medications. Administrator stated Resident Care Director is in charge of medication destruction and documentation and was not available during today's visit. At this time, LPA Rai determined this case management needs further investigation. This report was reviewed with Administrator Ida Gemignani-Stearns and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 29, 2025

Type of visit: POC

On July 14, 2025, Licensing Program Analyst Manuel Monter conducted an unannounced POC visit. LPA met with Administrator Ida Gemignani-Stearns.. LPA explained the purpose of the visit. On July 14, 2025, the facility was cited the following type A deficiency during a complaint investigation visit for the complaint 26-AS-20231205101721. The following code sections were cited on July 14, 2025, with a POC due date of July 15, 2025: 1. 87303 Maintenance and Operation (a) On July 24, 2025, LPA conducted a POC visit to clear the Type A POC's. LPA received a copy of the facility's plan of corrections. A copy of the Letter of Deficiencies Cleared letter was provided. No deficiencies cited during today's visit. This report was reviewed with Administrator Ida Gemignani-Stearns. and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Jul 24, 2025

Allegation investigated: Staff smoking marijuana at the facility Staff are charging residents for services not rendered

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator Ida Gemignani-stearns On December 5, 2023, the Department received a complaint alleging Staff smoking marijuana at the facility. On December 15, 2023, LPA Christine Dolores conducted the initial complaint investigation visit. LPA Dolores interviewed staff S2-S5. S2- S4 stated they have never heard or seen staff members smoking marijuana. Staff S5 stated he/she has heard about a staff member vaping but doesn’t want to get involved. Page 1 Out of 4 Unfounded LPA Dolores interviewed resident R1-R5. Residents R1-R5, stated they haven’t observed staff smoking marijuana inside the facility. On May 28, 2025, LPA Manuel Monter interviewed residents R6-R12. All residents interviewed denied stated they have never seen staff smoking/consuming drugs/ Alcohol and never seen staff working while intoxicated. LPA Monter interviewed facility ADM. ADM stated she has never seen staff smoking/consuming drugs/ Alcohol. ADM stated she has never seen staff working while intoxicated. On May 28 and June 6, 2025 LPA Manuel Monter interviewed staff S6-S11. All staff interviewed stated they have not seen staff smoking/consuming drugs/ Alcohol and never seen staff working while intoxicated. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Staff are charging residents for services not rendered On December 5, 2023, the Department received a complaint alleging Staff are charging residents for services not rendered. It has been alleged that resident R1 is being charged for services not rendered. On December 15, 2023, LPA Dolores interviewed resident R1. R1 states he/she is being charged for dressing and toileting but he/she is not receiving these services consistently. R1 states he/she does not receive these services sometimes. R1 states he’s not being billed properly. Page 2 Out of 4 LPA Dolores interviewed Staff S1. S1 stated R1 owes them for care services. S1 stated he/she doesn’t agree that they are not providing R1 services that are rendered. S1 stated R1 owes an outstanding balance and R1 has not been willing to pay the outstanding balance just pays rent and care he/she thinks he/she should be receiving. S1 stated R1 only wants to be charged for toileting services. S1 stated, previously it was dressing like compression socks that were on his/her care plan and they had to charge for those services, adding up to R1’s outstanding balance. S1 stated R1 doesn’t want to pay for showers and says he/she can do it on his/her own. S1 stated Care staff will assist him/her with showering sometimes. On February 27, 2024, the Department interviewed staff S12. S12 stated Dena stated that R1 has not paid his/her rent for the past 2 years and currently for this month of March 2024 only, owes about $11k. S12 stated the facility has reached out to R1’s family member and provided him/her the invoice ledger but never responded to them. S12 stated that the community complies to R1;s request but disagree with allegation that they are overcharging him/her for services not rendered to him/her. On May 28, 2025, LPA Manuel Monter interviewed residents R6-R12. Resident R6, R7, R12 stated he/she has been getting assistance with their ADL’s and there hasn’t been a time when they have not been assisted with their ADL’s. R8- R11 stated he/she doesn’t need assistance with their ADL’s. LPA Monter interviewed facility ADM. ADM stated the facility staff provides residents assistance with their ADL’s. ADM stated there hasn’t been an instance where a resident was neglected or didn’t receive ADL assistance. On May 28 and June 6, 2025, LPA Manuel Monter interviewed staff S6-S11. S6-S11 stated staff assist residents with their activities of daily living. S6-S11 stated there hasn’t been a time when residents haven’t been assisted with his/her ADL’s. Page 3 Out of 4 LPA Monter conducted a review of facility records (Rental/Care Fee monthly ledger) regarding resident(R1). Upon review, LPA found that R1 was admitted to the facility starting 1/27/2021. Within the first months of R1's admission to the facility, R1 had a total fee of $9730.79 with a waived community fee resulting in an updated total of $$7329.79. With the fees added the following month, R1's due amount totaled to $16,920.79. During the statement period of March 2021, R1 had only paid $6636.67 by check. The charges included (rent to end of January, February and March 2021, level of care 5, parking, pendant replacement) Since admission, R1 had an outstanding amount of fees owed to the facility. In addition, R1 would not pay the full amount from additional monthly charges. From the initial owed payment/fees, R1 had also acquired late fees and failed to pay total due amounts, which ultimately added to R1's total outstanding amount. Based upon department conducted interviews with residents there were no indications that staff were not meeting resident level of care needs. Interviews with former Executive Director (S1) and Business Office Manager (S12) indicated that R1 had been admitted to the facility in January 2021. Based upon review of R1’s payment ledger for rental and care fees, LPA found that R1 had outstanding fees owed to the facility. As a result, additional late fees accrued which increased the total amount of R1's total fees owed. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 4 Out of 4 LPA Dolores interviewed residents R1-R5. R1 stated he/she doesn’t need assistance with repositioning in bed. R2 and R4 stated they don’t need assistance with repositioning or toileting. R3 stated he/she is ambulatory and doesn’t need assistance with repositioning. R5 stated no one comes to reposition him/her. R5 stated staff comes to early to assist him/her in changing his/her cloths in the morning. R5 stated he/she has been left soiled diapers. R5 stated it can take up to an hour to get to him/her to change him/her. On May 28, 2025, LPA Manuel Monter interviewed residents R6-R12. Residents R6- R11 stated he/she hasn’t seen other residents’ bedrooms as dirty, disrepair or with foul odors. Residents R6 -R12 stated they have not seen residents who were left soiled for an extended period. R6 stated he/she does need assistance in being changed and has not had any issues. Residents R7 -R12 stated he/she doesn’t need assistance in being changed. Residents R6, R7, R12 stated they get assistance with their ADLs and there hasn’t been a time when they were not assisted with their ADL’s. Residents R8-R11 stated they don’t need assistance with their activities of daily living. LPA Monter interviewed facility ADM. ADM stated he/she has not seen any residents who were left soiled for an extended period. ADM stated staff assist resident with repositioning. ADM stated if it part of their care plan, then staff will reposition them every 2 hours or more if needed. On May 28 and June 6, 2025 LPA Manuel Monter interviewed staff S6-S11. Staff S6-S11 stated residents who need to be repositioned, are repositioned every 2 hours. Staff S6, S8, S10, S11 stated they have not found resident who were left soiled for an extended period. Staff S7 S9 stated he/she has found residents who were left soiled from the previous shift. Page 2 Out of 4. On May 28, 2025, LPA Manuel Monter toured the facility. LPA toured all the resident bedrooms in the memory care unit (1-13) and observed the bedrooms as clean and in good repair. LPA toured the following bedrooms in the assisted living section of the facility: 111, 132, 229, 219, 303, 316, 412,427. The bedrooms observed in assisted living were clean and in good repair. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Staff are not administering medication(s) to resident(s) as prescribed On December 5, 2023, the Department received a complaint alleging Staff are not administering medication(s) to resident(s) as prescribed. On December 15, 2023, LPA Christine Dolores conducted the initial complaint investigation visit. LPA Dolores interviewed staff S2-S5. Staff S2, S3 and S5 stated they doesn’t handle residents’ medications. Staff S4 stated he/she has been administering resident medications as prescribed and had no misses. LPA Dolores interviewed resident R1-R4. Resident R1, R2, R3 stated he/she handles his/her own medication. Resident R4 stated he/she gets her medications daily without any issues. On May 28, 2025, LPA Manuel Monter interviewed residents R6-R12. Residents R6, R10, R12 stated he/she has been getting his/her medication daily without any issues. Residents R7-R9, R11 stated they handle their own medication and do not need staff assistance for medication administration. LPA Monter interviewed facility ADM. ADM stated he/she residents are getting his/her medication on time. ADM stated there are no issues regarding residents getting their medication. ADM stated she is not aware of any issues or delays regarding medication administration. Page 3 Out of 4. On May 28 and June 6, 2025 LPA Manuel Monter interviewed staff S6-S11. Staff S6, S8 and S11 stated residents are getting their medications daily, per physician’s order. Staff S7 stated there has been times when medications that need to be administered in the morning were administered several hours later. S9 stated there has been times when residents didn’t get their medication or was given the incorrect medication. S10 stated he/she knows that a medtech at the facility is making medication. On July 14, 2025, LPA Monter randomly audited 4 resident medication records. The medication audit was completed by cross-referencing the residents’ medications containers with the Centrally Stored Medication log and the Medication Administration Record. As a result, LPA did not find any discrepancies on medications. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Page 4 Out of 4. On May 8, 2024, LPA Simi Rai interviewed Former administrator Will Carter, referred to as S1. S1 stated he/she has reached out to Orkin since facility has an existing contract. S1 stated they have used Orkin to thoroughly cleaning of resident's apartment. S1 stated cockroaches will come back after treatment since resident leaves food out in the room. S1 stated Orkin has been 4 times for R1’s bedroom. S1 stated R1 has allowed housekeeping to come once a week to clean his/her room and he/she has not refused any service. LPA Rai interviewed facility Maintenance Director (MD) Ollie Moor Jr. MD stated the pests issues have been ongoing for a year. MD stated the facility staff always clean R1’s room and the pest control folks go into R1’s room for treatment. MD stated R1 leaves food around and had conversations about leaving food around. MD stated there is regular housekeeping once a week. MD stated they will clean the room further so the issue isn't persistent, but the issue are the days that housekeeping doesn't come into the room. LPA Rai interviewed staff S6. S6 stated there has been a long-standing issue with roaches in R1’s apartment. S6 stated R1 has not refused to have housekeeping come in the room. S1 stated there always is a bag of candy and there are always wrappers near R1’s wheelchair on the floor so the sweet candy is attracts the cockroaches. On May 28, 2025, LPA Manuel Monter interviewed residents R6-R12. Residents R6-R12 stated they haven’t seen cockroaches or pests in the facility. LPA Monter interviewed ADM. ADM stated R1’s room had cockroaches, but she hasn’t seen them. ADM stated the facility has had exterminators come out to address the issue. On May 28 and June 6, 2025 LPA Manuel Monter interviewed staff S7-S11. S7 stated he/she hasn’t seen any pests inside the facility. S8 stated he/she has seen many cockroaches and ants in the kitchen. S9 stated he/she has observed ants in the memory care kitchen. S10 stated he/she has seen cockroaches in R1’s bedroom and a bedroom adjacent to R1’s bedroom. S11 stated he/she observed cockroaches in the memory care unit. S11 stated she has brought up this issue to management, but management has not addressed it. S12 stated there was a report in November 2024, that the memory care unit of the facility had cockroaches. S12 stated they have hired pest control, which addressed the issue. Page 2 Out of 3. On July 11, 2025, LPA Manuel Monter interviewed Staff S1. S1 stated due to R1’s condition R1 had difficulty cleaning up for him/herself. S1 stated R1 did not have any behaviors that would cause his/her bedroom to become dirty. S1 stated they were aware of R1’s troubles with being able to clean up for him/herself. S1 stated they also offered additional housekeeping for R1. S1 stated R1’s family member was also informed about the infestation. S1 stated R1 declined additional housekeeping services. R1 stated he/she didn’t want to pay for additional charges. S1 stated In April 2024, they did ask orkin to treat the apartment. S1 stated this was where they needed to vacate the entire apartment, and the room had to be empty for 8 hours. Based on record review, the facility has a contract with Orkin. The service agreement states, “Orkin agree to provide Pest control service (Control means the periodic eradication of existing infestations within practical limits) for control of the following pests: Roaches, ants, silverfish, rats & mice.” Based on records reviewed, the facility has invoices for Orkin services from January 2023- December 2024. Based on the investigation, although the facility maintained a contract with Orkin for regular pest control services, it did not ensure R1’s bedroom was free of cockroaches. This posed an immediate health, safety and personal rights risk to R1 and other residents in the facility. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC9099-D. This report was reviewed with Administrator Ida Gemignani-stearns . A copy of the report was provided. Appeal rights were provided. Page 3 Out of 3. END OF REPORTthe state’s words, verbatim · CDSS document, Jul 14, 2025 · control 26-AS-20231205101721

