Morningstar Assisted Living of West San Jose

Allegation investigated: Facility staff overcharged resident for board and care.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Administrator (ADM) Jake Pelletier. On 05/14/2026, the Department received a complaint with the allegation of facility staff overcharged resident for board and care. On 05/20/2026, the Department conducted an initial investigation visit at the facility. On 07/29/2026, the Department conducted a continue investigation visit. LPA interviewed Administrator Jake Pelletier and obtained documents. Continue on LIC9099-C. Page 1 of 3. Unfounded On 05/18/2026, LPA interviewed a witness (W1). W1 stated he/she is not sure if resident R1's statement about the facility overcharging for board and care is true or not because R1 has cognitive impairment. On 07/29/2026, LPA interviewed Administrator (ADM) Jake Pelletier. ADM stated resident R1 lived in the facility room #3138 before. ADM stated R1 paid deposit $1,500 on 05/20/2025 by check which is refundable. ADM stated R1 officially/financially moved in the facility on 05/25/2025, and officially/financially moved out from the facility on 08/03/2025. ADM stated R1 physically moved in the facility on 06/28/2025 and physically moved out from the facility on 07/30/2025. ADM stated based on the admission agreement, the facility charged service/community fee which equals to one month rent and it is refundable. ADM stated the facility refunds 80%, 60% and 40% if the resident moves out within one month, within 2 months and within 3 months. ADM stated the facility refund the full service/community fee if resident moved out from the facility after 3 months. ADM sated the facility credited back R1 $1,500 for the deposit, and charged R1 one month rent for July 2025, 4 days for June, and service/community fee which equals to one month rent. ADM stated R1's monthly rent was $9,710. ADM stated the facility totally charged R1 $20,714.67. ADM stated the facility issued a refund check $7,768 on 08/06/2025 which equals to 80% of the service/community fee of R1's monthly rent $9,710. ADM stated R1 picked on the check on 9/8/2025 and cashed it on 9/9/2025. Based on the review of R1's billing and ledger, the facility credited R1 back for the deposit $1,500. The facility charged R1 $19,214.67 which equals to one month rent ($9,710.00), 4 days' rent ($1,294.67), and service/community fee ($9,710). Based on the review of the returned check, R1 picked the check on 9/8/2025 and cashed the amount of the check $7,768.00 on 9/9/2025. Based on the review of R1's admission agreement dated 05/27/2025, 80% of the service/community fee will be refund to resident if resident moves out within one month and R1 signed the admission agreement. Continue on LIC9099-C, page 2 of 3. Based on the interview and record reviewed, R1 moved out from the facility after one month and 3 days. The facility treated R1 moved out from the facility within one month and refunded 80% of the service/community fee to R1. The facility refunded R1's deposit $1,500.00 to R1. R1 cashed the refunded check of the amount $7,768.00 on 09/09/2025. The Department has investigated the above allegations. Based on the investigation, records reviewed, and interviews conducted, the Department found that the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citations noted at today’s visit. Exit interview conducted with ADM. This report was provided to review and for signature. A copy of this report was provided to ADM.the state’s words, verbatim · CDSS document, Aug 12, 2026 · control 26-AS-20260514113140

Type of visit: Case Management - Other

On May 20, 2026, Licensing Program Analyst Manuel Monter conducted a case management-other visit to follow up on a technical assistance that was given on April 24, 2026 and met with Wellness Director Trisa Cysewski. LPA explained the purpose of the visit. During today's visit, LPA toured the memory care section of the facility. Maintenance Director Ryan Nash tested the delayed egress in the memory care. LPA observed the delayed egresses as functional. No deficiency was cited during todays visit. This report was reviewed with Wellness Director Trisa Cysewski. A copy of this report was provided.the state’s words, verbatim · CDSS document, May 20, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management visit and met with Well ness Director (WD) Trisa Cysewski. LPA came to the facility to conduct a wellness check and review the status of the repair of delayed opening exit doors of memory care unit. LPA addressed the purpose of today's visit to WD. WD stated the delayed opening exit doors of memory care unit is scheduled to fix by next Friday. WD the facility has 4 caregivers and 1 Med Tech for Memory care Unit in AM and PM shifts. 2 caregivers and 1 Med Tech in NOC shift for Memory care unit. WD stated the facility has 2 caregivers and 1 Med Tech in assisted living unit for AM and PM shifts, and 1 caregiver and 1 Med Tech in assisted living unit for NOC shift. LPA interviewed 8 care staff. LPA toured memory care unit with WD. Exit interview was conducted with WD. The report was provided to WD for review and for signature. A copy of the report was provided to WD.the state’s words, verbatim · CDSS document, May 1, 2026

Type of visit: Case Management - Other

Licensing Program Analysts Steve Chang and Manuel Monter conducted an unannounced visit for wellness check and met with Regional Coordinator Specialist from corporate Melissa Desterhouse (RCS). RCS stated the current census is 80 including 29 Memory care residents and 51 assisted living residents. RCS stated there are 4 caregivers and 1 Med Tech in Memory care unit and 2 caregivers and 1 Med Tech Assisted living unit. RCS stated there are 4 residents on hospice care. LPA toured the facility with Wellness Director (WD), RCS, and Maintenance Director (MD). LPA toured the first floor dining room and kitchen. The temperature of the freezer was observed at -2 degree F and the temperature of the refrigerator was observed at 38 degree F. 2 day perishable food supplies and 7 days non perishable food supplies were observed sufficient. The salon room, theater, and activity room, common restrooms, and one resident room in the first floor were checked. Elevators were observed functional. LPA checked the delayed opening exit doors of the memory care unit. When the delayed opening exit doors were pushed, the alarms sounded but the exit doors were able to open without delay. Fire extinguishers were found on service on 03/31/2026. Memory care unit dining room, a resident room, and activity room in memory care unit were checked. Continue on LIC809-C. LPA toured the third floor of assisted living unit. Medication cart was observed locked. Fitness center and resident rooms were checked. LPA toured the forth floor of assisted living unit. Medication cart was observed locked. Spa room, Medication room, and resident were checked. Medication room was unable to locked. The refrigerator and closet in Medication room were observed locked. Evacuation chairs were observed at the two stairs. LPA toured the office area and restroom in the basement. LPA requested resident roster and LIC500. LPA interviewed 8 care staff. Exit interview was conducted with RCS. A technical assistance was provided. The report was provided to RCS for review and for signature. A copy of the report was provided to RCS.the state’s words, verbatim · CDSS document, Apr 24, 2026

Allegation investigated: Due to lack of supervision, resident engaged in sexual relations with another resident. Staff do not ensure residents laundry is done.

