Oakland Heights Senior Living

Type of visit: Case Management - Incident

On 08/12/2026 at 11:00 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct a case management visit regarding an incident that was reported to CCLD involving residents R1 and R2. The reporting party stated in a video on social media that showed R1 and R2 walking on the shoulder of the freeway on 07/25/2026 after leaving the facility unassisted. The video footage of the incident was observed by LPA. S1 also reviewed the footage. According to an email from the front desk to the Executive Director, which was reviewed by LPA, on 07/25/2026, R1 and R2 left the facility and were reportedly headed to a store when they became lost. R1 and R2 were both observed traveling along the shoulder of the freeway. R1 and R2 returned to the facility without reported injuries. During the visit, LPA conducted an interview with S1. S1 stated that R1 and R2 are residents of the facility's assisted living. S1 stated that R1 and R2 are permitted to leave the facility unassisted. LPA reviewed R1 and R2's files and obtained a copy of R1 and R2's Assessment, Physician's Reports, and a copy of the visitor's log for 07/25/2026. R1 and R2's names were not listed on the visitor log dated 07/25/2026. ***CONTINUE ON 809C*** ***CONTINUE FROM 809*** The following deficiencies were observed: LPA reviewed R1 and R2's Resident Assessments and Physician's Reports. R1's Resident Assessment is dated 12/05/2025, and the Physician's Report is dated 03/05/2024. R2's Resident Assessment is dated 05/25/2026, and the Physician's Report is dated 02/10/2020. Based on the records reviewed, the facility has not updated R1 and R2's Resident Assessments and Physician's Reports since the incident occurred. Additionally, the facility did not submit an incident report to CCLD regarding the incident that occurred on 07/25/2026. The above deficiencies were observed (see LIC 809-D) and cited in accordance with the California Code of Regulations. Failure to correct the deficiencies by the POC due date may result in additional civil penalties. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 12, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Aug 19, 2026

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. Based on records review and interview, R1 and R2 left the facility unassisted on 07/25/2026, became lost, and were observed traveling along the shoulder of the freeway. The licensee did not update R1 and R2's appraisals following the incident which can cause a potential health and safety risk to the residents.the state’s words, verbatim · CDSS document, Aug 12, 2026

Plan of correction: Licensee shall complete updated reappraisals for R1 and R2 and submit copies to CCLD by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(b) · Plan of correction due date: Aug 26, 2026

(b) The licensee shall obtain an updated medical assessment when required by the Department. Based on records review, R1's Physician's Report is dated 03/05/2024 and R2's Physician's Report is dated 02/10/2020. Following the incident on 07/25/2026, in which R1 and R2 left the facility unassisted, and were observed walking along the shoulder of the freeway, the facility did not obtain updated medical assessments for R1 and R2 as required by the Department which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 12, 2026

Plan of correction: Licensee shall obtain updated medical assessments/Physician’s Reports for R1 and R2 and submit copies to CCLD by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 19, 2026

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days...(D)Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. Based on records review and interview, R1 and R2 left the facility on 07/25/2026, became lost, and were observed walking along the shoulder of the freeway. The facility did not submit a written incident report to CCLD regarding the incident within seven days of the occurrence which posed a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Aug 12, 2026

Plan of correction: Licensee shall submit the incident report for R1 and R2 to CCLD, review the regulation, and provide a letter of attestation to LPA by the POC due date.