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Jul 15, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times… for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by; Based on record review and interview the licensee did not ensure the facility was free of cockroaches. This poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 14, 2025

Plan of correction: ADM stated she will submit a letter of understanding regarding the regulation. ADM stated she will also submit a plan of action on how to address future pest outbreaks.

Allegation investigated: Resident is not being assisted with ADLs Facility is not providing the services to meet residents needs due to lack of staffing numbers Facility has a foul urine odor Facility staff is not reporting medication errors

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator Ida Gemignani-stearns. On February 13, 2024 , the Department received a complaint alleging Resident is not being assisted with ADLs/ Facility is not providing the services to meet residents needs due to lack of staffing numbers/ Facility has a foul urine odor On February 16, 2024, LPA Simi Rai conducted the initial complaint investigation visit. LPA Rai interviewed residents R1-R3. R1-R3 stated they don’t know if they are being assisted with ADL’s. R1-R3 stated when they need help, staff help them. R1 and R3 stated they haven’t smelled a foul urine odor in his/her room. R2 stated he/she doesn’t know if there is a foul odor in his/her room. Page 1 Out of 4 Unsubstantiated LPA Rai interviewed staff Former Administrator Will Carter, referred to as S1. S1 stated their Staffing model, allows number of staff based upon care administering each care has a point value, and there is a minute value associated with the point value. S1 stated Every week the housekeeping is being provided to the residents. On May 28, 2025, LPA Manuel Monter interviewed residents R4-R11. R4-R11 stated their rooms are clean. R4-R11 stated they haven’t seen any other residents bedrooms as dirty or with foul odors. R4-R8, R10-R11 stated there is enough staff to meet the needs of the residents. R9 stated there is not enough staff to meet the needs of the residents and that there are days when the staff is short staffed. R4-R5, R10-R11 stated there hasn’t been a time when they haven’t been assisted with their ADL’s. Residents R6 - R9 stated they don’t need assistance with their ADL’s from the facility staff. LPA Monter interviewed ADM. ADM stated the facility staff provides residents assistance with their ADL’s. ADM stated there hasn’t been an instance where a resident was neglected or didn’t receive ADL assistance. ADM stated there is enough staff to meet the needs of the residents. ADM stated the staffing is based on the care levels of residents. ADM stated she hasn’t seen any residents bedroom in disrepair or with foul odors. On May 28 and June 16, 2025, LPA Monter interviewed staff S2-S8. Staff S2 -S7 stated there hasn’t been a time when resident haven’t been assisted with their ADL’s. Staff S8 stated there has been some delays. S8 stated some residents want their shower earlier. S8 stated the issue is regarding the expectations. S8 stated the facility does their best to meet them when they want. Staff S2-S7 stated she hasn’t seen any bedrooms in disrepair or with foul odors. Staff S8 stated resident bedroom as are cleaned, and if a resident asks their room to be cleaned, then staff will clean their room. Staff S2 -S7 stated there is not enough staff to meet the needs of residents. S8 stated staffing is based on the residents acuity/ Care Levels & the facility does have enough staff. Page 2 Out of 4. On May 28, 2025, LPA Monter toured the following bedrooms. Garden house bedrooms 1-13 & Assisted living bedrooms, 111, 132, 229, 219, 303, 316, 412,427. LPA observed these bedrooms as clean, and in good repair. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Facility staff is not reporting medication errors On February 13, 2024, the Department received a complaint alleging Facility staff is not reporting medication errors. On February 16, 2024, LPA Simi Rai conducted the initial complaint investigation visit. LPA Rai interviewed staff Former Administrator Will Carter, referred to as S1. S1 stated there have been issues in the past were staff did not report in a timely manner. S1 stated He filled out an incident report, Same day, same shift to say that the error had occurred. On May 28 and June 16, 2025, LPA Monter interviewed staff S2-S8. Staff S2 & S6 stated there has been medication errors in the past but doesn’t know if it was reported. Staff S3 - S5 & S7 stated facility staff is reporting medication errors. Staff S8 stated the facility policy regarding medication error is to report it to licensing, their regional nurse and discuss actions on how to prevent this from occurring. S8 stated they had heard allegations of errors not being reported. S8 stated he believes this is interpersonal conflicts between Medtech’s. LPA Monter interview ADM. ADM stated regarding medication errors, they report it to resident care director who will catch it. ADM stated they Follow reporting requirements and list why it was missed. ADM stated she hasn’t been informed about any medication errors while she has been the administrator. Page 3 Out of 4. On July 14, 2025, LPA Monter randomly audited 4 resident medication records. The medication audit was completed by cross-referencing the residents’ medications containers with the Centrally Stored Medication log and the Medication Administration Record. As a result, LPA did not find any discrepancies on medications. Based on records reviewed, the facility has reported medication errors for the year. The facility submitted 2 incident reports for medication errors in 2024. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Page 4 Out of 4. On May 28, 2025, LPA Manuel Monter interviewed residents R4-R11. All residents interviewed stated they have not observed staff working under the influence. All residents interviewed stated they have not heard staff making fun of residents. LPA Monter interviewed ADM. ADM stated he/she has never seen staff smoking/consuming drugs/ Alcohol. ADM stated he/she has never seen staff smoking marijuana in the facility. ADM stated he/she has never seen staff working while intoxicated. ADM stated he/she has not seen or heard staff making fun or ridiculing residents for their physical appearance. On May 28 and June 16, 2025, LPA Monter interviewed staff S2-S8. All staff interviewed stated they have not observed staff working under the influence. All staff interviewed stated they have not heard staff making fun of residents. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. (This Report is being amended, to change the findings for the allegation, Facility has cockroaches in resident room, from Unfounded to Substantiated, due to erroneous finding on previous report.) Page 2 Out of 4. (This Report is being amended, to change the findings for the allegation, Facility has cockroaches in resident room, from Unfounded to Substantiated, due to erroneous finding on previous report.) Page 3 Out of 4. (This Report is being amended, to change the findings for the allegation, Facility has cockroaches in resident room, from Unfounded to Substantiated, due to erroneous finding on previous report.) Page 4 Out of 4.the state’s words, verbatim · CDSS document, Jul 14, 2025 · control 26-AS-20240213143445

Allegation investigated: Staff does not ensure resident's unit is free of pest.