Lincesing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Regional Coordinator Specialist Melissa Desterhouse (RCS).. On 12/17/2025, the Department received a complaint with the allegation that due to lack of supervision, resident engaged in sexual realtions with another resident. On 12/23/2025 and 01/06/2026, the Deaprtment conducted investigation visits. LPA interviewed 3 staff, 6 residents, and toured risedent rooms. LPA requested schedule of laundry, the incident report, physician reports and care plans of residents R1 and R2. Continue on LIC9099-C. Page 1 of 4. Unfounded Due to lack of supervsion, resident engaged in sexual relations with another resident: On 11/17/2025, around 7:12PM, facility staff received a notice from surveillance video system that a fall in a resident room in memory care unit. Facility staff went to the resident room to check and found resident R1 and R2 were undressed from the waist down. R1 was on the floor and was assisted by staff to get off the floor. R1 and R2 were assessed and both were found without injuries and were not under distress. Staff S1 reviewed the camera footage, the video showed that R2 and R1 potentially engaged in intercourse. Both residents R1 and R2 were then separated and put into their respective apartments. On 11/19/2025, the Department received the incident report from the facility. LPA called the facility and interviewed previous Wellness Director (PWD). R1 and R2 do not recall what happened. R1 and R2's families, police, and LTCO were notified. PWD stated, this was the first time that both R1 and R2 have exhibited these behaviors. LPA requested R1 and R2's Physician Report, and Care Plans. On 12/23/2025, LPA interviewed Vice President of Wellness from corporate (VPW). VPW stated resident R1 went to resident R2's room, both R1 and R2 are memory caret residents. VPW stated staff responded to surveillance video system because R1 was found on the floor. VPW stated staff entered R2's room to check and found R1 and R2 were without underpants. R1 was on the floor. R1 and R2 were assessed and no injuries were found. R1 and R2 were not under distress. R1 was on R2's bed and had engaged in intercourse which led to R1's falling off the bed. The sex appeared to be consensual. R2 was unable to remember what happened. R1 denied any sexual abuse or coercion. The facility notified LTCO, police and CCL office. The facility notifies R1 and R2's families. Both families do not have any concern about the incident. LTCO and police came to the facility on 11/18/2025 to investigate. The facility did not receive any accusation from Police and LTCO. VPW stated R1 and R2 were observed talking to each other before several times. VPW stated R1 and R2 seems to be friends. VPW stated after the incident, R1 and R2 still talk to each other and nothing seems strange. VPW stated this is the only one case between R1 and R2. VPW stated R1 and R2 talk to each other very often on common area. VPW stated R1 did not went to any other rooms before and after the incident. LPA interviewed staff S1. S1 stated he/she received notice from surveillance video system for a resident fell on the floor and went to check resident R2's room and found R1 and R2 were naked from wrist to bottom. S1 stated from the camera footage, R1 and R2 had intercourse. S1 stated the sex appears to be consensual. Continue on LIC9099-C. Page 2 of 4. S1 stated on 11/17/25 after dinner, around 7:20PM, he/she was distributing medications to residents in memory care unit, and caregivers were helping residents to prepare to go to beds. S1 stated there were 4 caregivers on duty for memory care unit. S1 stated he/she did not see R1 entered R2's room. S1 stated there were no noise, no screaming, and no shouting at that time period. S1 stated R1 does not complain anything. S1 stated both families do not have any complaint and no concerns. S1 stated R1 and R2 are friends. Based on the interview and record reviewed, the facility notified the incident to LTCO, Police, CCL office, and families. The facility did not receive accusation for the incident. Staff do not enure residents laundry is done: On 12/23/2025, LPA interviewed Vice President of Wellness (VPW) from the corporate. VPW stated the facility provide laundry service once per week and as needed. VPW stated the laundry including resident's clothes, bed sheet, and linens. VPW stated if the residents need more laundry service they can notify the facility. VPW stated the resident family needs to provide the laundry basket, and the resident's soiled clothes can be put in. VPW stated the facility has scheduled laundry for residents. VPW stated caregivers conduct the laundry and will put the clean clothes back to resident room and fold them into closet. VPW provided the copy of the laundry schedule. LPA toured 11 resident rooms with VPW, LPA did not see soiled clothes piled in the resident rooms. VPW stated caregivers can help to put the soiled clothes in basket, but only when caregivers enter the resident room. LPA interviewed 6 residents. 6 Out of 6 residents did not complain the facility laundry service. On 01/06/2026, LPA interviewed Operational Specialist (OS) from corporate. OS stated memory care unit residents have 2 laundries per week and assisted living unit residents have a laundry per week. OS stated each resident room has closets to put resident's clothes, bedding and linens. OS stated residents can bring their furniture in their rooms OS stated usually the closet space is big enough for resident to put their clothes and bedding/linen. OS stated some residents bring their cabinet/furniture to place their extra clothes and linens. Continur on LIC9099-C. Page 3 of 4. LPA toured all the 34 bedrooms in memory care unit with OS and Maintenance Director (MD). LPA did not observe any resident laundry basket with "overflow" soiled clothes. LPA did not observe resident room was unorganized or messed up with soiled clothes. LPA observed room #201 with clean and organized linens piled on a sofa. LPA checked resident rooms' closet and cabinet with OS, and found some closets/cabinets of resident rooms were full. OS explained if resident has too many clothes and linens for caregiver to put in closet and cabinet, they can bring their own closet or furniture. LPA observed some rooms having blankets on the chair or sofa which are believed that residents used them when they sat or slept on chair/sofa before, and residents left the blanks there on purpose. The Department has investigated the above allegations. Based on the investigation, records reviewed, and interviews conducted, the Department found that the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citations noted at today’s compliant investigation visit. Exit interview was conducted with RCS. This report was provided to review and for signature. A copy of this report was provided to RCS. Page 4 of 4.the state’s words, verbatim · CDSS document, Mar 4, 2026 · control 26-AS-20251217162749

Type of visit: POC

Licensing Program Analyst Manuel Monter conducted a POC case management visit to clear a deficiency cited on February 11, 2026 and met with Wellness Director Trisa Cysewski. LPA explained the purpose of the visit. The facility was cited the following Type A deficiency on February 11, 2026 87468.1 Personal Rights of Residents in All Facilities (a)(1), POC due date February 12, 2026. LPA received plan of corrections for type A deficiency by POC due date. Deficiency cleared during todays visit. POC cleared letter provided to Wellness Director Trisa Cysewski No deficiency was cited during todays visit. This report was reviewed with Regional coordinator specialist Melissa Desterhouse. A copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 20, 2026

Allegation investigated: Staff did not ensure resident received medication in a timely manner

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced complaint investigation visit and met with Administrator Camille Burke On September 29, 2025, the Department received a complaint alleging Staff did not ensure resident received medication in a timely manner. It has been alleged on August 17, 2025, the facility did not ensure a residents medication was administered timely. On October 2, 2025, LPA Steve Chang interviewed residents R1 and R2. Residents R1 and R2 were unable to provide an answer to questions posed and did not provide any relevant information due to neurocognitive disorder. Unsubstantiated On October 2, 2025, LPA Steve Chang interviewed resident R1. Residents R1 was unable to provide an answer to questions posed and did not provide any relevant information due to neurocognitive disorder. On December 26, 2026, LPA Monter interviewed Staff S1. S1 stated R1 would try to hit the care staff when they are providing care. S1 stated they can in as a group, 4, to change R1. S1 stated he/she was the first to pull R1 up. S1 stated his/her intent in pulling was to get R1 up, so they can change R1. S1 reiterated he/she approached this way due to the fact that R1 can be combative and they need to change R1 quickly. S1 acknowledged that he/she pulled R1 with too much force. S1 stated he/she had to pull because R1 is very strong and resistive to care and heavy. S1 stated the other issue was staff S2 had also pulled when he/she pulled, causing to much momentum. S1 stated this caused R1 to be pulled forward too much and resulted in R1 falling. S1 stated since R1 was already on the floor, R1 still needed to be changed on the floor. S1 stated while R1 was on the floor, he/she was just holding his/her hands because R1 was being resistive and combative with the staff. S1 stated that day was the first time they changed R1 on the floor. On January 6 and 16, 2026, LPA Monter interviewed staff S2 and S4. S2 stated when staff attempt to change resident R1: R1 will swing his/her arms and kick in response. S2 stated regarding the incident that occurred on September 26, 2025, they were assisting R1 with changing. S2 stated there were 3 staff assisting in changing R1. S2 stated they tried their best to change R1. S2 stated they tried to position R1 to the middle of the bed but R1 was pushing and hitting. S2 stated this resulted in R1 falling. S2 stated staff tried to prevent the fall, but R1 was still being combative. S2 stated since R1 was now on the ground, the other staff were helping R1 get changed. S2 stated it was difficult as R1 was still being combative, he/she and S1 were holding R1’s arms to prevent being hit by R1. S2 stated they don’t change R1 on the floor. Staff S4 stated regarding the incident that occurred on September 26, 2025, he/she was shadowing a care giver and was informed they would change R1. S4 stated based on what he/she was taught, the way they changed R1 was how he/she was shown by the other care givers. S4 stated he/she was only doing what he/she was taught. S4 stated R1 was being combative. S4 stated the days he/she was shadowing, he/she observed R1 being combative every time he/she was being changed. S4 stated he/she doesn’t remember the details of that day. S4 stated he/she doesn’t know what to say. S4 stated he/she only did as instructed. S4 stated he/she was sorry for what happened. On February 11, 2026, LPA reviewed video footage dated September 25, 2025 with Administrator Camille Burke. (This video footage has staff S2, S4 and S14 present.) ADM stated the video footage showed the staff members in question where clearly only goal oriented. ADM stated the method they used to get R1 up and changed was the incorrect way of changing a resident who is being combative. On February 11, 2026, LPA reviewed video footage dated September 26, 2025 with Administrator Camille Burke. (This video has staff S1-S4 present) ADM stated the video footage showed a similar situation where multiple staff members where using incorrect methods to change a combative resident, and using to much force to pull the resident up from their bed. Based on interviews and documents review the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED. A deficiency is being cited during todays visit. See LIC9099-D. This report was reviewed with Administrator Camille Burke. Appeal Rights were provided. On December 15, 2025, LPA Manuel Monter interviewed Witness W1. W1 stated on August 17, 2025, R2 was not provided his/her morning medications. W1 stated he/she used to have video footage showing R2 was not assisted that morning with his/her medications, but did not save the video footage. On December 17, 2025, LPA Manuel Monter interviewed staff S5-S10. 6 Out of 6 staff (S5-S10) stated they are not aware of any instance where a resident was not administered their medication. On December 17, 2025, LPA Manuel Monter interviewed residents R1, R3-R5. LPA attempted to interview R1, but R1 would digress to unrelated topics. R1 was unable to provide any relevant information due to neurocognitive disorder. R3 stated he/she gets his/her medication on time with no issues. 2 Out of 4 (R4 & R5) stated they handle their own medications and do not need staff assistance. On December 17, 2025, LPA Manuel Monter interview Administrator (ADM) April Trixia. ADM stated she isn’t aware of an instance where a resident was not administered their medication. On December 26, 2025 LPA Manuel Monter interviewed residents R6-R14. Resident 8 Out of 9 residents (R6-R13) stated they have been receiving their medications on time and hasn’t had any issues regarding their medications. Resident R14 was unable to provide an answer to questions posed and did not provide any relevant information due to neurocognitive disorder. On December 26, 2025, LPA Manuel Monter interviewed staff S1. S1 stated he/she does not handle residents medications and is not aware of any issues regarding residents medications. On January 6 and 7, 2026, LPA Manuel Monter interviewed S2, S4, S11-S13. S2 stated he/she has found medication tablets on the ground in residents bedrooms. S2 stated when he/she brought this to the attention of the Medtech’s, the Medtech’s would say it wasn’t them and had occurred on the previous shift. S2 stated he/she couldn’t specify which bedrooms or how many instances he/she has found medications on residents beds / bedroom floor. Staff S4 and S11 stated they don’t not handle residents medications and is not aware of any instance where medications were missed or not administered. Staff S12 and S13 stated they are not aware of any instance where a resident was not administered his/her medication. On January 6, 2026, LPA Manuel Monter interviewed former Wellness director, Angel Bustos, referred to as WD. WD stated he/she isn’t aware of an instance where a resident was not administered their medication. On January 6, 2026, LPA Manuel Monter interviewed former Memory Care Director Diana Salah, referred to as MC. MC stated isn’t aware of an instance where a resident was not administered their medication. MC stated he/she is aware of the allegation that R1 was not given his/her medication. MC stated R1 did receive his/her medication that day. The Department reviewed R2’s Medication Administration Record (MAR), dated August 2025. Based on the MAR Medication M1 and Medication M2 are to be administered at 9:00am. The MAR states M1 and M2, were given on august 17, 2025. Furthermore, both M1 and M2, instructions state both these medications need to be administered daily, but do not specify a specific time the medication needs to be given by. On February 5, 2026, LPA Manuel Monter randomly audited 3 resident’s medications (R15-R17). LPA audited the medications by cross referencing the medication bottles/containers and cross referencing with the Centrally Stored Medication Record and Medication Administration Record. 2 Out of 3 residents Medications reviewed (R15 & R16) had inconsistencies. On February 11, 2026, LPA interviewed Wellness Director (WD) Trisa Cysewski and Administrator Camille Burke why there was inconsistencies with R15 and R16's medications. Administrator Burke and Wellness director Cysewski stated they didn't know there was discrepancies. 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, Feb 11, 2026 · control 26-AS-20250929092054

