Nazareth House

Type of visit: Required - 1 Year

On 06/04/2026, at approximately 01:05 PM, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual inspection. LPA Watson was greeted by the Josephine Wazir – Executive Director, explained the purpose of the visit, and was granted access into the facility. The facility is licensed to serve (158) elderly adults ages 60 and above, of which (98) can be non-ambulatory. The facility has an approved hospice waiver for (20). The facility is a 2-story building and consists of 136 resident bedrooms, 136 resident bathrooms, lobby area, media room, reading room, activity room, dining room, 2 medication rooms, 4 elevators, Bistro, kitchen, nursing station, and patio with a shaded area for the residents. On 06/04/2026 between 01:05 PM and 04:57 PM the department toured the physical plant with Josephine Wazir / Executive Director. There were no obstructions on the premises. LPA inspected a total of (7) bedrooms and (7) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and there was storage for the residents’ personal belongings. CONTINUED ON LIC9099-C The bathrooms were found to be clean and operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 116.2°F to 116.4°F, and the temperature throughout the facility ranged from 77.9°F to 78.3°F. During the visit, the department observed the facility to be clean, sanitary, and appropriately furnished. All 66 fire extinguishers were fully charged and operable. The department observed that cleaning supplies, toxins, and sharp objects were appropriately stored and inaccessible to residents in care. On 06/04/2026 between 01:05 PM and 04:57 PM the department toured the kitchen and dining area, and there was sufficient seating for dining. There was a menu available for review posted in the dining room. The department observed a 5-day supply of perishable food and a 7-day supply of non-perishable food available for the residents in care, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drill was conducted on 09/15/2025. On 06/04/2026 between 01:05 PM and 04:57 PM the department reviewed seven (7) resident files for admission agreements, updated physician reports, needs and services plans, and Medication Administration Records (MARs), which indicated that residents have been given their medications as prescribed by their physicians and that files are current. The department also reviewed seven (7) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings, all of which were current. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and this report was discussed and provided to Josephine Wazir – Executive Director, at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jun 4, 2026

Type of visit: Case Management - Other

On May 7, 2025, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit visit to assess the health and safety of the residents in care. Upon arrival, LPA met with Josephine Wazir- Administrator and Ivan Barajas- Director of Nursing who was explained the purpose of the visit. At 2:15 PM, LPA conducted a tour of the facility, observing six (6) bedrooms, each furnished with the required items in good condition, and six (6) bathrooms that were clean and fully functional. The tour also included the kitchen and food storage areas, where LPA noted a (5) five-day supply of perishable food and a (7) seven- day supply of non-perishable items. During the visit, LPA observed Resident 1 (R1) in the patio area, engaged in arts and crafts with other residents alongside their one-on-one care provider. LPA attempted to interview Resident 2 (R2); however, R2 was no longer residing at the facility. Ivan explained that the family had provided Nazareth House with a 30-day notice, opting to move R2 to another facility. During the inspection, LPA Allen did not identify any health or safety concerns. No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to Josephine Wazir Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 7, 2025

Type of visit: Required - 1 Year

On 3/27/2025, At 8:40 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced annual comprehensive inspection. Upon arrival LPA called the facility introduced herself, explained the purpose of the visit and was granted access into the facility gates. LPA was greeted by Natalie Garcia upon entering the facility. At 9:00 AM, LPA met with Josephine Wazir- Executive Director. LPA explained the purpose of today’s visit. The facility is licensed to serve (158) elderly adults ages 60 and above, of which (98) can be non-ambulatory. The facility has an approved hospice waiver for (20). The facility is 2- stories that consists of 136 resident bedrooms, 136 resident bathrooms, lobby area, media room, reading room, activity room, dining room, 3 medication rooms, 4 elevators, Bistro, and kitchen and patio with shade. At 9:20, LPA and Josephine Wazir /Executive Director toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (7) bedrooms and (7) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and there was storage for the residents’ personal belongings. The bathrooms were found to be clean and operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 115.5°F to 116.2°F, and the temperature throughout the facility ranged from 74°F to 78°F. During the visit, LPA observed that the facility was clean, sanitary, and appropriately furnished LPA also, observed cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. At 10:45 AM LPA toured the kitchen and dining area and there was sufficient seating for dining. There was a menu available for review. LPA observed a 5-day supply of perishables and a 7-day supply of non-perishable food available for the residents in care which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 3/12/2025. At 11:10 AM, LPA reviewed seven (7) residents files for admission agreements, updated physician reports, needs and services plans, Medication Administration Records (MARS) which appeared that residents have been given their medications as prescribed by their physicians and files are current. LPA also reviewed seven (7) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings which were all current. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and this report was discussed and provided to Josephine Wazir- Executive Director at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 27, 2025

Allegation investigated: Questionable death. Unqualified staff are providing care and supervision to residents.