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Administrator Ida Gemignani-stearns. (This Report is being amended, to change the findings from Unfounded to Substantiated, due to erroneous finding on previous report.) On April 30, 2024, the Department received a complaint alleging Staff does not ensure resident's unit is free of pest. On December 15, 2023, LPA Christine Dolores interviewed resident R1-R5. R1 stated he/she has observed cockroaches and fruit flies inside his/her apartment. R2-R5 stated they haven’t seen pests in their apartment. LPA Dolores interviewed staff S2-S5. Staff S2 & S4 stated they have not seen pests in residents bedrooms. Staff S3 stated resident R1’s bedroom sometimes has cockroaches. S5 stated 4 resident bedrooms have cockroaches. Page 1 Out of 3. Substantiated On May 8, 2024, LPA Simi Rai interviewed Former administrator Will Carter, referred to as S1. S1 stated he/she has reached out to Orkin since facility has an existing contract. S1 stated they have used Orkin to thoroughly cleaning of resident's apartment. S1 stated cockroaches will come back after treatment since resident leaves food out in the room. S1 stated Orkin has been 4 times for R1’s bedroom. S1 stated R1 has allowed housekeeping to come once a week to clean his/her room and he/she has not refused any service. LPA Rai interviewed facility Maintenance Director (MD) Ollie Moor Jr. MD stated the pests issues have been ongoing for a year. MD stated the facility staff always clean R1’s room and the pest control folks go into R1’s room for treatment. MD stated R1 leaves food around and had conversations about leaving food around. MD stated there is regular housekeeping once a week. MD stated they will clean the room further so the issue isn't persistent, but the issue are the days that housekeeping doesn't come into the room. LPA Rai interviewed staff S6. S6 stated there has been a long-standing issue with roaches in R1’s apartment. S6 stated R1 has not refused to have housekeeping come in the room. S1 stated there always is a bag of candy and there are always wrappers near R1’s wheelchair on the floor so the sweet candy is attracts the cockroaches. On May 28, 2025, LPA Manuel Monter interviewed residents R6-R12. Residents R6-R12 stated they haven’t seen cockroaches or pests in the facility. LPA Monter interviewed ADM. ADM stated R1’s room had cockroaches, but she hasn’t seen them. ADM stated the facility has had exterminators come out to address the issue. On May 28 and June 6, 2025 LPA Manuel Monter interviewed staff S7-S11. S7 stated he/she hasn’t seen any pests inside the facility. S8 stated he/she has seen many cockroaches and ants in the kitchen. S9 stated he/she has observed ants in the memory care kitchen. S10 stated he/she has seen cockroaches in R1’s bedroom and a bedroom adjacent to R1’s bedroom. S11 stated he/she observed cockroaches in the memory care unit. S11 stated she has brought up this issue to management, but management has not addressed it. S12 stated there was a report in November 2024, that the memory care unit of the facility had cockroaches. S12 stated they have hired pest control, which addressed the issue. Page 2 Out of 3. On July 11, 2025, LPA Manuel Monter interviewed Staff S1. S1 stated due to R1’s condition R1 had difficulty cleaning up for him/herself. S1 stated R1 did not have any behaviors that would cause his/her bedroom to become dirty. S1 stated they were aware of R1’s troubles with being able to clean up for him/herself. S1 stated they also offered additional housekeeping for R1. S1 stated R1’s family member was also informed about the infestation. S1 stated R1 declined additional housekeeping services. R1 stated he/she didn’t want to pay for additional charges. S1 stated In April 2024, they did ask orkin to treat the apartment. S1 stated this was where they needed to vacate the entire apartment, and the room had to be empty for 8 hours. Based on record review, the facility has a contract with Orkin. The service agreement states, “Orkin agree to provide Pest control service (Control means the periodic eradication of existing infestations within practical limits) for control of the following pests: Roaches, ants, silverfish, rats & mice.” Based on records reviewed, the facility has invoices for Orkin services from January 2023- December 2024. Based on the investigation, although the facility maintained a contract with Orkin for regular pest control services, it did not ensure R1’s bedroom was free of cockroaches. This posed an immediate health, safety and personal rights risk to R1 and other residents in the facility. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. An initial complaint allegation on pests was received by the Department on 12/05/2023. Although this complaint investigation was found to be substantiated, the same allegation was also reported on 02/13/2024 and 04/30/2024, while the initial complaint was still under investigation. A deficiency citation was issued in response to the initial complaint; therefore, the complaints received on 02/13/2024 and 04/30/2024 are both substantiated but considered a continuation of the same pest related allegation in 12/05/2023. Page 3 Out of 3.the state’s words, verbatim · CDSS document, Jul 14, 2025 · control 26-AS-20240430134658

Allegation investigated: Staff physically abused resident, resulting in resident experiencing bruising Staff verbally abused client

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Administrator Ida Gemignani-Stearns. On 06/17/2025, the department received a complaint with the above allegations. On 06/17/2025, LPA Marrufo conducted an initial complaint investigation visit. On 06/19/2025, LPA Marrufo conducted an additional complaint investigation visit. On 06/13/2025, the facility submitted an Unusual Incident Report (IR) to the department. The IR stated that on 06/13/2025 at 4:00 PM, resident R1 reported to the facility Residential Care Director that on 06/11/2025 at 8:30 AM, staff S1 stated told R1 to “Shut up,” grabbed R1 by R1’s shirt collar and pulled R1 out of bed and into R1’s wheelchair, and then pushed R1 against the bathroom wall, causing R1 to experience pain to R1’s left shoulder. R1 declined to have R1’s shoulder injury evaluated. See LIC9099-C pages for more information. Page 1 of 3. Unsubstantiated During visit on 06/17/2025, LPA Marrufo conducted interviews with R1, R2 (R1’s spouse), and S1. R1 stated that S1 came into R1’s living unit around 8:20 AM on the morning of the incident. R1 stated that S1 grabbed R1 by the collar, lifted R1 from the bed, and pushed R1 into R1’s wheelchair. R1 stated to have told S1, “Stop it! Don’t do that,” while S1 was grabbing R1 by the collar. R1 stated S1 took R1 to the bathroom and put R1 on the toilet. R1 stated S1 picked up R1 by R1’s shirt and pushed R1 against the bathroom wall, hitting the grab bar that is mounted against the wall. R1 stated S1 was standing holding up R1 against the wall while standing behind R1. R1 stated that S1 has pushed R1 against the wall on other occasions and has told S1 not to push R1. R1 stated to have not reported any of S1’s prior behaviors to facility management. R1 stated S1 moved R1 into the kitchen for breakfast, and then S1 left the living unit. R2 stated that S1 had already left the living unit when R1 told R2 that S1 handled R1 roughly. R2 stated to have been in the other living room across from the bedroom when the incident occurred. R2 stated to have not heard anything that happened. R2 stated that when R1 was in the kitchen and S1 had left, R1 told R2 that S1 was very rude and grabbed R1 by the shirt. R2 stated to have seen the bruise on R1. R2 stated that R1 had a red bruise on the neck by the shoulder. R2 stated the bruise was about four finger spaces long. During interview, LPA Marrufo observed R1 and did not see any bruising on R1’s neck. During interview, S1 stated to have entered R1 and R2’s living unit between 8:00 AM to 10:00 AM on the morning of the incident. S1 stated that R1 has an injured arm, so S1 transferred S1 from the bed to the wheelchair by putting one arm under R1’s non-injured shoulder and another arm around R1’s waist to avoid injuring R1’s shoulder. S1 denied grabbing R1 by the shirt collar. S1 stated to have not pushed R1 against the bathroom wall. S1 stated to have not told R1 to “shut up.” S1 stated to have told R2 to be quiet but does not remember the exact words S1 used towards R2. LPA Marrufo conducted a telephone interview with R2 on 06/27/2025. R2 stated that S1 has never told R2 to “shut up” or be quiet. Page 2 of 3. Based on information from interviews conducted with staff, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with Administrator Ida Gemignani-Stearns and a copy of this report was provided. Page 3 of 3.the state’s words, verbatim · CDSS document, Jul 11, 2025 · control 26-AS-20250617101735

Allegation investigated: Licensee did not ensure the facility is in good repair at all times. Food of good quality was not served due to the food being served cold. Staff did not assist residents with transportation needs. Facility did not ensure the resident was accorded dignity due to the staff being rude to the resident in care. Facility did not ensure a healthful and comfortable accommodation due to the resident's toilet being too small.

On 07/11/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced visit to deliver the findings of the complaint investigation. LPA stated the purpose of the visit and met with Ida Gemignani-Stearns, General Manager. On 10/24/2024 the department received a complaint with the above allegations. On 10/31/2024, the Department conducted an unannounced initial complaint investigation visit. During the visit the Department interviewed the Administrator (ADM), and 7 staff (S1-S7) and 4 residents (R1-R4). LPAs obtained 2 Resident's Physicians Report, Appraisal and Needs and Services Plan. Page 1 of 3 Unsubstantiated Page 2 of 3 on 12/04/24 12 Residents (R1-R12) were interviewed. 12 out of 12 residents stated the staff has never treated them disrespectfully or rudely, residents have always been treated with dignity. 12 out of 12 residents stated they have never had transportation issues and that the van is always available for use when needed and that the front desk can make other transportation arrangements, when necessary and when the driver is unavailable or on vacation. 12 out of 12 residents stated, they have not missed any appointments due to no transportation. 12 out of 12 residents stated they have never had issues with food being cold, poor tasting and of low quality. During the visit LPA Fortes observed food being served and steam coming from the food when uncovered. During the investigation 6 Staff (S1-S6) were interviewed, including the Executive Director (ED). 6 out of 6 staff stated that the facility has never been in disrepair and if the residents have an issue the facility takes care of it the issue the same day. 6 out of 6 staff stated that the facility does not serve cold food and has quality control procedures to check the food 2 times prior to serving. S4 stated that if the residents want the food warmed, they will always warm it up for them. 5 out of 6 staff stated that they have never seen the staff be rude or disrespectful to the residents in care. 6 out of 6 staff stated the facility has never seen an issue with transportation and that the residence just needs to notify the front desk if they require transportation services outside the scope of the facility transportation services provided. 6 out of 6 staff interviewed stated that if the residents ask for anything the facility will always try to accommodate the residents’ needs in a timely manner, if the issue is related to a clogged sink or plugged up toilet the issue is normally resolved the same day. Page 3 of 3 ADM provided documentation of transportation services acquired during the driver’s absence from the facility. ADM also provided documentation showing when a resident’s sink was clogged and plumber fixed the issue in a timely manner. ADM stated that the clogged toilet is an immediate concern due to it being a health and safety issue. ADM stated that the facility staff needs to notify the facility administration 1 month prior to taking vacation or time off and it must be approved prior to employee taking the time off. ADM stated there was a Sunday that the facility was without a driver due to the driver calling in sick and resident’s appointments were changed. ADM stated the facility Maintenance Director had resigned and the Assistant Maintenance Director stepped in to cover while a new Maintenance Director was replaced. ADM stated that if the residents’ room is in disrepair the resident is offered an interim room while their room is repaired. On 07/11/25 General Manager (GM) Ida Gemignani was interviewed and stated all toilets are at the same height and width they are standard, Resident have the option to purchase a Riser For Seniors the facility does not provide these for health and safety reasons. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. No citations noted at today’s compliant investigation visit. Exit interview conducted with Ida Gemignani-Stearns, General Manager. This report was provided to review and for signature. A copy of this report was provided. End of Reportthe state’s words, verbatim · CDSS document, Jul 11, 2025 · control 26-AS-20241024103221