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Feb 12, 2026

87468.1 Personal Rights of Residents in All Facilities (a) (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on evidenced reviewed, on 9/25/25 & 9/26/26, staff S1-S4, & S14, were observed handling resident R1 in a rough manner and did not accord R1 with dignity when changing his/her diaper. This poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 11, 2026

Plan of correction: ADM stated the staff in question, S1-S4, S14 have been fired. ADM stated conducted a personal rights training and safe transfers for her staff on February 10, 2026. ADM stated she will send documentation showing her staff have attended the training. ADM stated she will send documentation to LPA by POC due date, February 12, 2026.

Type of visit: Case Management - Incident

Licensing Program Analyst Manuel Monter conducted an unannounced case management- Incident visit, regarding a SOC341, personal rights violation, regarding resident R1. LPA also subsequently violations issued discovered during the complaint investigation for 26-AS-20250929092054. LPA with Administrator Camille Burke Potential Violation discovered during compliant investigation process 26-AS-20250929092054 During complaint investigation, LPA randomly reviewed residents medications. LPA noted discrepancies with residents R15 and R16 medication records, when reviewing their Medication administration records, Centrally Stored Medication Records and a physical Pill count. At this time, this case in under review and Department will conduct a follow up visit , if warranted. Follow up on incident dated February 9, 2026 On February 10, 2026, the Department received a SOC341 regarding resident R1. R1 has camera in his/her apartment. R1's Family member brought the footage to the facility on 2/09/2026. The video footage showed the following, On February 5, 2026 at around 2.00am, Staff S1 did rounds to check on residents. R1 came to R1's Apartment. S1 approached R1 and woke him/her up to change his/her brief. At first S1 stated to resident he/she wanted to check if his/her brief was wet but resident refused and told S1 to go away. S1 kept insisting to change resident's brief and was persistent in his/her approach to the point resident had increased agitation and became combative. (Continued on LIC809-C) R1 continued to hit, punch and kick S1. S1 kept asking resident to stop hitting, punching and kicking him/her but resident continued shouting and asking S1 to leave him/her alone. S1 brought the wheelchair and placed it along side the bed and in-spite of R1's refusals and combativeness to comply to care, S1 transferred resident to his/her wheelchair after a few attempts, R1 kept screaming for help but S1 took resident to the bathroom and changed his/her brief. S1 then wheeled resident out of his/her apartment to the dining room. R1 was then wheeled back to his/her apartment after some time. R1 was calm at that time and said thank you to S1. LPA requested copies of the following documents: R1's Physician's Report and care plan. R1's Progress notes from December 2025 - February 2026 R1's Emergency Contact Sheet S1's Training records for 2026 and 2025 S1's LIC501 S1's Photo ID At this time, this case in under review and Department will conduct a follow up visit , if warranted. No deficiency noted today. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Feb 11, 2026

Allegation investigated: Staff who is not a skilled medical professional performed glucose testing Staff did not dispose expired medications per facility procedures. Licensee/Administrator is not completing the required staff training hours per Title 22 regulations.