On 08/13/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced visit to the facility listed above to deliver findings for a complaint. LPA met with Administrator, Josephine “Fina” Wazir, and the purpose of today’s visit was explained. LPA conducted previous visits that consisted of: On 08/15/23, LPA conducted a facility tour, interviewed Chief Executive Officer and Regional Operations Manager of the company, and received pertinent documents related to the investigation. LPA Gibbs reviewed, and received copies of the facilities staff and resident Roster, staff training records of staff who provide care for residents diagnosed with Dementia, Plan of Operation related to Care of Persons with Dementia, resident Identification and Emergency Information, Preplacement Appraisal, Physician's Report, Physician’s Orders, Hospice Medication Profile, Needs and Services Plan, and staff notes. On 03/13/24, LPA toured the facility, interviewed Staff (S3-S6), interviewed Resident (R2-R9), and received additional documents pertinent to the investigation. The documents include Resident R1’s Admission Agreement, Narrative Charting notes for R1, and Hospice notes. The investigation revealed the following: Unsubstantiated Allegation: Questionable Death The complaint allegation alleges that due to untrained staff transferring R1 to the hospital for dementia related behavior led to confusion and transfer trauma resulting in R1’s death. During record review, LPA received and reviewed a copy of the staff Narrative Charting for R1, upon review LPA observed R1 was transferred to UCLA (Westwood) Hospital for a needed mental health evaluation on 04/19/23. Additionally, LPA observed UCLA ER contacted the facility on 04/20/23, to inform them they were transferring R1 to Glendora Hospital for admission. During interviews with W1, LPA was informed R1 was being transferred due to UCLA being at capacity. LPA reviewed the discharge document from Glendora Hospital and observed R1 was treated at Glendora Hospital from 04/20/23 till 04/22/23 due to a neurocognitive disorder. Glendora Hospital then transferred R1 to College Medical Center on 04/22/23 due to R1 requiring additional medical care. LPA reviewed the discharge documents for R1 and observed that R1 was diagnosed with acute hypoxic respiratory failure and found to have a dissection at the distal part of the aortic with an additional diagnosis of pneumonia. R1 received care at College Medical Center till discharged on 04/26/23. During R1’s admission at College Medical Center, the family opted for hospice care and comfort measures only, due to R1s worsening health status. After discharge, R1 was transported back to the facility on 04/26/23. Upon review of R1’s Death Certificate, LPA observed it stated the immediate cause of death to be “Cardiopulmonary Arrest.” (2) Continued On LIC9099-C During interviews with Staff S4-S6, were asked what the procedure was if a resident is exhibiting agitation and aggressive behavior, three (3) out of three (3), stated the physician is notified, PRN is provided (if prescribed), and if needed sent to the hospital for a medication and psychiatric evaluation. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Allegation: Unqualified staff are providing care and supervision to residents. The complaint allegation alleges the facility accepted a resident with a diagnosis of dementia without a Memory Care program in place and that staff lack the training and support to aid residents with dementia. During file review of the facility’s Plan of Operation, LPA observed the facility has a Plan of Operation Related to Care of Persons with Dementia beginning on page 120. During resident file review, LPA received and reviewed R1’s Physician’s Report conducted on August 19, 2022, prior to R1’s admission to the facility on 09/07/22, the Physician’s Report does not list dementia as primary or secondary diagnosis. LPA observed the report indicated R1 has a “Mild Cognitive Impairment.” Additionally, LPA reviewed ten (10) Staff Training Logs consisting of caregivers and med techs and observed ten (10) out of ten (10) had the required training in dementia. (3) Continued On LIC9099-C During interviews with Staff (S1-S6), they were asked if they receive Dementia Care Training, six (6) out of six (6), stated they participate in training on Relias annually and they have participated in In-Service Training regarding care for residents with dementia. During interviews with Residents R2-R9, they were asked if they believe staff are trained to provide appropriate care to all the residents, eight (8) out of eight (8) stated yes, the staff are appropriately trained to care for residents. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. During today’s visit LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Josephine “Fina” Wazir, and a copy of this report was provided. (4)the state’s words, verbatim · CDSS document, Aug 13, 2024 · control 11-AS-20230814112634