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced case management-Incident visit and met with General Manager (GM) Ida Gemignani-Stearns and Senior Resident Care Director (SRCD) Michael Lucio regarding an Incident Report (IR) submitted to the Department on 6/30/2025. LPA stated the purpose of the visit. On 6/30/2025 the Department received an IR for Resident R1 who reported financial theft on 6/26/2025 by unknown individuals. During today's visit LPA interviewed GM, SRCD and 1 resident. LPA requested additional documentation and an SOC 341 to be submitted to the Department by 5PM on 7/2/2025. No deficiencies cited during today's visit. An exit interview was conducted with SRCD Michael Lucio, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 2, 2025

Allegation investigated: Facility staff did not report a resident's fall to responsible parties Facility did not ensure resident's safety, result in resident sustaining an injury. Facility is charging resident for unauthorized services Facility staff administered medication without physician's order.

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to deliver complaint investigation findings. LPA met with Resident Care Director Michael Lucio, and explained the purpose of the visit. On September 19, 2023, the Department received a complaint alleging, Facility did not ensure resident's safety, result in resident sustaining an injury. // Facility staff did not report a resident's fall to responsible parties. It has been alleged that resident R1’s Family member (FM1) was not notified about R1’s fall on September 13, 2023. Page 1 Out of 5. Unfounded On September 27, 2023, LPA Simi Rai interviewed Staff 1 (S1). S1 stated Resident 1 (R1) sustained a bruise and a small laceration on R1's right eye after attempting to reach something on the counter and slipped and fell. During the incident, R1's private companion was in the room and notified staff. Staff contacted 911. R1 was not transported to the emergency room and signed a release form due to the fire department saying there was no ambulances available and an eight hour wait for the emergency room. According to S1, R1 did not have a responsible party. LPA Simi Rai interviewed staff S2. S2 stated the facility checks on R1, if the private companion does not come to the facility, every two hours. S2 stated R1 has a pendent to call staff but does not use it. S2 reports that R1's service only include medication assistance. According to an interview with Staff 2 (S2), R1 fell on September 13, 2023 at 6:00 PM. R1 reported the fall at 6:05 PM. R1's care companion called the receptionist. Staff observed R1 on the floor in the kitchen with a bump on the forehead and a "gash" on the left hand. R1 told the fire department R1 would like to stay at the facility. Staff provided ice compress for the swelling on the hand and head. The facility notified R1's PCP via fax. Since R1 did not have a responsible party at the time of the fall, there was no report made. On September 27, 2023, during an interview with R1, R1 did not want to discuss R1's injury. When asked if R1 had a fall recently, R1 did not know. R1 reported feeling satisfied with the services provided by facility staff and says R1 is receiving care from the staff. When asked about the bandage on R1's hand, R1 did not wanted to discuss the injury and could not recall the incident. Based on a review of R1’s Progress notes, dated September 13, 2023, R1’s companion called the receptionist and stated R1 had fallen. When staff arrived, the resident was found sitting on the floor in the kitchen. R1 had a skin tear on his/her left hand, a gash on his/her right side of his/her face near his/her eyebrow and a bump on his/her forehead. 911 was contacted to assess R1. R1 decided to just stay home. Based on a review of R1’s file, R1 had a durable power of attorney, which was executed on October 10, 2023. FM1 is not listed as the durable power of attorney. Based on a review of R1’s admission agreement dated February 28, 2023, R1 does not have any noted responsible party. Page 2 Out of 5. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Facility staff administered medication without physician's order. On September 19, 2023, the Department received a complaint alleging Facility staff administered medication without physician's order On September 19, 2023, the Department interviewed Witness W1. W1 stated the facility was providing R1 with a medication M1 that had yet to be released to the facility. W1 stated the order for the new medication was never provided and was confused on how R1 would be taking the medication without the physician order. W1 stated that she is confused about the matter and that she can't elaborate further regarding the matter. It has been alleged that medication M1 was administered without the physician’s order. On September 27, 2023, LPA Simi Rai interviewed staff S2. S2 stated R1's PCP ordered a new medication on 09/01/2023. Prior to R1's dementia diagnosis, R1 was responsible for own medications, ordering the medication, and administering them. After the diagnosis, R1's services changed from independent to assisted living. According to an interview with R1, R1 reported waiting on one of the medications already being ordered and waiting for it to deliver to the facility. Based on a review of Kaiser Permanente fax communication, dated September 1, 2023, R1 was prescribed medication M1. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 3 Out of 5. Facility is charging resident for unauthorized services On September 19, 2023, the Department received a complaint alleging Facility is charging resident for unauthorized services. It has been alleged the facility did not consult with Resident Barbara's Family Member, referred to as FM1 and obtain permission to hire a private caregiver for the resident prior to employing the private caregiver. On September 27, 2023, LPA Simi Rai interviewed Staff 1. S1 stated R1 agreed to paying for a private companion on September 4, 2023 after the facility observed R1 was having eloping behavior. The eloping incident occurred during a NOC shift. NOC shift staff observed R1 entering the facility at 5:00AM and was unaware that R1 left the facility. S1 stated the private companion is with the resident every day from 7:00 AM - 7:00 PM. S2 stated R1 had private companion services because of R1’s change of condition and to established for his/her safety. S2 stated R1 would come downstairs and be confused as to why R1 came downstairs, R1 would not remember where R1's apartment was located, and R1 would stay in the dining room after eating meals and tell staff that no one talked to R1 and R1 did not eat yet. S2 stated R1 was also found outside at 3:00 AM/4:00 AM by staff. S2 stated after that incident, the private companion services was offered. S2 stated R1 saw his/her primary care physician, where he/she was diagnosed with a neurocognitive disorder. S2 stated reported that R1 has expressed liking the private companion because the resident can go on walks 3-4 times a day, goes to activities, and has been eating and drink fluids regularly. Based on a review of R1’s progress notes: on August 18, 2023, stating FM1 and R1’s Case manager met to discuss next step with R1’s new condition. Based on a review of R1’s Physician’s Report dated February 23, 2023, R1 had mild cognitive impairment. Based on a review of R1’s Physicians report dated August 18, 2023, R1 has a neurocognitive disorder. Page 4 Out of 5. Based on a review of R1’s admission agreement dated February 28, 2023, R1 does not have any noted responsible party. Furthermore, the Admission agreement states, on page 4, “if you begin receiving a different level of care, this is a new service and the rate for the new level of care shall be charged immediately. Based on a review of R1’s file, R1 had a durable power of attorney, which was executed on October 10, 2023. FM1 is not listed as the durable power of attorney. Moreover, a review of R1’s private care giver services continued after the establishment of the power of attorney, until November 2, 2023. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 5 Out of 5. END OF REPORT.the state’s words, verbatim · CDSS document, Jun 27, 2025 · control 26-AS-20230919081904

Allegation investigated: Facility staff are threatening resident with eviction.

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to the facility to deliver complaint investigation findings. LPA met with Resident Care Director Michael Lucio and explained the purpose of the visit. On February 6, 2024, the Department received a complaint alleging Facility staff are threatening resident with eviction. On February 16, 2024, LPA Simranjit Rai interviewed Staff 1 (S1). S1 reported that the facility has not initiated the eviction process for Resident 1 (R1) although R1 has a past due charges. According to S1, S1 informed R1 and R1’s family member regarding the past due charges and did not hear from the family member. S1 had a meeting with R1 and explained the process of an eviction if the resident does not pay the past due balance. Page 1 Out of 2. Unfounded On February 27, 2024, LPM Romeo Manzano interviewed S1. S1 stated R1 has had a past due balance since December of 2021. S1 stated the facility has not issued an eviction notice, nor have they issued him a 60 day notice increase of rent for 2024. According to an interview with Staff 2(S2), S2 stated according to the facility records R1 has received facility services, notice of rental increases, reached out to R1's responsible party, and has continued to provide services. On February 21, 2025, LPA Valerio interviewed R1. R1 stated R1 is moving out next month. R1 has continued to live at the facility since 2021. R1 stated the reason for moving next month was because the facility cannot "take care of me". On May 28, 2025, Licensing Program Analyst Manuel Monter interviewed residents R2-R9. All residents interviewed stated they have not heard or seen staff threaten residents with eviction. LPA interviewed facility ADM. ADM stated she has not seen or heard staff threatening residents with eviction. On May 28 & June 16, 2025, LPA interviewed staff S3-S9. All staff interviewed stated they have not heard or seen staff threaten residents with eviction. Based on a review of an email communication, resident R1 sent an email to the facility on, February 15, 2024, informing them that he/she was giving his/her 30 day notice and was moving out. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Jun 20, 2025 · control 26-AS-20240206154903

Allegation investigated: Facility staff slapped resident Facility staff treat resident in a rough manner

