Motion Picture & Television Fund

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility today to conduct a required annual visit at approximately 1:00 P.M. Upon arrival LPA met with the Dining Manager Maria Lopez. LPA introduced self and reason for the visit was explained. Administrator, Lorena Soria, couldn’t be present at the time of the visit. The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At approximately 1:30 P.M., a tour of the physical plant was conducted with Maria Lopez. There are three separate residential areas for the licensed facility: Country House Cottages, Lodge, and Villa. The Cottages are for independent residents, the Lodge is assisted living, and the Villa consist of independent and assisted living residents. Required postings observed in the common areas of the facility. LPA inspected the common areas throughout the three buildings. These included the Country House library, activity rooms, and computer rooms. The areas were observed to be properly furnished and relatively clean at the time of the visit. Sanitizer observed available in all buildings. All three kitchens and dining room observed. Dining furniture was observed to be in good condition in each building. Knives and sharp objects observed to be kept inaccessible to residents in care. Kitchen appliances appeared to be in operable condition. LPA observed a sufficient supply of perishable and non-perishable food in each building. During the inspection, LPA observed the ice machine and dish washer in the Villa building inoperable. Staff reported that they are waiting for a part. Ice is brought from the other building and dishes are transferred as well to the other kitchen to be washed. LPA inspected eight (8) randomly selected bedrooms throughout the Cottages and The Lodge. The resident bedrooms were properly furnished and with sufficient lighting. (Continue to LIC809c) Hot water temperature was tested in eight randomly selected residents’ bedrooms. Hot water temperature measured within the required range of 105 - 120 degrees Fahrenheit. Resident bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The facility maintained a comfortable temperature in each building. Smoke detector(s) and carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were observed throughout the facility, fully charged and were last serviced 01/15/2025. Facility is gated. Entry/exits were free of obstructions. There are several shaded areas with adequate outdoor furniture for resident use. The outdoor areas were clean and free of hazards. No bodies of water noted at the time of the visit. There are two (2) buildings with staff offices, gym, and a pool for residents. Pool was locked and inaccessible to residents at the time of visit. During the inspection the LPAs interviewed nine (9) residents and three staff members. Due to time constraints annual inspection will continue on another date for records review, Villa building physical plant and medication procedures and policy review. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 20, 2025

Allegation investigated: Due to lack of care and/or supervision, resident fell and sustained fractures Staff made an inappropriate comment in the presence of a resident

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findings for the allegations listed above. Upon arrival, LPA met with facility staff. LPA then met with Martha Gutierrez, Residential Living Manager and explained the reason for the visit. Entrance interview conducted. During an initial complaint visit conducted on 06/24/2024, LPA Brian Balisi conducted a physical plant tour, interviewed staff and reviewed and obtained copies of pertinent documentation. LPA Valeria Conway then corresponded via email with the Executive Director and conducted additional interviews with both residents and staff telephonically. LPA Dulek reviewed all documents obtained throughout the course of the investigation. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated Continued from LIC 9099 Allegation “Due to lack of care and/or supervision, resident fell and sustained fractures:” The complaint alleges that Resident #1 (R1) fell while using the restroom, resulting in multiple rib fractures. LPA reviewed R1’s physician’s report dated 11/27/2023, which indicated that R1 has diagnoses which include Mild Cognitive Impairment and gait impairment. R1 was determined to be non-ambulatory at that time. R1’s physician’s report did not indicate that R1 required transfer assistance and R1 was determined to be able to care for their own toileting needs. R1’s service plan dated 01/20/2024 indicated that R1 was participating in the facility’s fall program to reduce the risk of falls. Staff also offered R1 additional spot checks. Interviews and documents reviewed revealed that R1 fell on the following dates: 12/26/2023, 06/08/2024, and 06/11/2024. Staff interviewed stated that after a resident has fallen or is determined to be a fall risk, staff conduct additional documented status checks and staff complete a fall risk assessment. The facility provided incident reports, as well as documentation of status checks, fall risk assessments for all R1’s identified falls. The facility also provided documentation of notification sent to R1’s physician related to recent falls. Reporting party indicated that R1 does have a walker that has been recommended for R1’s safety, however it’s R1’s personal preference to not use their walker. On 06/11/2024, facility staff assisted R1 to the restroom then staff stepped out of the room as R1 requested privacy. R1 attempted to get up on their own and fell. R1 reported pain in their ribcage, facility staff encouraged R1 to go to the Emergency Room, but R1 declined additional medical attention. Later that day, after speaking with their family member, R1 went to the Emergency Room. Medical records reviewed revealed that R1 did not sustain any fractures due to the falls. X-ray results indicated “no displaced rib fractures” and no pelvis or hip fractures. Although R1 did fall while using the restroom, the resident did not require 1:1 supervision at all times and did request privacy. Additionally, medical records indicate R1 did not sustain any fractures as a result of the fall. Therefore, the information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Allegation: “Staff made an inappropriate comment in the presence of a resident:” It was alleged that when staff brought R1’s commode to the restroom, that staff commented on the commode’s odor. During the investigation, staff and residents were interviewed. No staff nor residents Report Continued on LIC 9099-C Continued from LIC 9099-C interviewed have heard any such comments. Residents reported that staff are professional in their interactions with the residents. Staff denied the allegation. Reporting party was unable to provide any specific information to corroborate the allegation and although LPAs attempted to contact R1 multiple times, LPAs were unable to reach R1. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. No citations issued. Exit interview conducted. A copy of today’s report was provided.the state’s words, verbatim · CDSS document, Jun 19, 2025 · control 29-AS-20240620144147