Type of visit: Case Management - Annual Continuation

[-On 8/6/2026 at 9:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct an Annual continuation inspection for initial annual conducted 7/10/2026. LPA met with Executive Director, Anthony Garcia and explained the purpose of the visit. The facility’s fire clearance was approved for 166 non-ambulatory, 10 may be bedridden, Hospice waiver for 10. LPA toured the facility with Executive Director, Anthony Garcia including but not limited to random residents apartments, bathrooms, multiple common areas, and courtyards. LPA reviewed 5 residents records. LPA reviewed 5 staff records and 4 of 5 have current first aid training and 5 out of 5 associated to the facility. Updated copies of the following documents were requested for facility file and are to be mailed to CCL by 9/01/2026: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Report continues on LIC809-C Pg. 2 THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT 7/10/2026: At 9:42am LPA observed the main living room floor/carpet covered with debris, trash, and crumbs. at 11:12am LPA observed it had still not been cleaned (throughout visit LPA observed floors, surfaces, unsanitary ie hallway floors with spills and sticky, in dining spills that have turned sticky, in kitchen/dining splatters of unknown substances on floor and wall, doors with dirt, crumbs of food throughout facility) at 10:50 observed thick cobwebs and dust on windows At 9:44am LPA observed unlocked knives in Bistro area. At 10:48am LPA observed unlocked cleaning supply of spic and span in resident dining At 10:33am LPA observed improper food storage in kitchen (ie fresh cilantro left out at room temperature (warm to touch), refrigerate after opening foods left at room temperature, left open peanut butter, in refrigerator improperly sealed dressing, sour cream, in dry pantry improperly sealed sugar, and tortillas At 10:49AM LPA observed live roach in resident dining/kitchen area At 10:52AM LPA observed unlocked resident files in common hallway (downstairs, main building 2361) LPA observed in R9's room improper bedding where the sheet or covering was ripped exposing mattress and blanket. LPA observed in R10's room improper bedding where there was only an unclean flat sheet with brown drips that appeared to be feces and a single blanket LPA observed in R7's room unsecured medications a review of residents physicians report dated 7/7/23 states that resident is unable to manage medications and PRNs, and is unable to store medications. medications observed include but are not limited to Tylenol, Donepezil 5mg, melatonin, Tussin cough, and others. LPA observed in R8's room PRNs a review of residents 602 dated 7/7/23 states that resident is unable to manage medications and PRNs, and is unable to store medications. medications observed include but are not limited to Tylenol and Musinex. Report continues on LIC809-C Pg. 3 THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT 8/6/2026: During file review LPA observed Employee file incomplete S2 (missing job application, health screening, TB test) During file review LPA observed Staff not up to date on required annual training's S2-S5 (S4 missing First Aid, S2-S5 missing full required annual training's all previous training's are prior to 2025) *Civil Penalties assessed $250 for repeat violations in a 12 month period* The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Aug 27, 2026

(a)Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidence by: Based on observations, the licensee did not comply with the section cited above by having unlocked sharps and chemicals in resident common areas which posed an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: By POC facility agrees to conduct a formal training to all care staff and house keepers in relation to storage space and access and provide training materials to CCLD. $250 Civil Penalty Issued For Repeat Violation in 12month Period.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Aug 27, 2026

(h)The following requirements shall apply to medications which are centrally stored:(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidence by: Based on observations and record review, the licensee did not comply with the section cited above by having medications that are required to be centrally stored accessible to residents R7, and R8 which posed an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: By POC facility agrees to conduct a formal training to all care staff in relation to medication management and assistance and provide training materials to CCLD.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 3, 2026

(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: Based on observation, the licensee did not comply with the section cited above by facility being unclean and unsanitary throughout (the main living room floor/carpet covered with debris, trash, and crumbs, floors, surfaces, unsanitary ie hallway floors with spills and sticky, in dining spills that have turned sticky, in kitchen/dining splatters of unknown substances on floor and wall, doors with dirt, crumbs of food throughout facility) which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: By POC facility agrees to develop and implement daily checks and cleanings of common areas and notify CCLD to reinspect

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(a) · Plan of correction due date: Sep 3, 2026

(a)The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidence by: Based on observation, the licensee did not comply with the section cited above by facility being unclean and unsanitary throughout (the main living room floor/carpet covered with debris, trash, and crumbs, floors, surfaces, unsanitary ie hallway floors with spills and sticky, in dining spills that have turned sticky, in kitchen/dining splatters of unknown substances on floor and wall, doors with dirt, crumbs of food throughout facility) kitchen staff not ensuring proper food storage which poses a potential health and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: By POC facility agrees to conduct a formal training with all kitchen staff regarding proper food preparation and storage and provide training materials used to CCLD as well as notify CCLD to reinspect