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Wellness Director Trisa Cysewski On August 12, 2025, the Department received a complaint alleging Staff who is not a skilled medical professional performed glucose testing. It has been alleged an unskilled staff preformed glucose testing for resident R1. On August 21, 2025, LPA Steve Chang interviewed Executive Director (ED) Stephanie Hall. ED stated the facility does not provide the install service of sensor or blood sugar monitoring device for residents. LPA Chang interviewed Wellness Director (WD) Angel Bustos. WD stated the facility does not provide the service to install a censor or blood sugar monitoring device in resident's body. Page 1 Out of 6 Unfounded LPA Chang interviewed R1. R1 stated he/she does not have insulin injections. R1 stated every 2 weeks the the blood sugar monitoring device is switched from his/her right/left arm to the other arm. On December 17, 2025, LPA Manuel Monter interviewed staff S1-S6. 6 Out of 6 (S1-S6) staff stated the only people who can preform glucose testing is the nurse or the resident themselves. 6 Out of 6staff (S1-S6) stated he/she hasn’t seen any unqualified staff administering glucose testing. On December 26, 2025, LPA Manuel Monter interviewed staff S7. S7 stated he/she has not observed anyone administer insulin or do glucose testing. S8 stated he/she doesn’t handle residents medications and isn’t aware regarding insulin or glucose testing. On December 26, 2025, LPA Manuel Monter interviewed Residents R1. R1 stated he/she has a continuous glucose monitor, which sends the information to the app. R1 stated he/she doesn’t need to do any finger pricks or any form of injections to monitor his/her glucose. R1 stated he/she also takes medication tablets for his/her diabetes. R1 stated his/her family member is the person who switches the censors for him/her blood sugar monitor every 2 weeks. On January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 3 Out of 5 staff (S8, S11, S12) stated they doesn’t handle residents medications and doesn’t know about residents insulin or glucose testing. S9 stated only a nurse can administer insulin or preform glucose testing. S10 stated the resident’s family does the switching of the glucose sensors. S10 stated he/she only marks it on the MAR. On January 6, 2025, LPA Manuel Monter interviewed Wellness Director (WD) Angel Bustos. WD stated at the facility, they do not administer residents insulin. WD stated facility staff do not do any injections of any kind, and only the nurse can do this. WD stated she initially put the sensor for resident R1. WD stated R1’s family member was changing the sensor. WD stated the family changes the sensor, while the medtech gives the family the new sensor and marks it on the MAR. Page 2 Out of 6 On January 8, 2026, LPA Manuel Monter interviewed Administrator (ADM) April Princesa. ADM stated regarding the changing of R1’s glucose testing sensors: R1’s family member changes R1’s sensors every 2 weeks. ADM stated the med tech will provide the new censor to R1’s Family member and will observe the changing of the censors and will mark it on the MAR. ADM stated medtechs check the blood sugar for R1 by putting the phone on to check the blood sugar, via the censor. On January 13, 2026, LPA Manuel Monter interviewed R1’s Family Member (FM). FM stated he/she changes R1’s glucose testing censors. FM stated the staff at the assisting living facility don’t do it. FM stated he/she has been changing R1’s sensor for the last 3 months. FM stated there used to be a nurse at the facility that used to change it, once he/she left, he/she needed to do it. The Department reviewed R1’s Physician’s report, dated March 4, 2025. The Physician’s report states R1 is not able to administer his/her own medications The Department reviewed R1's Individual Service Plan, dated October 29, 2024. The plan states the facility staff will assist R1 with diabetes treatment plan. 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 did not dispose expired medications per facility procedures. On August 12, 2025, the Department received a complaint alleging Staff did not dispose expired medications per facility procedures. It has been alleged expired medication are being kept in the 4th floor med room. On August 21, 2025, LPA Steve Chang toured facility med room and med carts in the 2nd floor, 3rd floor and 4th floor. LPA did not observe any expired medications. LPA also inspected medication in refrigerator of med room and did not observe any expired medications. Page 3 Out of 6 LPA Chang interviewed Memory Care Coordinator (MC) Diana Sala. MC stated she maintains the medications destruction documents. MC showed and provided the medication destruction log. MC showed the medication destruction box in Wellness direction office. LPA Chang interviewed Assisted Living Coordinator (ALC), Jacque Barcellano. ALC stated company SHARPS helps the facility to destroy the expired medications. ALC stated there are 2 medication destruction box in Wellness director office and assisted living director office. ALC provided the medication destruction log documents. On August 21, 2025, LPA Chang made the following observations: LPA to toured the med room and med carts in 2nd, 3rd and 4th floor. LPA checked the medications, LPA did not see the expired medications. LPA observed all the med carts were locked and Med room was locked. LPA checked the medications in refrigerator of Med room. LPA did not see the expired medications inside. On December 17, 2025, LPA Manuel Monter interviewed staff S1-S6. 5 Out of 6 Staff (S1-S4, S6) stated they are not aware of the details regarding expired medications. 5 Out of 6 staff (S1-S3, S5) stated expired medications are locked in the wellness directors office in the first floor for destruction. Staff S5 stated expired medications are destroyed by the nurse. On December 17, 2025, LPA Manuel Monter toured the fourth floor med room. LPA observed the refrigerator in the med room, which contained medications that were not expired. On December 24, 2025, LPA Manuel Monter interviewed staff S7. S7 stated he/she isn’t aware of the expired medication procedures. On January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 3 Out of 5 staff (S8, S11, S12) stated they do not handle residents medications and are not aware of the facility’s expired medication protocols. 2 Out of 5 staff (S9-S10) stated when there is expired medications, Medtech’s are supposed to take them to the wellness directors office on the first floor for destruction. Page 4 Out of 6 On January 6, 2026, LPA Manuel Monter interviewed Wellness Director (WD), Angel Bustos. WD stated when there is an expired medication, Medtech’s take the expired medications to her office (Wellness directors office) for destruction, when in two members will destroy the medication in the presence of each other and recorded. The Department reviewed the facility’s Medication Destruction Policy, dated September 2024. The policy states discontinued, unused or expired medications will be destroyed by the community. Until destroyed, medications will kept secure in the medication room. If medications may be returned to the pharmacy for destruction for credit, follow the pharmacy policy on returns. If medications are destroyed at the community: two team members will destroy the medications. Two team members will perform the destruction in the presence of each other. Medications will destroyed either utilizing the drug buster disposal system or medsafe basic / medsafe. 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. Licensee/Administrator is not completing the required staff training hours per Title 22 regulations. On August 12, 2025, the Department received a complaint alleging Licensee/Administrator is not completing the required staff training hours per Title 22 regulations. On December 17, 2025, LPA Manuel Monter interviewed staff S1-S6. 6 Out of 6 (S1-S6) staff stated staff have been provided their required training. 6 Out of 6 (S1-S6) Staff stated they are not aware of any staff who were not provided training. On December 17, 2025, LPA Manuel Monter randomly reviewed 5 staff records. LPA observed staff training records to be complete. On December 24, 2025, LPA Manuel Monter interviewed staff S7. S7 stated he/she was provided his/her required training. S7 stated he/she is not aware of any staff that were not provided their required training. Page 5 Out of 6 On January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 4 out of 5 staff (S8, S9, S10, S12) stated staff have been provided their required training and they are not aware of any staff who were not provided with their training. S11 stated he/she was provided with training and was/is shadowing and learning his/her position. On January 6, 2026 LPA Manuel Monter interviewed Memory Care Director (MC) Diana Salah. MC stated staff have been provided their required training and she is not aware of any staff who were not provided with their training. On January 23, 2026, LPA Manuel Monter randomly reviewed 4 staff training records. LPA observed staff training records to be complete. LPA Manuel Monter interviewed Wellness Director (WD) Angel Bustos. WD stated staff have been provided their required training and she is not aware of any staff who were not provided with their training. 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 6 Out of 6. LPA Monter interviewed residents R10-R13. Resident R10 did not respond to questions posed by LPA and was unable to provide any relevant information due to neurocognitive disorder. Resident R11 stated he/she likes the food the facility makes. R11 stated there hasn’t been a time when a resident was served food that was under cooked, boiling hot, or cold. 2 Out of 4 Residents (R12 & R13) stated the food the facility makes is always overcooked and has never been undercooked. 2 Out of 4 Residents (R12 & R13) stated the food always comes out cold. On December 26, 2025, LPA Manuel Monter interviewed staff S7. S7 stated he/she hasn’t observed food being served to residents during his/her shift. S7 stated he/she isn’t aware of any issues. On December 26, 2025, LPA Manuel Monter interviewed Residents R1, R3, R4, R8, R14- R17. 6 Out of 8 Residents (R1, R3, R4, R8, R14, R15) stated the food served at the facility is adequate. R17 stated the food the facility makes is good. R16 stated he/she doesn’t like the food served at the facility. 7 Out of 8 residents (R1, R3, R4, R8, R14, R15, R17) stated he/she has never been served food that was cold or undercooked. 1 Out of 8 Residents (R16) stated meals are served cold to the residents at least once a week. 1 Out of 8 Residents (R16) stated he/she was served undercooked salmon once but doesn’t remember the date. On December 26, 2025, LPA Manuel Monter interviewed Kitchen Staff K1-K3. 3 Out of 3 Kitchen Staff (K1-K3) interviewed stated they have not seen any resident being served food that was undercooked or served meals that were cold. On December January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 2 Out of 5 Staff ( S11) stated meals are not served during their shift and isn’t aware of any issues regarding residents’ meals. 4 Out of 5 Staff (S8- S10, S12) stated they have not seen any resident being served food that was undercooked or served meals that were cold or too hot. Page 2 Out of 5 On January 6, 2026 LPA Manuel Monter interviewed Memory Care Director (MC) Diana Salah. MC stated he/she has never seen residents served food that was under cooked (meat / vegetables). MC stated she has never seen food served to resident cold or too hot. MC stated food is brought to the memory care unit from a cart. MC stated the meals are on hot plates then given to residents, warm. LPA Manuel Monter interviewed Wellness Director (WD) Angel Bustos. WD stated he/she has never seen residents served food that was under cooked (meat / vegetables). WD stated she has never seen food served to resident cold or too hot. 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 is not meeting residents' needs due to lack of staffing. On August 12, 2025, the Department received a complaint alleging Staff is not meeting residents' needs due to lack of staffing. On August 21, 2025, LPA Steve Chang interviewed Executive Director (ED) Stephanie Hall. ED stated for AM shift memory care unit, there are 5 caregivers and 1 Med tech for 34 residents. ED stated for AM shift assist living unit, there are 2 caregivers and 1 med tech for 26 assisted living residents and 24 independent residents. ED stated there is a nurse for AM shift. ED stated PM shift is the same as AM shift. ED stated for NOC shift, there are 2 caregivers for memory care unit and one caregivers for Assist living unit. 1 med tech for both AL and MC unit. ED stated nurse is on call for NOC shift. On December 17, 2025, LPA Manuel Monter interviewed staff S1-S6. 5 Out of 6 staff (S1, S2 S4 – S6) stated there is enough staff to meet the needs of the residents. 1 Out of 6 Staff (S3) stated there isn’t enough staff. Page 3 Out of 5. LPA Monter interviewed residents R10-R13. Resident R10 did not respond to questions posed by LPA and was unable to provide any relevant information due to neurocognitive disorder. R11 stated there is enough staff to meet the needs of the residents. 2 Out of 4 residents (R12-R13) stated there is not enough staff. 2 Out of 4 residents (R12-R13) stated the issue is that there has been 3 different administrators in the past year and a lot of staff turn over. On December 17, 2025, LPA Manuel Monter toured the facility and toured resident bedrooms: 247, 222, 223, 224, 227, 225, 219, 221, 217, 215, 211, 228, 209, 207, 205, 203, 201, 230, 231, 235, 245, 237, 239, 244, 241, 243, 242, 249, 255, 251, 253, 1133, 3124. While touring these bedrooms, LPA observed the bedrooms as clean and in good repair. While touring the memory care LPA did not observe residents in a soiled / disheveled state. On December 26, 2025, LPA Manuel Monter interviewed staff S7. S7 stated there isn’t enough staff to meet the needs of the residents. S7 stated there are many residents and its difficult to assist so many residents, with only 2 care givers and a medtech during the Night shift. On December 26, 2025, LPA Manuel Monter randomly tested a residents pendant to assess the facility’s response time. Facility staff responded the pendant in 5 minutes and 53 seconds. On December 26, 2025, LPA Manuel Monter interviewed Residents R1, R3, R4, R8, R14- R17. 3 out of 8 residents (R1,R3, R16) stated there is not enough staff to meet the needs of the residents. R1 stated he/she has pressed his/her pendant and the staff can take up to 20 minutes to respond. R1 R3 R16 stated due to the turn over there may not be enough staff to respond quickly to residents needs. 5 out of 8 Residents (R4, R8, R14, R15, R17) stated there is enough staff to meet the needs of the residents. On January 6 and 7, 2026, LPA Manuel Monter interviewed staff S8-S12. 3 out of 5 staff (S8, S9, S11) stated there is enough staff to meet the needs of the residents. 2 Out of 5 staff (S10, S12) stated there isn’t enough staff to meet the needs of residents in the facility. S10 stated there is a lot of call outs in the memory care unit and it is difficult for the facility to have a full staff to meet the needs of the residents in the memory care unit. S12 stated the facility memory care unit is always short staffed. S12 stated staff are constantly quitting and the memory care unit is so short staffed, they always need coverage assistance. Page 4 Out of 5. On January 6, 2026, LPA Manuel Monter interviewed Memory Care Director (MC) Diana Salah. MC stated there is enough staff to meet the needs of the residents. MC stated on the instances where staff call out sick, she and the assisted living coordinator will help cover if needed. LPA Manuel Monter interviewed Wellness Director (WD) Angel Bustos. WD stated there is enough staff to meet the needs of the residents. WD stated on the instances where staff call out sick, she and the Memory Care Director will help cover if needed. 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 5 Out of 5. END OF REPORTthe state’s words, verbatim · CDSS document, Jan 23, 2026 · control 26-AS-20250812163239