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to deliver complaint investigation findings. LPA met with Administrator Ida Gemignani-stearns, and explained the purpose of the visit. On June 20, 2023, the Department received a complaint alleging Facility staff slapped resident/ Facility staff treat resident in a rough manner. It has been alleged that staff slapped resident R1 and treated him/her in a rough manner. On June 28, 2023, LPA Dolores interviewed residents R1-R5. Resident R1 stated he/she could not remember the time of when the incident occurred; however, R1 stated the staff slapped R1's arm, did not know why the staff slapped R1's arm, recalled having two staff assist taking R1 to the bathroom, and remembered the staff were being rough by pushing and poking R1. R1 stated the staff was not patient and telling R1 to hurry up. Page 1 Out of 3. Unsubstantiated 4 Out of 5 residents (R2-R5) interviewed stated they have not seen staff slapping/hitting residents or treating them in a rough manner. LPA Dolores interviewed staff S1. S1 stated an incident with two staff members (S2, S3) and R1 on 06/16/2023 or 06/17/2023. Based on S1's internal investigation, the staff members denied the allegation of slapping the resident or handling the resident in a rough manner. The staff did admit to assisting the resident with transferring the resident from their wheelchair to the bathroom. S1 stated prior to the incident, there had not been any concerns. S1 did stated R1 could not confirm the cause of the bruise on R1's arm. LPA Dolores interview witness W1. W1 stated he/she asked R1 about staff slapping R1. R1 was confused and could not answer the question. W1 reported seeing three (3) bruises on R1. W1 stated he/she believed that the bruises may have come from an assistive device that is installed in R1's bathroom. W1 stated R1 has a private caregiver, whom is not associated/employed with the facility, and observed the bruise on R1 on 06/17/2023. W1 stated in terms of R1’s definition of rough, he/she couldn’t get that information from R1. On May 28, 2025, LPA Monter interviewed residents R6-R13. All residents interviewed stated they have not seen staff slapping/hitting residents or treating them in a rough manner. LPA Monter interviewed staff S4-S9. All staff interviewed stated they have not seen staff hitting or slapping resident in care. 5 Out of 6 staff interviewed (S4-S7, S9) they have not seen staff handle residents in a rough manner. 1 Out of 6 staff (S8) stated he/she remembers of an event where two staff members were rough when providing care but could not remember where or when this occurred. On June 4 & 5, LPA Manuel Monter interviewed staff S2 and S3. Both staff interviewed stated they did not hit/slap residents in care. Both staff interviewed stated they did not treat residents in a rough manner. Both staff interviewed stated they haven’t seen staff hit/slap residents in care or staff treating residents in a rough manner. On June 6, 2025, LPA Monter interviewed staff S10. S10 stated he/she hasn't seen or heard about staff slapping/hitting residents or treating them in a rough manner. Page 2 Out of 3. Based on a review of Local Law enforcement report, on June 17, 2023, local law enforcement was informed about the alleged physical abuse of R1. The report indicates staff S2 and S3 as the two staff member in question who were alleged of doing physical abuse. Based on a review of R1’s Progress notes, dated June 21, 2023, states R1 informed staff that on June 16, 2023 two care givers were rough with him/her. R1 described the staff as Ethiopians, tall slender and could possibly be brothers/sisters. R1 stated when he/she was being transferred, one of the care givers hit him/her on his/her left arm and caused a bruise and a small skin tear. Based on a review of Accent Care Hospice Provider note, dated June 17, 2023, R1 noted pain to left elbow and skin tear to elbow. R1 stated he/she doesn’t remember exactly what happened but noted small drops of blood on floor to the left of toilet. Appears to have bumped his/her arm on the raised toilet seat handle. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. This report was reviewed with ADM Ida Gemignani-stearns and a copy of the report was provided. Page 3 Out of 3. END OF REPORT.the state’s words, verbatim · CDSS document, Jun 6, 2025 · control 26-AS-20230620154218

Allegation investigated: Facility staff are not assisting resident(s) with showering. Facility staff are not assisting resident(s) with wheelchair transfers.

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with ADM Ida Gemignani-stearns On November 30, 2023, the Department received a complaint alleging Facility staff are not assisting resident(s) with showering/ Facility staff are not assisting resident(s) with wheelchair transfers. It has been alleged that residents are not getting the staff assistance they need be able to shower or get in and out of their wheelchairs. On December 7, 2023, LPA Simi Rai interviewed residents R1-R4. R1 stated he/she receives help with showers, with no issues. R1 stated he/she doesn’t need transfer assistance, but hasn’t heard any residents not receiving help to transfer from their wheel chair. Page 1 Out of 3. Unfounded R2 stated he/she does not need assistance with showers but staff will help his/her showers if he/she needs it. R2 stated she hasn’t heard anything about a resident with a wheelchair needing help with a shower and not receiving it. R3 stated the staff giver him/her showers, no issues. R3 stated staff assist her with transfers, with no complaints. R4 stated he/she receives help from staff with his/her showers, with no issues. R4 stated she hasn’t heard about residents with wheelchairs, needing transfers into showers having any issues. LPA Rai interviewed General Manager (GM), Will Carter. GM stated staff have not reported any incidents where resident was not assisted with showers and wheelchair transfers. LPA Rai interviewed staff S1-S5. S1 stated all residents receive their showers and receive help transferring from the wheel chair to the shower. S2 does not recall a time when a resident on a wheelchair was not given a shower because the staff did not assist the resident. S3 stated the only way a resident doesn’t receive a shower is when the resident refuses to be given a shower. S3 stated there hasn’t been any incidents regarding a resident with a wheelchair. S4 stated residents who need 2-3 staff assistance with showers, are provided assistance. S5 stated he/she will encourage the residents to shower and if the resident refuses a shower, he/she will reschedule the shower with them. On May 28, 2025, LPA Manuel Monter interviewed residents R5-R11. R5 stated he/she does get assistance with his/her shower, but it can be delayed up to an hour. R6 stated he/she doesn’t need assistance with showers. R5, R6 and R11 stated he/she does need assistance with transfers and has not had any issues with transfers. Residents R7, R8, R9, R10 stated he/she doesn’t need assistance with transfers or showers. LPA interviewed staff S6-S9. All staff interviewed stated staff assist residents with showers and transfers. All staff interviewed stated there hasn’t been a time when a resident who needed assistance, wasn’t assisted. Page 2 Out of 3. LPA Monter interviewed facility Administrator (ADM) Ida Gemignani-Stearns. ADM stated residents are given showers without any issues. ADM stated there hasn’t been any misses. ADM stated she hasn’t heard about any issues. ADM stated the residents are getting assistance with transferring. ADM stated there hasn’t been a time when residents who needed to be transferred were neglected. On June 6, 2025, LPA Monter interviewed Staff S10. S10 stated residents are given showers without any issues or misses. S10 stated residents are getting assistance with transfers. S10 stated residents are not being neglected their shower or transfers. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 3 Out of 3. LPA Rai interviewed staff S1-S5. S1 and S3 and S5 stated he/she doesn’t know about residents medication administration, as their jobs do not entail medication administration. S2 stated there has been no issues with medication administration, and medications are only not administered if a resident refuses or the resident left the facility to an appointment without letter the facility know about the leave. S4 stated medications are administered on time. On May 28, 2025, LPA Manuel Monter interviewed residents R5-R11. R5 and R9 stated he/she is getting his/her medication daily, with no issues. R6 and R7 and R8 R10 R11 stated he/she handles his/her own medication and doesn’t need assistance from staff. LPA interviewed staff S6-S9. 3 Out of 4 staff interviewed (S6,S8,S9) stated residents are getting the medications every day, on time. S7 stated there have been times when medication was administered late. S7 stated medication that needs to be administered at 6am, was given at 10:30am. S7 stated this happens when there is only 1 medtech for both the memory care and assisted living. LPA Monter interviewed facility Administrator (ADM) Ida Gemignani-stearns . ADM stated he/she residents are getting his/her medication on time. ADM stated there are no issues regarding residents getting their medication. ADM stated she is not aware of any issues or delays regarding medication administration. On June 6, 2025, LPA Manuel Monter interviewed staff S10. S10 stated that residents are getting their medications as per physicians orders. S10 stated there hasn't been a time when residents didn't get their medication administered or delayed. Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.the state’s words, verbatim · CDSS document, Jun 6, 2025 · control 26-AS-20231130094329

Allegation investigated: Facility did not follow physician’s order when administering medication to a resident Facility increased residents services without proper notice

On 5/7/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Executive Director, Ida Gemignani-Stearns. The department toured the facility, interviewed staff, outside parties, reviewed records and made observations during the course of the investigation. Complaint alleges facility did not follow physician’s order when administering medication to a resident. Upon review of resident medication records LPA identified a prescription dated 10/19/2023, to discontinue; reducing the dosages of trazadone to 2 times per day. However, medication administration records indicate that the facility had continued to administer trazadone to R1, 3 times per day and not in accordance to the new prescription. Continued onto LIC9099-C Substantiated Complaint alleges facility increased residents services without proper notice. Based upon a review of resident records LPA identified a notice of rate increase dated 11/1/2023. The letter stated that the rate increase for R1 was effective the same date of 11/1/2023 and is not within required time frame to for proper notification. Complaint also indicates an increased level of care not given proper notice. In addition, LPA identified a documented assessment for R1 indicating a higher level of care dated 10/17/2023. However the assessment did not include the increased rate and effective date nor was it signed by R1 or R1's responsible party indicating acknowledgement. Allegations, facility did not follow physician’s order when administering medication to a resident and facility increased residents services without proper notice are found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, May 7, 2025 · control 26-AS-20231031135900

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 8, 2025

87465 Incidental Medical and Dental Care (a)(4) The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidence by:the state’s words, verbatim · CDSS document, May 7, 2025

Plan of correction: Licensee to submit a written plan to address administration of medication and to provide staff training such as but not limited documentation of medications records and administration of medication for person in care. Written plan to be submitted by POC date 5/8/2025.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: May 14, 2025

1569.655 Increase in fee rates for elderly residents (a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice...**This was not met as evidence by**the state’s words, verbatim · CDSS document, May 7, 2025

Plan of correction: Licensee to submit written plan to ensure compliance with proper notification of rate increases for all persons in care. Written plan to be submitted by POC date 5/14/2025.