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: Sep 3, 2026

(b)The following food service requirements shall apply: (27)All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidence by: Based on observations the licensee did not comply with the section cited above by an alive roach being in the cabinet located in the resident dining kitchen area which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: By POC facility agrees to have pest control come and treat facility perimeters as well as kitchen area and submit proof of service to CCLD

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(c)(1) · Plan of correction due date: Aug 27, 2026

(c)All information and records obtained from or regarding residents shall be confidential.(1)The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement was not met as evidence by: Based on observations the licensee did not comply with the section cited above by having resident files accessible and unlocked exposing confidential information in common hallway in the downstairs, main building which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: By POC facility agrees to ensure all files of residents current and past are in a secure location to ensure confidentiality and provide CCLD with the new location/ area of storage.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(3)(C) · Plan of correction due date: Sep 3, 2026

(3)Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (C)Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. This requirement was not met as evidence by: Based on observations the licensee did not comply with the section cited above by R9 and R10 having inadequate linens for their respective beds which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: By POC facility agrees to dispose of all ripped linens, ensure all residents linens are clean, ensure all residents have readily accessible all required linens, and notify CCLD to reinspect.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a) · Plan of correction due date: Sep 3, 2026

(a)The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met as evidence by: Based on record review the licensee did not comply with the section cited above by S2's file being incomplete in missing their job application/start date, health screening, and TB test results) which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: By POC facility agrees to audit all staff files and ensure completion then notify CCLD.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c) · Plan of correction due date: Sep 3, 2026

(c)All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 This requirement was not met as evidence by: Based on record review the licensee did not comply with the section cited above by S2-S5 not having required annual training's which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: By POC facility agrees to audit all staff files and ensure completion od all required training's for care staff by a CCLD approved vendor and notify CCLD.

Type of visit: Required - 1 Year

On 7/10/2026 at 8:30 AM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Anthony Garcia and explained the purpose of the visit. The facility’s fire clearance was approved for 166 non-ambulatory, 10 may be bedridden, Hospice waiver for 10 . LPA toured the facility with Executive Director, Anthony Garcia including but not limited to random residents apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyards. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 116.3, 108.5, 115 degrees Fahrenheit. Residents’ bathrooms/ shower room are equipped with grab bars and non-skid mats. There is a minimum of 2-day of perishable foods. Fire extinguisher was last serviced on 4/01/2026. Emergency Disaster Plan was last posted on 05/12/2026. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 7/08/2026. LPA will return for an annual continuation to review documents and tour additional building. LPA will cite for deficiencies observed on todays visit upon return. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 10, 2026

Allegation investigated: Staff did not ensure resident's pendent was working properly

On 04/28/2026 at 10:30 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to deliver findings in regards to the allegation above. LPA met with Executive Director Anthony Garcia and explained the purpose of the visit. During the course of the investigation, LPA interviewed S1, S2, S3, R2 and R3. LPA also inspected a few pendents and the monitor in the main office that alerts staff. Allegation: Staff did not ensure resident's pendent was working properly Investigation Findings: It was reported to the department that R1 fell and pressed the emergency fob given to R1 by the facility to alert staff of R1’s fall. The fob did not function when activated. R3 had to alert staff of the fall. LPA interviewed S1 about the signal system in the facility. S1 informed LPA that residents are issued pendants to alert staff in emergencies. Continued on LIC9099-C Substantiated Continued from LIC9099 When the pendant is pressed, an alert will prompt on three monitors spaced throughout the facility. The alert shows who is calling for help and where the resident is calling from. Staff respond to the alert and touch their ID badge to the pendent to clear the alert. S2 demonstrated to LPA how the pendants alert and operate. The pendent will flash yellow when pressed to indicate a low battery, and the resident is instructed to inform staff when the battery gets low. S3 informed LPA that residents in Independent Living are instructed and reminded to inform staff when the battery gets low so staff can change out the battery. S3 reported that R1 was given a pendent with instructions on how to operate and check the battery, however R1 had never informed staff of a low battery nor brought the pendent in for staff to look over. Although staff instructed in R1 how to operate and check the battery status of the provided pendent, it is still the responsibility of staff to monitor the pendent and ensure it is in working condition. As staff did not regularly inspect the pendent after giving it to R1, staff did ensure the pendent was functioning, therefore the allegation is SUBSTANTIATED. Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Deficiency is cited from Title 22 California Code of Regulations (see LIC9099D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12-month period may result in an additional civil penalty. Deficiency and plan and proof of correction were discussed with Executive Director Anthony Garcia f Exit interview conducted, Appeal Rights, and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 28, 2026 · control 15-AS-20260126121040