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to deliver the results of a complaint investigation 26-AS-20250812163239. During the complaint investigation, a case management deficiencies visit was conducted due to violations discovered during the investigation process. LPA met with Wellness Director (WD) Trisa Cysewski and explained the purpose of the visit. The Department reviewed R1’s July and August 2025 Medication Administration Record (MAR). Based on a review, the facility is recording R1’s blood glucose level twice daily. The MAR is also tracking the change in glucose monitoring sensor every 2 weeks. The Department reviewed R1’s Physician’s Order Report, dated December 13, 2025. Based on a review R1’s glucose monitoring is scheduled to be completed daily at 5:00am and 5:00pm. R1’s glucose sensor is changed every 2 weeks. On January 8, 2026, LPA Manuel Monter interviewed Administrator (ADM) April Princesa. ADM stated R1’s family member changes R1’s censors every 2 weeks. ADM stated the med tech will provide the new censor to R1’ son and will observe the changing of the censors and will mark it on the MAR. ADM stated Medtech’s check the blood sugar for R1 by using the glucose monitoring device and check the blood sugar, via the censor. Page 1 Out of 2. On January 23, 2026, LPA interviewed Wellness Dirctor (WD) Trisa Cysewski. WD stated the facility can conduct a training with her medtechs she would send documentation showing her medtechs have been trained regarding R1’s glucose monitoring devices such as but not limited to: function, how the glucose censor is supposed to be changed, and interventions when the reading is out of normal ranges. LPA advised WD the facility to update R1's service plan to address the care and supervision for his/her dialysis. WD stated she will request a detailed physician order with parameters for the glucose monitoring device, such as who would change the sensor, and interventions when the reading is out of normal ranges. The Department reviewed R1’s Individual Service Plan, dated November 1, 2025. The plan states under diabetes; R1 does not require blood glucose monitoring. Furthermore, the individual service plan does not state who would be changing R1’s glucose testing censor and evaluating the area for any adverse effects. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Wellness Dirctor (WD) Trisa Cysewski and a copy of the report and appeal rights were provided Page 2 Out of 2. END OF REPORTthe state’s words, verbatim · CDSS document, Jan 23, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Jan 30, 2026

87463 Reappraisals (a) The pre-admission appraisal…shall be updated in writing as frequently as necessary…to keep the appraisal accurate…shall be referred to as the reappraisal. This requirement was not met as evidence by: Based on records reviewed, R1’s individual service plan does not address or explain how the facility will manage R1’s glucose monitoring requirements or how the glucose sensor will be replaced. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 23, 2026

Plan of correction: ADM stated she would send an updated individual service plan detailing how the facility will manage R1’s glucose monitoring requirements or how the glucose sensor will be replaced. ADM stated the individual service plan will also indicate how to monitor the device and what interventions for out-of-ordinary range readings. ADM stated she will send the plan of correction to LPA by POC due date, January 30, 2026.

Allegation investigated: Staff handled resident in a rough manor Staff stole residents' medication

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Carlos Espino, Associate Executive Director. On 01/30/2025, the Department received a complaint with the above allegations. On 02/07/2025, LPA Marrufo conducted an initial complaint investigation visit. On 05/06/2025 and 01/02/2026, LPA Marrufo conducted additional complaint investigation visits. Allegation: Staff handled resident in a rough manner When the department received the complaint, it was alleged that staff S1 would forcefully shower residents. During visit on 02/07/2025, LPA Marrufo interviewed staff S2-S5, who stated to have never observed S1 forcefully shower a resident or handle a resident in a rough manner. S1-S5 stated to have never handled a resident in a rough manner and to have never observed another staff handle a resident in a rough manner. See LIC9099-C page for more information. Page 1 of 2. Unfounded During visit on 02/07/2025, LPA Marrufo interviewed S1. S1 stated to have never forcefully showered a resident or handled a resident in a rough manner. During visit on 05/06/2025, LPA Marrufo interviewed residents R1-R9, who stated to have never been forcibly showered or handled roughly by S1 or any other staff. During visit on 01/02/2026, LPA Marrufo interviewed staff S6, who stated to have never observed S1 forcefully shower a resident or handle a resident in a rough manner. S6 stated to have never handled a resident in a rough manner and to have never observed another staff handle a resident in a rough manner. Allegation: Staff stole residents' medication When the department received the complaint, it was alleged that S1 gave resident’s pain medications to employees. During visit on 02/07/2025, LPA Marrufo reviewed the medication records and medications for 6 residents, including R7 and R8. R7 was missing half a tablet of medication M1. R8 was missing half a tablet of medication M2. During visit on 02/07/2025, LPA Marrufo interviewed staff S1-S5, who stated to have not observed a staff give a resident’s medication to another staff. During visit on 05/06/2025, LPA Marrufo interviewed residents R1-R9, who stated to have not suspected staff of stealing their medications. During visit on 01/02/2026, LPA Marrufo interviewed S6, who stated to have not observed a staff give a resident’s medication to another staff. This agency has investigated the complaint allegations listed. Based on interviews with staff and residents and review of records, the CCLD has found that the complaint allegations are UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. This report was reviewed with Carlos Espino, Associate Executive Director, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 2, 2026 · control 26-AS-20250130110626

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Carlos Espino, Associate Executive Director. The purpose of the visit was to issue an advisory note to the facility for medications that were found to be missing during a medication review as part of a complaint investigation. During visit on 02/07/2025, LPA Marrufo reviewed the medication records and medications for 6 residents, including R7 and R8. R7 was missing half a tablet of medication M1. R8 was missing half a tablet of medication M2. An Advisory Note was issued. See LIC9102 for more information. This report was reviewed with Carlos Espino, Associate Executive Director, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 2, 2026

Allegation investigated: Facility did not provide resident with transportation to medical appointment. Facility did not adhere to Admission Agreement by charging resident for services not rendered