Allegation investigated: Staff are overcharging a resident for services not received

On 3/13/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by General Manager, Will Carter The department toured the facility, interviewed staff, outside parties, reviewed records and made observations during the course of the investigation. Complaint alleges staff are overcharging a resident for services not received with R1 required by facility to pay for unexplained rental fees. Based upon department conducted interviews with resident (R1, R2 & R3) there were no indications that staff were not meeting resident level of care needs. Interviews with former Executive Director (S1) and Business Office Manager (S2) indicated that R1 had been admitted to the facility in January 2021. Based upon review of R1’s payment ledger for rental and care fees, LPA found that R1 had outstanding fees owed to the facility. As a result, additional late fees accrued which increased the total amount of R1's total fees owed. The agency has investigated the allegation and we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Nothe state’s words, verbatim · CDSS document, Mar 13, 2025 · control 26-AS-20231221215159

Allegation investigated: Facility is not accommodating to the residents preference by not providing an alternative to water Facility did not provide proper supervision in the dining room of memory care Facility is not changing resident's diaper

On 3/13/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by General Manager, Will Carter The department toured the facility, interviewed staff, outside parties, reviewed records and made observations during the course of the investigation. Complaint alleges facility is not accommodating to the residents preference by not providing an alternative to water. Upon interviews with multiple caregiver staff, LPA was informed that other beverage options are available and offered to residents and resident (R1) including juice, coffee, tea, ensure and other flavored beverage packets. Upon tour of the memory care unit, LPA confirmed several beverage options available for residents including but also alternative to water. R1 is no longer residing in the facility for additional observations. Continued onto LIC9099-C Unsubstantiated Complaint alleges facility did not provide proper supervision in the dining room of memory care. Upon review of R1 progress notes and interviews with multiple caregiver staff, LPA was informed that R1 had a history of verbal and physical behaviors towards staff and other residents in care. Upon tour of the memory care unit, LPA observed one common area connected to a dinning space, which complete separation of residents poses a difficulty. Staff indicated proper responses for redirection and ensuring resident personal rights, all while attempting to address R1's behaviors. LPA did not find any indications or observations of staff not providing appropriate supervision to residents in the dinning area. Complaint alleges facility is not changing resident's diaper. Upon interview with multiple caregiver staff and a review of R1 records and progress notes, LPA found contradicting information regarding R1's responses to continence care from staff. Staff statements were consistent to frequency of resident checks and attempts and did not provide corroborating evidence. R1 is no longer residing in the facility for additional observations. Upon tour of the memory care unit, LPA did not observe any other residents that weren't provided adequate continence care. A finding that the complaint allegations, facility is charging for services not being provided, facility is not accommodating to the residents preference by not providing an alternative to water, facility did not provide proper supervision in the dining room of memory care, facility is not changing resident's diaper are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Mar 13, 2025 · control 26-AS-20231031135900

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Annual Continuation visit and met with Karen Nickolai, Administrator. The visit was a continuation of the Required 1 Year Annual Inspection that was started on 11/27/2024. During visit on 11/27/2024, LPA Marrufo reviewed the resident medication records for residents R1-R8. The Centrally Stored Medication and Destruction Records for R3, R4, R5, R6, and R8 had prescription numbers that were incorrect. LPA reviewed the resident records for R1-R8 and staff records for 8 staff and found them to be complete. A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Administrator Karen Nickolai and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 4, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6)(E) · Plan of correction due date: Dec 11, 2024

87465(h)(6)(E) Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (E) The prescription number and the name of the issuing pharmacy. This requirement was not met as evidenced by: Licensee did not ensure that 5 out of 8 reviewed Centrally Stored Medication Logs had correct presciption numbers, which poses a potential health risk for residents in care.the state’s words, verbatim · CDSS document, Dec 4, 2024

Plan of correction: Licensee agrees to conduct in-service training with staff to ensure that staff correctly record the prescription numbers of resident medications in the Centrally Stored Medication Logs by POC Due Date. The Licensee agrees to submit copies of staff training records that include names of staff trained, dates of training, and names and qualifications of trainers to CCL by POC due date.

Type of visit: Case Management - Incident

On 12/4/24 LPA Santino Fortes conducted an unannounced Case-Management and met with Administrator (ADM) Karen Nikolai. The purpose of the visit was to follow up regarding an Incident Report submitted by facility to the Department on 11/28/24. The incident report stated that Resident R1 entered the kitchen area in the memory care unit and grabbed another resident's medications from staff S1's medicine distribution tray and consumed them. The incident report states that R1 has been on heightened observation for 72 hours and is currently doing well. During visit LPA interviewed Staff S1 who was the Medication Technician who was administering medication when R1 accessed and consumed the medication. During Interview, S1 stated that the medication tray was on a kitchen counter and within arms reach of S1. S1 stated the medications were not left unattended. The kitchen swing door was not locked which allowed R1 access to the kitchen area and the medications. During visit LPA discussed with ADM about ensuring staff lock the kitchen swing door in the memory care area so that residents do not have access to medications in the kitchen area. S1 will review proper medication handling techniques with ADM and actively lock medication tray immediately after each distribution of medications to residents. A Technical violation was issued. See LIC9102 Advisory note for more information. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with ADM Karen Nikolai and a copy of this report was providedthe state’s words, verbatim · CDSS document, Dec 4, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Karen Nikolai, Administrator. During visit, LPA Marrufo toured the facility inside and out. LPA toured the kitchen area and 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 toured the outside area and found it to be clear of obstructions. LPA toured two out of two resident hallway bathrooms and found each bathroom had available soap, paper towels, and functioning lights. LPA tested the water temperature in the sinks of both bathrooms and found the temperatures to be at 105 F and 109 F. LPA toured 8 resident living units and found each living unit had available bedding and clothing storage areas. The water temperatures in the bathroom sinks measured between 105 F to 111 F. 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 at this time. This report was reviewed with Karen Nikolai, Administrator, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 27, 2024

Allegation investigated: Resident's call cord is in disrepair

On 11/15/2024, Licensing Program Analysts (LPA's) Tobola and Jain arrived unannounced for the purpose of delivering complaint investigation and was greeted by General Manager, Karen Nickolai. The Department conducted tour of the facility, interviewed staff and made observations during the course of the investigation. Complaint alleges, resident’s call cord is in disrepair. Based upon a tour of the facility, LPA tested call bell/chords in multiple resident bedrooms on each floor throughout the facility. Upon LPA observation, staff were notified and responded appropriately with no indication of call cords damaged. Due to a lack of corroborating evidence, the allegation is found to be unsubstantiated. A finding that the complaint allegations, resident's call cord is in disrepair is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No A finding that the complaint allegations, resident's call cord is in disrepair is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Nov 15, 2024 · control 26-AS-20220118151741

Allegation investigated: Facility doesn't have proper emergency protocols for wheelchair bound resident's

On 11/15/2024, Licensing Program Analysts (LPA's) Tobola & Jain arrived unannounced for the purpose of delivering complaint investigation and was greeted by General Manager, Karen Nickolai. The Department conducted tour of the facility, interviewed multiple staff and residents, reviewed facility records and made observations during the course of the investigation. Complaint alleges facility doesn't have proper emergency protocols for wheelchair bound resident's. Based upon tour of the facility and interviews with Executive Director, LPA found that the facility protocol for assisting non-ambulatory residents out of the facility included the use of emergency evacuation chairs. Upon inspection LPA's observed multiple evacuation chairs located at each stairwell on the second and fourth floors. LPA's did not observe any of the facility stairwells without an evacuation chair present at the time of visit. A finding that the complaint allegations, facility doesn't have proper emergency protocols for wheelchair bound resident's is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Nothe state’s words, verbatim · CDSS document, Nov 15, 2024 · control 26-AS-20220119100726

Allegation investigated: -Staff are not properly storing medication -Staff are not properly disposing of medication -Med Tech Room door is in disrepair -Facility is not reporting incidents

On November 7, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unnannounced complaint visit to deliver the findings for the above allegations. LPA met with General Manager, Karen Nickolai and explained the purpose of the visit. Regarding the allegation, staff are not properly storing medication, according to the reporting party, the Med Techs at the facility are pulling medication and putting it into pill organizers and left on the table instead of being locked up. In addition, the reporting party indicated that there are medication errors and violations at the facility and stated that if an audit is conducted, there will be discrepancies. During the visit, LPA interviewed the General Manager at the time, conducted a medication audit and observed the medication room. Based on observations made during the visit conducted on 4/20/2022, LPA observed facility to be pre-pouring medication in plastic organizers or small cups labeled for morning and with bedroom numbers. The medication observed were being dispensed in small cups for 24 to 48 hours in advance. In addition, during medication audit conducted on 4/20/22, LPA and Med-tech observed 8 packs of Acetaminophen in the overstock cabinet to not be logged on the Centrally Stored Medication Record (CSMR). Staff 2 (S2) was not sure why they are not on the CSMR. Based on CSMR review of Resident 1 (R1), LPA observed a medtech initial stating "error" with no explanation to why there is an error on the back of the MAR. Resident's Lotanoprost eye drops were not on the CSMR. According to the General Manager at the time, she was not aware that staff are pre-pouring medication for more than 24 hours and indicated that staff should be aware to only pre-pour medication for no more than 24 hours. (Continue to 9099C) Substantiated LPA was unable to interview R2 during the investigation as R2 is no longer at the facility and LPA was unable to interview staff due to the staff involved no longer being employed at the facility. Based on interviews conducted & records reviewed, the department has determined that although the above allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED. Report is reviewed with General Manager, Karen Nickolai and a copy is provided. Regarding the allegation, staff are not properly disposing of medication, according to the reporting party, the facility is not properly disposing expired medication and is not aware if residents are being administered expired medication by staff. During the investigation, LPA interviewed staff and observed the medication room. On 4/20/22, LPA observed a bin full of medication that needed to be destructed. According to staff interviewed, the last time the facility properly destroyed medication was on 2/15/22 because the facility has not had a nurse since March of 2022 and the nurse would be the one who would usually destruct the medications with the med-techs or the administrator as witness. In addition, according to the General Manager at the time, staff are supposed to destruct medications weekly however medications that needed to be destructed have not been destructed since 2/15/22 and LPA conducted the complaint visit on 4/20/22. On 11/7/24, LPA observed the medication room and observed a full box of medications that needs to be destructed on the floor. Regarding the allegation that med-tech room door is in disrepair, according to the reporting party, the Assisted Living med-tech room door is in disrepair, does not lock and is usually propped open, making medication accessible to residents in care. During the investigation, LPA interviewed the General Manager at the time and observed the Assisted living med-tech room. According to the General Manager at the time, in December of 2021, he/she was made aware that the med-tech room door was in disrepair and contacted third-party contractor, Vortex for a quote, however he/she did not send a confirmation to Vortex to repair the door. In addition, the General Manager at the time indicated, it was not till February 2022 when he/she officially sent an order to get the door repaired. Based on observations during the visit, LPA observed the med-tech room. LPA observed the top door hinge to be loose, a sign on the door stating disrepair and a nail in a ziplock bag from the missing nail on the door hinge. According to observations and interviews, the Med Tech room in assisted living is located inside the assisted living office, which is always locked. If the door is open, there is staff supervising the office and med-room. Continue to 9099C. Regarding the allegation, facility is not reporting incidents according to the reporting party, on 4/7/2022, resident 2 (R2) reported being hit by a care staff and doesn’t believe the General Manager at the time reported this incident to the state. LPA interviewed General Manager who indicated that there was an incident that occurred on 4/6/22 where a R2’s private caregiver reported to the Assisted Living Director at the time that R2 complained of a facility caregiver being abusive. The General Manager at the time admitted to not filing an SOC341 because she did not see signs of abuse or neglect after conducting the internal investigation. In addition, the General Manager at the time also admitted to not filing an incident report to CCLD for unknown reasons. The Department has conducted an investigation of the above allegations. Based on observations, staff interviews and records review, the preponderance of evidence standard has been met. Therefore, the Department found the above allegations to be SUBSTANTIATED. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Failure to correct said deficiencies may result in additional civil penalties. Report is reviewed with the General Manager and a copy is provided with appeal rights.the state’s words, verbatim · CDSS document, Nov 7, 2024 · control 26-AS-20220412103116