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(i)(B) · Plan of correction due date: May 12, 2026

Facilities shall have signal systems which shall meet the following criteria: Transmit a …auditory signal to a…location…loud enough to summon staff. This requirement was not met as evidence by Based on observation, the licensee did not comply with the section cited above by not having the supplied pendent functioning which posed a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 28, 2026

Plan of correction: By POC date Executive Director agrees to check all batteries for all pendents and create a system to regularly check the batteries.

Type of visit: Case Management - Other

On 04/28/2026 at 10:30 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to deliver an amended complaint dated 01/30/2026. LPA met with Executive Director Anthony Garcia and explained the purpose of the visit. Amended 9099. Created new 9099 with a Substantiated allegation. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 28, 2026

Type of visit: Case Management - Health Checks

On 04/06/2026 at 12:00 PM, Licensing Program Analyst (LPA) P. Manalo conducted a Health & Safety inspection as a result of a priority 2 complaint. LPA met with Executive Director, Anthony Garcia and explained the purpose of the visit. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperature was measured at 100.1, 104, 106, and 120 degrees Fahrenheit in the hallway bathrooms and/or resident bathrooms. There are 7-days of non-perishable and 2-day of perishable food supplies were sufficient. Facility orders food supplies twice a week. Carbon monoxide detectors were observed in operating condition. Smoke/ Fire Alarm is undergoing repairs and reinstallation by vendors Bay Alarm. First-aid kit was complete. Fire extinguisher was last serviced on 04/24/2025 and 04/01/2026 all around the facility. Liability Insurance is effective from 10/01/2025 to 10/01/2026. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Executive Director. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Apr 7, 2026

87309(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items... This requirement is not met as evidenced by: Based on observations and record review, the licensee did not comply with the section cited above by having unlocked medications such as polyethylene glycol in R1’s room in memory care and unlocked bug spray in the common area which posed an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 6, 2026

Plan of correction: Staff removed the items and locked it. Deficiency cleared during today's visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(2) · Plan of correction due date: Apr 10, 2026

87303(e)(2) Maintenance and Operation (2)... the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having the water temperature measured at 100.1 degrees Fahrenheit which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 6, 2026

Plan of correction: By POC date, the Executive Director agrees to have the water temperature within range and send proof to CCLD.

Type of visit: Case Management - Other

On 2/25/2026 at 3:00PM, Licensing Program Analysts (LPAs) G. Luk and K. Nguyen arrived unannounced to conduct a case management visit to follow up facility’s inclusion of a Bed Bug Addendum in resident’s admission agreement. LPAs met with Executive Director, Anthony Garcia and informed him the reason for the visit. LPAs reviewed the facility’s current admission agreement/contract dated 1/9/2026. This includes Appendix J Bed Bug Addendum which reads, “As such, you shall be responsible for any damages incurred by us as a result of such infestation, including but not limited to the cost of treatment for the Community and any surrounding units as recommended by a qualified and licensed pest control company…” Per regulation 87468.1(a)(2), resident shall be “...accorded safe, healthful and comfortable accommodations, furnishings and equipment.” Additionally, under regulation 87303(a), “the facility shall be clean, safe, sanitary and in good repair at all times.” Therefore, it is the facility’s responsibility to ensure residents are provided with safe, healthful, and comfortable accommodations which includes bed bug eradication. The cost cannot be transferred to the residents in care. An admission agreement shall not contain any written or oral agreements to waive facility responsibility for 'the provision of safe and healthful facilities, equipment and accommodations.' The deficiency was observed (see LIC 809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 25, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(h)(2) · Plan of correction due date: Mar 11, 2026