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit and met with Executive Director (ED) Jolie Higgins to deliver the investigation finding. On 08/07/2025, the Department received a complaint with the above 2 allegations. On 08/14/2025, the Department conducted an investigation visit. LPA interviewed previous Executive Director (PED), and 2 staff. LPA requested the admission agreement, transpiration service policy, physician report, and appraisal needs and service plan, Continue on LIC9099-C. page 1 of 4. Unfounded Facility did not provide resident with transportation to medical appointment: On 08/14/2025, LPA interviewed precious Executive Director (PED). PED stated the facility policy is that residents need to make reservations 72 hours in advance for the facility transportation service. PED stated there is no emergency room visit and no urgent care visit for the facility transportation vehicles. PED stated if the facility has the available capacity space for the transportation even the resident does not make reservations 72 hours in advance, the facility still provides the transportation service. PED stated Otherwise the facility arranges other transportation opportunities. PED stated if the needs of transportation is for emergency room visit, the facility will call 911. PED stated in July 2025, resident R1 requested for urgent care/emergency room transportation. PED stated the facility told R1 that the facility will call 911 but R1 refused. ED stated the facility offered the opportunity to call Uber for the transportation and the facility will pay for it but R1 refused. LPA interviewed staff S1. S1 stated the facility policy is that residents need to make an appointment 72 hours in advance for transportation and the facility does not provide transportation for emergency room visit or urgent care visit S1 stated on 07/21/2025, resident R1 told him/her that R1 wanted to go to emergency room due to foot pain. S1 stated he/she told R1 that the facility transportation does not provide the service for emergency room visit due to the liability issue but he/she can call 911 to have ambulance to send R1 to emergency room. S1 stated R1 refused S1 to call 911. S1 stated he/she told R1 that the facility can call Uber to send R1 to emergency room and the facility pays the fee and R1 refused the offer. R1 told S1 that he/she will call S1 later to let S1 know what is R1's decision. S1 stated he/she did not receive R1's callback regarding R1's decision. S1 showed the phone call log on his/her cell phone. Based on the review of the facility transportation log, R1 had the facility transportation services on 07/06/2025, 07/07/2025, 07/10/2025, 07/16/2025, 07/20/2025, and 07/22/2025. Based on the interview and record reviewed, the facility provided the transportation service to R1. R1 requested the facility to transport R1 to emergency room and refused the facility to call 911 to transport R1 to emergency room. Continue on LIC9099-C. Page 2 of 4. Facility did not adhere to Admission Agreement by charging resident for services not rendered: On 08/14/2025, LPA interviewed previous Executive Director (PED). PED stated resident R1 moved in the facility on 06/26/2025 and moved out on 07/31/2025, but the facility only charged R1 one month rent from 07/01/2025 to 07/31/2025. PED stated based on admission agreement, if the resident moves out from the facility within one month the facility refunds 80% of the community fee which is equal to one month rent. PED explained the community fee equals to the resident's one month rent. The facility refunds to residents 80%, 60%, 40% of the community fee if residents move out within one month, within two months, or within 3 months. PED explained the facility does not refund the community fee if residents move out from the facility after 3 months. PED explained the purpose of the community fee is to let residents make a serious consideration/decision before moving in the facility. PED stated if residents really dislike to live the facility within 3 months, the facility refund some portion of the community fee to residents. PED stated this is specified in R1's admission agreement page 9. PED stated R1 signed the agreement and initial on page 9 of the agreement. PED stated the corporate already processed the refund check for R1. PED stated on 07/20/2025 to 7/22/2025, he/she talked to R1 regarding the refund of 80% of community fee when R1 asked about the procedures of moving out from the facility. LPA interviewed staff S2. S2 stated the facility prepared the check with the 80% of R1's community fee. S2 stated he/she received R1's refund check on 8/11/2025 from the corporate. S2 stated he/she tried to contact R1 to pick up the check but was unable to talk to her. S2 stated R1 is the conservator of self. LPA reviewed R1's billing statement dated 06/23/2025, the community fee equals to one month rent is specified and it shows R1's signature on the billing statement. LPA reviewed R1's Admission Agreement dated 05/23/2025, the community fee and refund policy of community fee is specified in the admission agreement. Continue on LIC9099-C. Page 3 of 4. Based on the review of the copy of the cashed check, resident picked up the check on 09/08/2025 with R1's signature, and the check with the amount of $7,768.00 was cashed on 09/09/2025. The Department has investigated the above allegations. Based on the investigation, records reviewed, and interviews conducted, the Department found that the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citations noted at today’s visit. Exit interview conducted with ED. This report was provided to review and for signature. A copy of this report was provided to ED. Page 4 of 4.the state’s words, verbatim · CDSS document, Dec 5, 2025 · control 26-AS-20250807165257

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Executive Director (ED) Jolie Higgins. LPA reviewed 9 residents files and 6 staff files. License, Administrator Certificate, and personal rights posters were observed in the facility. LPA toured the facility inside and out with ED. The facility has four stories and basement. LPA toured the basement, first floor, second floor, third floor and forth floor including lobby, front desk, bistro area, dining room, activity room, theater, salon, kitchen, resident apartments, medication room, spa, enrichment, fitness room, restrooms, activity rooms, offices, storage rooms, and laundry area. LPA tested the delayed opening exit door in the memory care unit with maintenance director (S1). The alarm sounded when the exit door was pushed and cares came on site immediately. LPA inspected the courtyard. Room temperature was observed at 72 degree F, hot water was observed at 118 degree F. Temperature of refrigerator was observed at 35 degree F, and the temperature of freezer was observed at -18 degree F. Food storage can hold the 2 days of perishable food and 7 days of non-perishable food for the entire building. Fire extinguishers were on service on 3/31/2025. The facility was equipped with smoke and carbon monoxide detectors. carbon monoxide detectors were tested, and were working fine. S1 provided the fire alarm system test report dated 09/16/2025. Medication rooms, medication carts, laundry room and chemical storage room were observed locked. Continue on LIC809-C. Page 1 of 2. First Aid Kits were checked and found to be in compliance. The entire building hallways and common area had functioning light fixtures. LPA observed 2 functioning elevator in the facility. Evacuation chairs were found at the stairs. The last time the facility conducted the fire drill was on 11/30/20/25.. No deficiency noted today. Exit interview was conducted with ED. The report was provided to ED for signature. A copy of the report was provided to ED. Page 2 of 2.the state’s words, verbatim · CDSS document, Dec 5, 2025

Allegation investigated: Facility kitchen has cockroaches and/or rodents. The facility refrigerator's maximum temperature of 40 degrees F (4 degrees C) and/or freezer temperature of 0 degrees F or below is not maintained. All utensils used for eating and drinking and in preparation of food and drink are not cleaned and sanitized after each usage. Food items are not stored, prepared in a safe and healthful manner. Staff engaged in food preparation and service were not observing personal hygiene and food services sanitation practices which protect the food from contamination.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Operations Specialist April Princesa (OS). On 09/17/2025, the Department received a complaint with the above allegations. On 09/25/2025, the Department conducted an initial investigation visit. LPA, with 3 county vector control staff toured the facility including kitchen, dining room, memory care unit small kitchen, memory care unit dining room, boiling room, trash room, a resident room in assist living unit, a resident room in memory care unit, and exterior of the building. LPA interviewed previous Executive Director (PED), cooks, servers and Maintenance Director Continue on LIC9099-C. Page 1 of 4.. Unfounded Facility kitchen has cockroaches and/or rodents: On 09/26/2025, LPA with 3 county vector control staff toured and inspected the facility including kitchen, dining room, memory care unit small kitchen, memory care unit dining room, boiling room, trash room, resident room in assist living unit, resident room in memory care unit, and exterior of the facility building. There were no cockroaches or rodents found in the facility and no signs of cockroaches or rodents existing in the facility. LPA interviewed staff S1. S1 stated he/she never saw rodents or cockroaches in the facility. S1 stated the facility has pest control company come to check every week. LPA interviewed the facility Maintenance Director (S2).S2 stated the facility does not have cockroaches or rodents. LPA interviewed previous Executive Director (PED). PED stated he/she have the confident that the facility does not have cockroaches or rodents. Based on the review of the report of county vector control staff, There were no cockroaches or rodents found in the facility. The facility refrigerator's maximum temperature of 40 degrees F (4 degrees C) and/or freezer temperature of 0 degrees F or below is not maintained: On 09/26/2025, LPA checked the temperature of the freezer and the refrigerator in the kitchen. The temperature of the freezer was observed at --17 degree F and the temperature of the refrigerator was observed at 25 degree F. LPA interviewed staff S1. S1 stated the temperature of the freezer is always kept below 0 degree F and the temperature of the refrigerator is always kept below 40 degree F. Based on the review of the temperature log in the kitchen, the temperature of the freezer is always kept below 0 degree F and the temperature of the refrigerator is always kept below 40 degree F. Continue on LIC9099-C. Page 2 of 4. All utensils used for eating and drinking and in preparation of food and drink are not cleaned and sanitized after each usage: On 09/26/2025, LPA toured and inspected the kitchen. LPA did not observed unwashed/soiled utensils in the kitchen. LPA interviewed staff S1. S1 stated all the utensils are washed through the washing machine after usage and are ready/available before the next meal. LPA interviewed staff S3. S3 stated he/she rinses dishes and put in the washing machine after meals. S3 stated the facility washes utensils after each meal and always are available before the next meal. LPA interviewed 2 servers. Both stated they delivers food to dining room and resident rooms if needed. Both stated they collect the dishes from dining room and resident rooms and put in kitchen to wash through the washing machine. Both sated all utensils are washed before the next meal and always before 8:00PM every day. Food items are not stored, prepared in a safe and healthful manner: Staff engaged in food preparation and service were not observing personal hygiene and food services sanitation practices which protect the food from contamination: On 09/26/2025, LPA toured and inspected the kitchen. All people are required to wear caps to enter the kitchen. LPA observed kitchen workers were wearing masks, gloves aprons, and hats. The kitchen workers clothes were observed neat and clean. The temperature of the freezer was observed at -17 degree F and the temperature of the refrigerator was observed at 35 degree F. The temperature logs were maintained for the freezer and refrigerators. The environment of the kitchen was observed in hygiene condition. No food were observed left unattended. LPA interviewed staff S1. S1 stated no food are left unattended overnight. S1 stated he/she received the training of food handling/preparation. S1 showed his/her training certificate. S1 stated staff follow the standard practices to prepare food. Continue on LIC9099-C. Page 3 of 4. LPA interviewed staff S3. S3 stated he/she received the training of food handling/preparation. S3 showed his/her training certificate. S3 stated he/she follows the standard practices of handling/preparing food. The Department has investigated the above allegations. Based on the investigation, records reviewed, and interviews conducted, the Department found that the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citations noted at today’s compliant investigation visit. Exit interview conducted with OS. This report was provided to review and for signature. A copy of this report was provided to OS. Page 4 of 4.the state’s words, verbatim · CDSS document, Dec 4, 2025 · control 26-AS-20250917161223