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: Nov 14, 2024

87465 Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement has not been met as evidenced by: Based on observations made during the visit conducted on 4/20/2022, LPA observed facility to be pre-pouring medication in plastic organizers or small cups labeled for morning and with bedroom numbers. The medication observed were being dispensed in small cups for 24 to 48 hours in advance. Nevertheless, the facility is transferring residents' medications from the originally received container to small cups.the state’s words, verbatim · CDSS document, Nov 7, 2024

Plan of correction: Deficiency is cleared and corrected the time of the visit. LPA observed medication room and did not observe any pre-poured medication.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Nov 14, 2024

87465 Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes... This requirement is not met as evidenced by: Based on observations and record review, LPA and Med-tech observed 8 packs of Acetaminophen in the overstock cabinet to not be logged on the Centrally Stored Medication Record (CSMR). In addtion, LPA observed R1's eye drop not logged on the CSMR.the state’s words, verbatim · CDSS document, Nov 7, 2024

Plan of correction: Licensee/administrator shall conduct training with med-techs to ensure all prescribed medications are logged on the CSMR and a record is maintained for each centrally stored medication.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(i) · Plan of correction due date: Nov 14, 2024

87465 Incidental Medical and Dental Care: (i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident... Based on observations, on 4/20/22, LPA observed a bin full of medication that needed to be destructed. In addition, on 11/7/24, LPA observed a full box of medications that needed to be destructed.the state’s words, verbatim · CDSS document, Nov 7, 2024

Plan of correction: Licensee/administrator shall submit a plan on how to ensure medications that require destruction is destructed so the destruction box isn't full or overfilling. Plan shall include company being used for destruction (if any), protocols, process, and how often.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 14, 2024

87303 Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidenced by: Based on observations LPA observed the top door hinge to be loose, a sign on the door stating disrepair and a nail in a ziplock bag from the missing nail on the door hinge. In addition, based on interviews conducted, it was indicatd that the door has been in disrepair for more than 2 months.the state’s words, verbatim · CDSS document, Nov 7, 2024

Plan of correction: Deficiency is cleared and corrected during the visit. LPA observed med-tech room to be in good repair.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Nov 15, 2024

87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency...within seven days of the occurrence of any of the events specified in (A) through (D) below... This requirement is not met as evidenced by: Based on interview conducted with the General Manager at the time, there was an incident that occurred on 4/6/22 where R2 complained of a facility caregiver being abusive. The General Manager at the time admitted to not filing an incident report to CCLD for unknown reasons which poses a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Nov 7, 2024

Plan of correction: Licensee/administrator shall submit a plan in writing on how the facility will ensure all incidents that occur at the facility will be submitted to CCL within regulatory requirements.

Allegation investigated: -Staff children sleeping in the common area -Facility plumbing in disrepair

On November 7, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unnannounced complaint visit to deliver the findings for the above allegations. LPA met with General Manager, Karen Nickolai and explained the purpose of the visit. Regarding the allegation staff children are sleeping in the common area, according to the reporting party, Staff #1 (S1) brings her children to the facility several times a week and allows them to run around the facility and sleep on the ground in the common area. In addition, the reporting party indicated that S1 does not monitor her children and directs staff to watch them instead of caring for residents. LPA interviewed the general manager, staff, and residents at the time. Based on interviews conducted, no children have ever slept at the facility and S1's children are only there for an hour or two, however would sit in S1’s office or the activity room. In addition, based on 5/5 residents interviewed, the children are not disruptive, and they are never in the way of residents. Resident interviewed also indicated that they have not observed any children running around or any children sleeping in the common areas. Futhermore, according to the staff interviewed, S1’s children do not sleep or run around at the facility, they usually sit in one place and color and it’s usually in the activity room or S1’s office. (continue to 9099C) Unsubstantiated Regarding the allegation, facility plumbing is in disrepair, according to the reporting party, the memory care unit has a nonfunctional hand washing sink. During the complaint investigation, LPA toured the facility, interviewed the general manager and staff at the time, and observed the hand washing sink in the memory care unit. According to interviews conducted, there may have been a cracked pipe, however the plumbing has been fixed and the sink is in good repair and working condition. During the complaint visit that was conducted on 5/12/22, LPA observed that the plumbing was repaired and plumbers were present at the facility during the visit. According to the general manager and interviewed staff, the facility has a maintenance director and a third-party contracting agency, Sener, that has been continuously working on the plumbing issues at the facility. Although there was a sink that was not functioning at the time due to remodeling, there were other sinks that were functioning at the facility and in specific, in the memory care unit and it was not affecting the daily operation of the facility. Based on interviews conducted & observations, the department has determined that although the above allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED. Report is reviewed with the General Manager and copy is provided.the state’s words, verbatim · CDSS document, Nov 7, 2024 · control 26-AS-20220504133632

Allegation investigated: Residents’ care needs are not being met Staff not providing residents with food of good quality Resident charged for services not received.

Licensing Program Analyst (LPA) conducted an unannounced investigation visit to deliver an amended investigation report and met with General Manger (GM) Karen Nickolai. On 7/9/2024, Licensing Program Analyst (LPA) Steve Chang delivered the investigation findings report and met with General Manger (GM) Karen Nickolair. On 01/13/2022, the Department received a complaint with the above allegations. On 1/21/2022, the Department conducted an initial investigation visit and met with the prior General Manager (PGM) Corinne Gies. Due to the facility having COVID outbreak on 1/21/2022, LPA interviewed PGM at the facility backyard. LPA requested resident Physician's Report, Functional Capability Assessment, Admission Agreement, Housekeeping schedule, staff schedule, food menu, and emergency call log and maintenance log. Continue on LIC9099-C. Page 1 of 4. Unfounded Resident care needs are not being met: The allegation is that resident R1 does not receive timely showers and the garbage does not get taken out timely. On 12/13/2023, LPA interviewed resident R1. R1 stated he/she rejected the facility's shower service and caregivers' every two hours checking to reduce the monthly payment due to his/her budget concern. R1 stated he/she pays the facility monthly payment by self and wants to reduce the facility monthly payment. R1 stated he/she hires a private caregiver to come in his/her room 3 days per week to help his/her care needs. R1 stated he/she requests the private caregiver to provide 3 showers per week for him/her, to clean his/her room, and to take out the trash from his/her room. R1 stated he/she goes to supermarket to buy food and eats meals in his/her room. R1 stated the facility housekeepers come to clean the room one time per week and take out the trash. LPA interviewed 3 residents. 3 Out of 3 residents stated the facility housekeepers clean their rooms at least one time per week. 3 out of 3 residents stated they have at least 2 showers per week. 2 Out of 3 residents stated caregivers take out the trash when they visit the rooms. 3 Out of 3 residents stated they don't have any complaint against the facility. LPA interviewed previous General Manger (GM1). GM1 stated resident R1 refused the facility shower service, caregivers' checking on R1, and facility meal service to reduce his/her monthly payment. GM1 stated R1 eats the meals in his/her room. GM1 stated R1 hires a private caregiver to help R1's care needs and to clean R1's room. On 05/23/2024, LPA interviewed 7 residents. 7 Out of 7 residents stated the housekeepers clean the rooms at least one time per week. 7 Out of 7 residents stated they have at least 2 showers per week. LPA interviewed GM1. GM1 stated the facility already communicated with R1 that the facility policy is that residents need to receive the care and supervision provided by the facility. Continue on LIC9099-C. Page 2 of 4. Based on the interviews, R1 refused the care and services provided by the facility to reduce R1's monthly payment, and refused to pay the facility's care and service. R1 hired a private caregiver to provide him/her care. R1 declined to use the facility's service and hired a private caregiver. Staff not providing residents with food of good quality: On 12/13/2023, LPA interviewed resident R1. R1 stated he/she refused the facility meal service to reduce the monthly payment due to the his/her budget concerns. R1 stated he/she pays the facility monthly payment by self. R1 stated he/she goes to supermarket to buy food for meals. R1 stated he/she just came back from the supermarket for grocery shopping and showed LPA the food he/she bought. R1 stated he/she just finished lunch in the room by having breads and drinks that he/she bought. LPA observed the food R1 bought from supermarket were stored in the room for R1's meals. LPA interviewed previous General Manager (GM1). GM1 stated R1 refused the facility meal service to reduce the monthly payment and eats meals in his/her room. LPA interviewed 2 residents. 2 out of 2 residents stated the facility food is good. Both stated they do not have any complaint for the food service. On 05/23/2024, LPA interviewed 8 residents. 7 out 8 residents stated the facility food is good and without any complaint for the food service, and 1 out 8 stated the facility food is not very good but is acceptable. Based on the interviews, resident R1 refused the facility meals service to reduce the monthly payment and bought food from supermarket and had the meals in the room. R1 did not use the meals provided by the facility. Continue on LIC9099-C. Page 3 of 4. Resident charged for services not received: The allegation is that the facility did not refund the money for resident's stay in hospital for 4 days. On 12/13/2023, LPA interviewed R1. R1 stated he/she was in hospital from 12/7/21 to 12/10/21 and did not receive facility service during the 4 days time period. LPA interviewed previous General Manager (GM1). GM1 stated based on the facility policy, the facility will refund the money if resident was in hospital for more than 14 days. On 05/23/2024, LPA interviewed R1. R1 stated after he/she communicated with the facility and he/she understands that the facility will refund the money if residents out of the facility for more than 2 weeks. Based on the document review, R1's signed Residency and Service Agreement dated 1/29/2021, there is no description regarding the refund for resident's hospitalization. A review of current facility Residency and Service Agreement dated May 2024, it specifies "When you have been away from your Apartment for 14 consecutive days, credit for Assisted Living Services will be given beginning on day 15 until you return." The Department has investigated the above allegations. Based on the investigation, observations, records reviewed, and interviews conducted, the Department found that the above allegations are UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. Exit interview was conducted with GM. This report was provided to GM for signature. A copy of the report was provided to GM. Page 4 of 4.the state’s words, verbatim · CDSS document, Sep 17, 2024 · control 26-AS-20220113142014