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Valeria Conway and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at 9:30 A.M. Upon arrival LPAs met with Nursing Manager Martha Gutierrez and explained the reason for the visit. Administrator, Lorena Soria, couldn’t be present at the time of the visit; however, Nursing Manager is authorized to sign today’s report. Entrance interview. The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At 9:50 A.M., a tour of the physical plant was conducted. There are three separate residential areas for the licensed facility: Cottages, Lodge, and Villa. The Cottages are for higher functioning residents, the Lodge is assisted living, and the Villa is a mix of high functioning residents and assisted living. Required postings were observed in various common areas of the facility. The following was observed for the three residential areas: COMMON AREAS: LPAs inspected the common areas throughout the buildings. These included the library, activity rooms, and computer rooms. The common areas were observed to be properly furnished and relatively clean at the time of the visit. LPAs observed sanitizer readily available in areas with high touch surfaces. Dining room furniture was observed to be in good condition in each building. The facility maintained a comfortable temperature in each building. LPAs observed evacuation chairs in all stairwells. Smoke detector(s) and carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were observed throughout the facility, fully charged and were last serviced 01/11/2024. Continued on LIC 809-C Continued from LIC 809 Last emergency disaster drill conducted quarterly; the last one was conducted on 09/12/2024. The last fire safety inspection was completed on 10/22/2023 and it was found to be in compliance with fire code regulations at the time of inspections. KITCHENS: There are three (3) separate kitchens. Knives and sharp objects observed to be kept inaccessible to residents in care. Kitchen appliances appeared to be in operable condition. LPAs observed a sufficient supply of perishable and non-perishable food in each building. During the inspection, LPAs observed several expired items including a box of stuffing and two (2), 32 oz container of yogurt. Technical violation issued. Items were discarded at the time of the visit. SORRUNDING GROUNDS; Facility is gated. Entry/exits were free of obstructions. There are several shaded areas with adequate outdoor furniture for resident use. The outdoor areas were clean and free of hazards. No bodies of water noted at the time of the visit. There are two (2) buildings with staff offices, a gym, and a pool for residents. Pool was locked and inaccessible to residents at the time of the visit. BEDROOMS: LPAs inspected thirteen (13) randomly selected bedrooms throughout the Cottages, The Lodge and The Villa. The resident bedrooms were properly furnished and with sufficient lighting. At 10:15 A.M. LPAs observed Resident #1 (R1) sleeping on the floor. Staff stated R1 chooses not to have a bed. LPAs informed staff an exception request is need it. Starting at 10:15 A.M. LPAs measured hot water temperature in 13 randomly selected residents’ bedrooms. Hot water temperature measured within the required range of 105 - 120 degrees Fahrenheit. Resident bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. Continued on LIC 809-C RECORDS: Between 12:45 P.M. and 3:00 P.M., ten (10) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Ten (10) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order at this time. MEDICATIONS: Medications review conducted during inspection. The medications are centrally stored and inaccessible to residents in care. Medications are properly documented on the centrally stored medications and destruction record. Medications appeared to be administer as prescribed during the inspection. During the inspection the LPAs interviewed thirteen (13) residents and five (5) staff members. LPAs obtained the following documents: Resident Census, Staff rooster, last emergency drill, vehicle registration for facility owned vans and last fire inspection. The following citation is being cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 25, 2024