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management visit and met with Executive Director Stephanien Hall. On 8/21/2025, the Department received a death report regarding resident R1. On 7/30/2025, The Department received a incident report regarding R1's fall incident. LPA interviewed ED, 3 staff (S1, S2, S3). LPA requested R1's physician report, appraisal needs and service plan, and incident report. LPA toured R1's room with ED. This case needs further investigation. Exit interview was conducted with ED. The report was provided to ED for review and signature. A copy of the report was provided to ED.the state’s words, verbatim · CDSS document, Aug 22, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Conducted an unannounced Plan of Correction visit to follow up the case management conducted on 2/19/2025, and met with Executive Director (ED) Benito Del Toro and Wellness Director (WD). The facility was cited as Title 22 section 87468.1(a)(2) Personal Rights of Residents in All Facilities. Licensee did not provide the necessary care and supervision to meet R1's care needs, which resulted in R1's elopement from the facility on 1/18/2025, On 2/20/2025, the Department received the Plan of correction from WD. LPA checked the new alarm system in memory care unit with ED and WD. The facility adds a secondary alarm for each exit door to make the volume of the alarm louder. LPA discussed resident R1's updated Service plan with WD. LPA discussed the facility staff response protocol with ED and WD. LPA reviewed the facility staff training log for elopement and the staff drill log for elopement. LPA discussed the facility door check protocol with ED and WD. toured the facility with ADM. The facility has 4 resident bedrooms, 2 staff rooms, 3 bathrooms, living room, family room, kitchen, dining area, and laundry room. No citation noted for today's visit. Exit interview was conducted with ED. The report was provided to ED for review and signature. A copy of the report was provided to ED.the state’s words, verbatim · CDSS document, Mar 26, 2025

Allegation investigated: Due to staff neglect or lack of supervision, a resident R1 left the facility unassisted. The facility did not send a written incident report when a resident R1 left the facility unassisted to Licensing office. The facility does not have an appraisal needs and service plan for resident R1.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver an investigation visit and met with Wellness Director Blyth Obien (OB) . On 12/27/2024, the Department received a complaint with the above allegations. On 1/3/2024, the Department conducted an initial investigation visit. LPA interviewed ED and 3 staff. LPA requested R1' physician report, pre appraisal, service/care plan, and admission agreement. Continue on LIC9099-C. page 1 of 4. Unfounded Due to staff neglect or lack of supervision, a resident R1 left the facility unassisted: The allegation is that resident R1 left the facility unassisted due to facility staff neglect or lack of supervision. On 1/3/2025, LPA interviewed Executive Director (ED) Joyce Welch. ED stated R1 moved in 12/10/2024, and lives in assisted Living unit. ED stated on 12/23/2024, around 11:00AM - 11:30AM, he/she received a phone from a kitchen staff who was driving to facility to work and saw R1 was walking away from the facility. ED stated he/she went out to look for R1 and saw R1 was walking in a distance. ED stated he/she called the facility activity director (AD) who was driving the facility vehicle back to the facility to find R1 and to get R1 back to the facility. ED stated AD found R1 after R1 had bought cigarette at gas station and was walking back to the facility. ED stated R1 returned to the facility with AD before 12:00PM and was observed without any injury. ED stated the facility staff notified R1's responsible party the incident. ED stated R1 is able to leave the facility unassisted based on R1's physician report. LPA interviewed staff (S1). S1 stated R1 usual goes out to smoke outside the main entrance and returns to the facility when R1 finishes smoking. S1 does not know if R1 can leave the facility by himself or not. S1 stated on 12/23/2024 around 11:00AM, R1 went out from main entrance to smoke outside and later R1 was found walking to gas station to buy cigarette. S1 stated R1 returned to the facility with Activity Director AD before 12:00PM. S1 stated R1 directly walked to the dining room for lunch after R1 returned to the facility. S1 stated R1 usually goes outside to smoke and returned to the facility. S1 stated this is the first time R1 walked to gas station to buy cigarette. S1 stated after the incident, R1 needs to sign out and sign in at the front desk. LPA interviewed Assisted Living Coordinator (ALC). ALC stated he/she was informed the incident. ALC stated on 12/23/2024 around 11:00AM - 11:30AM, R1 walked to 2 blocks away gas station to buy cigarette. ALC stated a staff saw R1 was walking away from the facility and called ED. ED called activity director AD to pick up R1. ALC stated R1 returned to the facility before noon with AD. ALC stated R1 was evaluated without any injury after R1 retuned to the facility. LPA interviewed Wellness Director (WD), the facility Nurse. WD stated he/she is the one notified R1's responsible party. WD stated R1 was evaluated without any injury after R1 returned to the facility. WD stated he/she reviewed R1's physician report before he/she notified R1's responsible party. Continue on LIC9099-C. Page 2 of 4. WD stated R1 is able to leave the facility unassisted. WD stated FM told him/her that R1 is able to leave the facility by self. On 1/3/2025, LPA interviewed resident R1's family member (FM). FM stated R1 is able to leave the facility unassisted. FM stated the facility staff notified him/her the incident. FM stated after the incident, he/she and the facility agree that R1 needs to sign out and sign at the front desk. FM stated he/she is looking for day program for R1. FM stated R1 will have day program on Monday, Wednesday and Friday. Based on the review of R1's physician report dated 12/12/24, R1 is able to leave facility unassisted. The facility did not send a written incident report when a resident R1 left the facility unassisted to Licensing office. On 1/3/2025, LPA interviewed Executive Director (ED). ED stated resident R1 is able to leave the facility unassisted based on R1's physician report dated 12/12/2024. ED stated this case is not an elopement. LPA interviewed Wellness Director (WD). WD stated R1 is able to leave the facility unassisted. WD stated this is not an elopement. WD stated he/she notified R1's responsible party about R1's incident and R1's responsible party told him/her that R1 is able to leave the facility unassisted. ED stated This is the first time R1 walked out from the facility. A kitchen staff saw R1 walked away from the facility while he/she was driving to facility and called ED. ED went out to look at R1 and found R1 was walking away from the facility. ED asked facility activity director (AD) who was driving the facility car to the facility to drive the facility car to take R1 back to the facility. ED stated R1’s pre assessment was done by him/her. The pre assessment specifies R1 does not need service/care which means R1 is independent. LPA interviewed Assisted Living Coordinator (ALC). ALC stated R1 is independent and is able to leave the facility unassisted. ALC stated this is not an elopement. LPA interviewed R1's Responsible Party. R1's Responsible Party stated R1 is able to leave the facility unassisted based on the physician report. Continue on LIC9099-C. Page 3 of 4. The facility does not have an appraisal needs and service plan for resident R1: On 1/3/2025, LPA interviewed Executive Director (ED). ED stated resident R1 moved in the facility on 12/10/2024. ED stated the facility has R1's preplacement appraisal form signed by the facility and by R1's responsible Party. ED stated the facility has R1's admission agreement dated 11/27/2024 and were signed by the facility and R1's responsible party. ED stated the facility has R1's Individual Service Plan crated on 12/17/2024 in the facility computer system and is keeping updating. ED stated the facility will have the service plan ready when R1 has moved in the facility for 30 days, and to discuss with R1's responsible Party and to sign by R1's responsible party. The Department has investigated the above allegations. Based on the investigation, records reviewed, and interviews conducted, the Department found that the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citations noted at today’s compliant investigation visit. Exit interview conducted with OB. This report was provided to review and for signature. A copy of this report was provided to OB. Page 4 of 4.the state’s words, verbatim · CDSS document, Feb 19, 2025 · control 26-AS-20241227173840

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management visit to follow up with the case management conducted on 1/24/2025, and met with Wellness Director Blyth Obien (BO). On 1/18/2025, resident R1 was found not in the facility around 12:30PM. From the footage of the surveillance system, resident R1 left the facility without staff knowledge around 12:00PM. Facility staff searched for R1 but were unable to find R1. Facility staff notified R1's family and police. R1 was found on 1/18/2025, at 1:09PM without injury. Based on the interview with Previous Executive Director (PED), R1 exited from the building exit door #3 which is delayed egress door with 15-20 seconds delay opening mechanism and with alarm, but staff in the memory care unit at that time period did not hear alarm sounded. PED stated this is the first time R1 left the facility without staff knowledge. PED stated there is no police report case number for this incident. Based on the interview with R1's family (FM), the facility staff notified FM immediately and the facility staff searched eagerly for R1. Based on the review of R1's physician report dated 12/13/2024 and R1's care plan dated 12/12/2024, R1 has dementia, wandering behavior, and is unable to leave facility unassisted. Citation noted for today's visit. See LIC809-D. Exit interview was conducted with BO. The report was provided to BO for review and signature. A copy of the report was provided to BO.the state’s words, verbatim · CDSS document, Feb 19, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Feb 20, 2025

87468.1 Personal Rights (a)(2) Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interview and record review, Licensee did not provide the necessary care and supervision to meet R1's care needs, which resulted in R1's elopement from the facility on 1/18/2025, which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 19, 2025

Plan of correction: Wellness Director stated to submit a plan of correction by the POC due date to provide the training to staff to provide care and supervision to meet residents' needs and to provide the staff training log.