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced visit to deliver an amended investigation report for the complaint control number 26-AS-20220113142014. On 7/9/2024, LPA delivered an investigation report for the complaint control number 26-AS-20220113142014. LPA met with General Manager Karen Nickolai (GM) and explained the purpose of today's visit. No citation was issued today. Exit interview was conducted with GM The report was provided to GM for signature. A copy of the report was provided to GM.the state’s words, verbatim · CDSS document, Sep 17, 2024

Allegation investigated: Staff neglect resulted in a resident's death Staff is sleeping while residents are present

On 7/16/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit. LPA met with General Manager Karen Nickolai and explained the purpose of today's visit. Regarding the allegation of staff neglect resulted in a resident's death, RP stated that there was resident (R1) who was not given proper care, R1 passed away because staff was neglectful and R1 did not receive CPR until maybe 30 minutes later when the oncoming shift came and the EMT's came in. Based on statements obtained, on 03/07/2023, R1 pressed the call button at 5:46am. Staff (S4) responded and cleared the call button alarm at 5:50am. R1 expressed having "abdominal pain" and S4 stated another caregiver would come back to check on R1 since it was the middle of a shift change. S4 informed incoming caregiver (S5) that R1 was experiencing a "stomachache" and S5 told S4 it would take a while before S5 would be able to go check on R1. S4 returned to R1’s room and found R1 unresponsive. S4 contacted 911 at 6:16am and performed CPR until paramedics arrived. R1s death certificate lists cause of death as cardiac arrest. Unsubstantiated Interviews obtained state that staff are to immediately contact 911 if a resident has fallen, is vomiting, expresses shortness of breath or chest pain, or if they have some sort of severe injury. If a resident is expressing sickness or stomach pain, the facility is to monitor the resident, contact the family and inform the primary care physician. Based on interviews obtained, R1 only reported abdominal pain and never mentioned shortness of breath or chest pain. Regarding the allegation of staff is sleeping while residents are present, RP stated that the coworker is speculated to be always sleeping, no one knows because he/she cannot be contacted over radio, and RP even called the company iPhone, and he/she did not pick up the phone. There were six staff members who were interviewed. One staff (S1) mentioned that Management has tried to come at random times during the night but has never found both staff to be sleeping. Another staff (S3) also mentioned that S3 would show up at the facility at all times of the night and would never catch a staff member sleeping. Another staff (S5) stated that S5 has never seen staff sleeping and has never had any concerns about staff sleeping during their shift. S4 also shared that it's hard for night shift staff to sleep because ''they're so busy." Staff need to respond to resident alarms in less than five minutes. If staff take longer than five minutes, "they need to answer to that." S4 has always responded to pendant alarms as fast as they can. The only time there is a delay is if S4 is currently helping another resident. Based on interviews & records review, the department has determined that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation dids or did not occur, therefore the allegation is UNSUBSTANTIATED. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Jul 16, 2024 · control 26-AS-20230512153909

Allegation investigated: Facility resident bedroom is not sanitary Staff not responding to call button

Licensing Program Analyst (LPA) conducted an unannounced investigation visit to delivered an amended investigation report and met with General Manger (GM) Karen Nickolai. On 7/9/2024, Licensing Program Analyst (LPA) Steve Chang delivered the investigation findings report and met with General Manger (GM) Karen Nickolair. On 01/13/2022, the Department received a complaint with the above allegations. On 1/21/2022, the Department conducted an initial investigation visit and met with the prior General Manager (PGM) Corinne Gies. Due to the facility having COVID outbreak on 1/21/2022, LPA interviewed PGM at the facility backyard. LPA requested resident Physician's Report, Functional Capability Assessment, Admission Agreement, Housekeeping schedule, staff schedule, food menu, and emergency call log and maintenance log. Continue on LIC9099-C. Page 1 of 6. Unsubstantiated This is an amended report, please see LIC9099 with the finding of "UNFOUNDED". Continue on LIC9099-C. Page 2 of 6. Facility resident bedroom is not sanitary: On 12/13/2023, LPA interviewed resident R1. R1 stated the facility housekeepers clean his/her room one time per week and take out the trash from his/her room. R1 stated he/she refuses the staff to come in to check on him/her to reduce the monthly payment charges. R1 stated he/she hires a private caregiver to come to his/her room 3 days per week to clean up the room and take out the trash. LPA interviewed previous General Manager (GM1). GM1 stated R1 refused caregivers' checking on him/her. GM1 stated the caregivers were unable to enter the room to take out the trash in R1's room because R1 refused caregivers to come in R1's room to check R1. GM1 stated R1 refused the facility meals service to reduce the monthly payment. GM1 stated R1 eats meals in his/her room that scatters some food in the room. GM1 stated the facility provides housekeeping service one time per week. GM1 stated the facility caregivers take out trash when they visit the resident bedrooms. LPA interviewed 3 residents. 2 out of 3 residents stated caregivers took out the trash when they visited the rooms. LPA inspected 3 resident rooms. 3 out of 3 resident rooms were observed without sign of cockroaches or bugs. 3 out of 3 residents stated they don't have cockroaches, bug, or ant in the rooms. LPA toured R1's room. R1's room was observed scattered with food in the room. The room was observed with signs of a few cockroaches. R1 stated he/she eats meals in the room. R1 stated he/she hires a private caregiver to clean the room. On 5/23/2024, LPA interviewed 7 residents and inspected 7 resident rooms. 7 out of 7 residents stated the housekeepers clean the room at least one time per week. 7 out of 7 residents stated caregivers took out trash when they visited the rooms. 7 out of 7 residents stated they don't have cockroaches, bugs or ants in the rooms. Based on the interviews and observation, R1 refused facility caregivers to enter his/her room and hires a private caregiver to clean his/her room. No other rooms were observed with sign of cockroaches, bugs or ants, and no other residents complained their rooms were not in sanitary condition. Continue on LIC9099-C. Page 3 of 6. Staff not responding to call button: On 1/21/2022, LPA interviewed prior General Manager (PGM). PGM stated the pendant bell alarm system and emergency pull alarm system in the bedroom both go to computer system and paging system. The staff and front desk will get notice immediately. On 12/13/2023, LPA interviewed resident R1. R1 stated he/she refused the facility call button service to reduce the monthly payment. R1 stated he/she uses a third party company for call button service due to cheaper which is not connected to the facility. R1 stated the caregivers come to his/her room within 10-15 minutes when he/she pulled the emergency call. R1 stated one time he waited for over one hour when he pulled the emergency call after he finishing toilet. R1 was unable to provide the exact date and time of the incident and was unsure if the emergency call was out of order. LPA interviewed two residents. 2 out 2 residents stated the response time of call button is between 10 -20 minutes. Both stated the facility staff always responded to the call button. LPA interviewed previous General Manager (GM1). GM1 stated R1 does not use the facility call button system. R1's call button system was connected to third party company and was not connected to the facility. On 5/23/2024, LPA interviewed 8 residents. 1 out 8 stated he/she does not use the facility call button service. 2 out 8 stated the facility staff respond to the call button within 5 minutes. 4 out 8 residents stated the facility staff respond to the call button within 5 minutes. 1 out 8 resident stated the facility staff respond to the call button immediately, but one time it took 25 minutes. Based on the document review, on 1/6/2022 around 10:06AM, R1's room Bath E-call was not working. Parts replaced was requested. No evidence to indicate if this incident matching R1's incident of long waiting for response for the emergency call. Based on the interviews and documents reviewed, R1 refused the facility call button service to reduce the monthly payment and uses third party company's service. R1 stated usually the facility staff respond to the emergency within 10-15 minutes. Continue on LIC9099-C. Page 4 of 6. This is an amended report, please see the LIC9099 with the finding of "UNFOUNDED". Continue on LIC9099-C. Page 5 of 6. The Department has investigated the above allegation. Based on interviews and observation, the department has found the above allegations are unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid, there is not a preponderance of evidence to show the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. Exit interview was conducted with GM. This report was provided to GM for signature. A copy of the report was provided to GM. Page 6 of 6.the state’s words, verbatim · CDSS document, Jul 9, 2024 · control 26-AS-20220113142014