Type of visit: Required - 1 Year

On 6/9/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Josephine Wazir /Executive Director. LPA explained the purpose of today’s visit. The facility is licensed to serve (158) elderly adults ages 60 and above, of which (98) can be non-ambulatory. The facility has an approved hospice waiver for (20). The facility is 2- stories that consists of 136 resident bedrooms, 136 resident bathrooms, lobby area, media room, reading room, activity room, dining room, 3 med rooms, 4 elevators, Bistro, and kitchen and patio with shade.. LPA Iniguez and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (10) bedrooms and (10) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 115.5°F to 116.2°F, and the room temperature ranged from 76°F to 78°F. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 2/22/24. A review of (5) residents' service files and (6) staff personnel files was maintained in order. LPA reviewed (3) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance was given to LPA during this visit. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies; therefore, no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Josephine Wazir / Executive Director.the state’s words, verbatim · CDSS document, Jun 9, 2024

Allegation investigated: Facility is retaining resident(s) with higher level of care needs.

On 1/31/24, Licensing Program Analyst (LPA) Felisa Shirley and LPM Stephanie Cifuentes conducted an unannounced subsequent visit to this facility. LPA was met by Administrator, Josefina Wazir, and explained the purpose of the visit is to deliver findings for the allegations mentioned above and was granted access to the facility. The investigation consisted of the following: On 8/23/23, The investigation consisted of the following: LPA Shirley conducted interviews with the Administrator, Josephine “Fina” Wazir (S1) Staff (S2 – S8) and residents (R1 – R5). LPA requested, received and reviewed copies of the following documents: Staff and Resident Rosters, resident files which contained, Preplacement Appraisals, Physician’s Reports, Resident Identification and Emergency Information, Needs and Services Plan, Elopement Risk Assessment, and Acknowledgment/Approval of Use of Egress Alert Device. Con'd on 9099-C Substantiated The investigation revealed the following: Allegation: Facility is retaining resident(s) with higher level of care needs On 8/21/2023 LPA Shirley reviewed the facility file at the El Segundo Office. LPA Shirley noted that facility does not have dementia care as part of its plan of operation. On 8/23/2023 LPA Shirley reviewed facility files at facility listed above. LPA observed that the file for R1 contained the following documents which listed dementia as a diagnosis: Preplacement Appraisal Information, dated 7/19/22 and Physician’s Report for Residential Care Facilities For the Elderly, dated 7/19/22. R1’s Needs and Services plan, dated 8/4/2022 page 2 states, “Provide escort and reminders to and from activities” and an Elopement Risk Assessment signed 6/8/23 which indicated R1 was an elopement risk. LPA Shirley conducted a walkthrough of the facility and found that there is no secured perimeter. LPA interviewed Staff1-Staff 8 and asked if facility had a memory care unit. Of those interviewed, 7 out of 8 stated the facility does not have a memory care unit. Based on interviews, file review, and tour of facility there is sufficient evidence to support the allegation: “Facility is retaining resident(s) with higher level of care needs”. The facility does not have an approved dementia care operation, nor do the facility premises have a secured perimeter. The preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 6 are being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, Jan 31, 2024 · control 11-AS-20230815095513

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(c) · Plan of correction due date: Feb 14, 2024

87208 Plan of Operation A licensee who accepts or retains residents diagnosed by a physician to have dementia shall include additional information in the plan of operation as specified in Section 87705(b). This requirement is not met as evidenced by: Based on records review and interviews R1 was admitted to facility with Dementia, which required a higher level of care than the facility could provide as dementia information was not included on the plan of operation. This poses a potential threat to residents in carethe state’s words, verbatim · CDSS document, Jan 31, 2024

Plan of correction: Licensee will review regulation 87705: Care of persons with Dementia and submit in writing via email or fax their understanding of the regulation by the POC due date and submit an addendum to their plan of operation if they wish to retain residents with Dementia.