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Steve Chang and Kenneth Madrigal conducted an unannounced case management - incident visit and met with Executive Director (ED) Joyce Welch. On 1/21/2025, the Department received an incident report that on 1/18/2025, a resident (R1) was found not in the facility around 12:50PM. R1 was last seen in the facility around 11:00AM. Based on the footage of the surveillance camera system, R1 left the facility around 12:00PM. The facility notified R1's family and Police Department. R1 was found walking on the street around 1:09PM without injury. LPA interviewed ED, 2 staff (S1, S2). LPAs toured the facility with ED. LPAs interviewed resident R1 and R1's family member. ED stated the police officers did not provide the police report case number. ED stated this is R1's first time elopement incident. LPAs checked the facility delayed egress door system of memory care unit. LPA requested R1's physician report, appraisal needs and service plan. This case management need further investigation. Exit interview was conducted with ED. The report was provided to ED for review and signature. A copy of the report was provided to ED.the state’s words, verbatim · CDSS document, Jan 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Administrator (ADM) Joyce Welch. LPA reviewed 4 residents files and 4 staff files. License, Administrator Certificate, and personal rights posters were observed at main entrance. LPA toured the facility inside and out with ADM. The facility has four stories and basement. The facility has 103 apartments/bedrooms with capacity of 149. LPA toured the basement, first floor, second floor, third floor and forth floor including lobby, front desk, bistro area, dining room, activity room, theater, salon, kitchen, resident apartments, medication room, spa, enrichment, fitness room, restrooms, activity rooms, offices, storage rooms, and laundry area. LPA inspected the courtyard. Room temperature was observed at 70 degree F, hot water was observed at 114 degree F. Temperature of refrigerator was observed at 37 degree F, and the temperature of freezer was observed at 0 degree F. Food storage can hold the 2 days of perishable food and 7 days of non-perishable food for the entire building. Fire extinguishers were on service on 3/8/2024. The facility was equipped with smoke and carbon monoxide detectors. carbon monoxide detectors were tested, and were working fine. Medication rooms, medication carts, laundry room and chemical storage room were observed locked. First Aid Kits were checked and found to be in compliance. Non-slippery floors and grab bars were installed in restrooms. The bedrooms has screened windows. The entire building hallways and common area had functioning light fixtures. LPA observed 2 functioning elevator in the facility. Evacuation chairs were found at the stairs. The last time the facility conducted the fire drill was on 11/20/24. No deficiency noted today. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.the state’s words, verbatim · CDSS document, Dec 13, 2024

Allegation investigated: Lack of supervision resulted in Resident on Resident Altercation.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Executive Director (ED) Joyce Welch. On 4/16/2024, the Department received a complaint with the allegation that facility staff lack of supervision resulted in resident on resident alterations. On 4/19/2024, the Department conducted an initial investigation visit. LPA interviewed ED, a staff, a resident and a private companion. LPA requested resident roster, LIC500, resident physician report, appraisal needs and service plan, and incident reports. Continue on LIC9099_C. Page 1 of 3. Unsubstantiated Lack of supervision resulted in Resident on Resident Altercation: The allegation is that facility staff lack of supervision resulting in on 4/10/2024 around 3:30PM, a resident R1 wandering into another resident R2's room and having alteration between R1 and R2. Both R1 and R2 live in the memory care unit. On 4/19/2024, LPA interviewed Executive Director (ED) Joyce Welch. ED stated on 4/10/2024, resident R1 entered resident R2's room. R1 has neurocognitive impairment and thought that is R1's room. R2 asked R1 to leave the room and R1 got mad. R2 has a private companion (PC1) at that time. PC1 stated R2 told PC1 that R1 attacked R2 but PC1 stated he/she did not observe it. LPA interviewed PC1. PC1 stated he/she was in the restroom when the incident occurred. PC1 stated he/she did not see R1 attacked R2 but he/she saw R1 in R2's room when he/she exited from the restroom. PC1 stated he/she asked R1 to leave R2's room. LPA interviewed resident R2. R2 has neurocognitive impairment. R2 stated he/she cannot recall the incident. R2 stated the facility has a good environment to live. R2 stated he/she likes the facility. LPA interviewed Wellness Director (S1). S1 stated R2 has private companion from 6:00AM to 6:00PM Monday to Saturday. S1 stated on 4/10/2024, he/she received a report that resident R1 entered resident R2's room and R1 and R2 had altercation. S1 stated he/she went to R2's room immediately and R1 already left R2's room. S1 assessed R2 immediately. S1 stated he/she did not find any injury on R2, and R2 stated he/she is fine. S1 stated he/she notified Police, Ombudsman, CCL office and resident families immediately. S1 stated after the incident, the facility provided a week's staff training to prevent the similar incident to occur. R1 moved in the facility on 4/2/2024. R1 did not have similar incident before during 9 day's stay in the facility. Based on the review of R1's Pre-Admission evaluation document dated 3/17/2024, R1 has neurocognitive impairment, elopement, exit seeking/wandering and needing occasional intervention. Based on the review of the LAW Enforcement Task Report, the R2 had no visible injuries. and this is the R1's first incident. Continue on LIC9099-C. Page 2 of 3. Based on documents 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 allegation did or did not occur. No citation noted today. Exit interview was conducted with ED. A copy of the report was provide to ED. Page 3 of 3.the state’s words, verbatim · CDSS document, Oct 17, 2024 · control 26-AS-20240416164940

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Oct 10, 2024

87464 Basic Services(f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interview and record review, the facility did not provide the necessary care and supervision to resident R1 to meet R1's care needs and leading to R1's wandering into R2's room and had altercation with R2, which poses/posed an potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 17, 2024

Plan of correction: Administrator stated to submit a plan of correction by the POC due date to ensure residents to receive necessary care and supervision, and to provide staff training to prevent similar incident to happen. Administrtor to submit the staff training log to CLL office.

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Steve Chang and Mita Partoza conducted an unannounced pre-licensing inspection visit, and met with Administrator (ADM) Joyce Welch and Turney Munson VP of Operation. LPAs toured the facility inside and out with ADM and VP. The facility has four stories, a rooftop and under ground parking lot. The facility has 103 apartments/bedrooms with capacity of 149. No residents currently resides in the facility. LPAS inspected the following areas: resident apartment, medication, spa, enrichment, theater, fitness, activity rooms, the dinning and, laundry area. LPAs also inspected the outdoor, kitchen and memory care floor which is located on the 2nd floor. LPAs observed the delay opening for the memory floor and tested emergency buttons on the wall, and the emergency call box for 911. The memory care floor is secured in compliance with Title 22. First Aid Kits was checked and found to be in compliance. Non-skids floors and grab bars were installed in restrooms. The bedrooms has screened windows. The entire building hallways and common area had functioning light fixtures. Room temperature was at 68 degree F, and hot water temperature was at 115 degree F. Temperature of refrigerator was observed 32 degree F, and the temperature of freezer was observed 0 degree F. Food storage can hold the 2 days of perishable food and 7 days of non-perishable food for the entire building. Fire extinguisher was acquired on 3/14/23. 7/28/23 and are strategically placed in the entire building. Underground parking has ample space for visitors and staff and comply with ADA. Rooftop was observed to be secured with family area. LPAs tested the fire alarms, alarms in restroom and resident bedrooms that alerts staff on timely manner. ADM stated caregivers and managers are alerted on their work tablets. LPAs tested the emergency call box and it connected to 911 dispatcher. continued to LIC 809C page 1 of 2 The facility is equipped with fire alarm system, smoke and carbon monoxide detectors for each floor. Fire alarm and smoke detectors were tested by ADM and was observed to be in good working condition. Fire alarm exit route were observed and found to have nothing obstructing the walkways. LPAs observed 2 functioning elevator in the facility. The medication room and medication carts have locking mechanisms and medication carts will be stored in the wellness office at the end of each day. Component III was conducted with ADM. LPAs answered ADM's questions. No deficiency noted today 12/07/2023. Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM. Page 2 of 2.the state’s words, verbatim · CDSS document, Dec 7, 2023

Type of visit: Office

Facility Type: RCFE Application Type: INTL Capacity: 149 Census (if any clients in care): 0 COMP II Participants: Joyce Welch administrator, Phil Altman VP Ops Interview Method: Virtual interview On 11/16/23, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Nov 16, 2023