Admission Agreements. (h) The admission agreement shall not contain the following: (2) Written or oral agreements to waive facility responsibility or liability for the health, safety or the personal property of residents, or the provision of safe and healthful facilities, equipment and accommodations. This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by including bed bug appendix in the admission agreement which poses a personal rights violation to the persons in care.the state’s words, verbatim · CDSS document, Feb 25, 2026

Plan of correction: Licensee will remove the noncompliant language from the Admission Agreement, including Appendix J (Bed Bug Addendum), that could be interpreted as waiving or shifting facility responsibility or liability for resident health, safety, personal property, or provision of safe and healthful accommodations. The revised Admission Agreement will be sent to CCLD by POC date. Civil penalty of $250 is being assessed for a repeat violation.

Type of visit: Case Management - Other

On 02/09/26 at 12:40PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced Case Management visit to review the facility’s inclusion of a Bed Bug (Appendix N) Addendum on current and future residents’ admissions agreements dated 11/2024 and January 2025 as stated in the notification sent by ED dated 12/05/25 to all residents of the facility. This Addendum requires each resident to agree to the Lease and Bed Bug Addendum (Appendix N) terms and conditions or face potential eviction or termination of their lease agreement. LPA met with executive director (ED) and explained the purpose of the visit. At 12:55PM, LPA obtained a signed copy of resident's current admission agreement with Bed Bug Addendum (Appendix N) included. ED stated the new version of the residency admission agreement was approved by Licensing on 11/07/24 when there was a change in ownership and new management at the facility effective 01/10/2025 under Oakland Heights Senior Living. LPA advised ED the Department will review current residency admission agreement with Bed Bug Appendix N Addendum and follow-up with another case management visit. No deficiency cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 9, 2026

Allegation investigated: Staff did not answer resident's calls for assistance timely

*THIS IS AN AMENDMENT OF REPORT DATED 01/30/2026* On 01/28/2026 at 10:30 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings in regards to the allegations above. LPA met with Executive Director Anthony Garcia and explained the purpose of the visit. During the course of the investigation, LPA interviewed S1, S2, S3, R2 and R3. LPA also inspected a few pendents and the monitor in the main office that alerts staff. Allegation: Staff did not answer resident's calls for assistance timely Continued on LIC9099-C Unsubstantiated Continued from LIC9099 Investigation Findings: It was reported to the department that the facility did not answer the resident’s call for assistance timely. The facility had issued a wearable emergency fob to R1 that did not function resulting in another resident having to seek assistance for R1. LPA spoke with R3, the resident that sought help for R1. R3 heard R1 fall, walked into the kitchen and saw R1 on the floor. R1 told R3 that R1 pressed the pendent, but it did not light up to indicate it made the call. R1 then asked R3 to call for help. R3 walked out of the apartment and to the front desk of the facility and asked S3 to call 911. S3 called 911, EMTs responded promptly. S3 also informed caregivers in the facility that R1 had fallen, and caregivers went to the room to assist. R3 reported staff acted immediately when informed of the fall, therefore the allegation of Staff did not answer resident’s calls for assistance timely is UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 30, 2026 · control 15-AS-20260126121040

Allegation investigated: Staff did not answer resident's calls for assistance timely

*THIS IS AN AMENDMENT OF REPORT DATED 01/30/2026* On 01/28/2026 at 10:30 AM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings in regards to the allegations above. LPA met with Executive Director Anthony Garcia and explained the purpose of the visit. During the course of the investigation, LPA interviewed S1, S2, S3, R2 and R3. LPA also inspected a few pendents and the monitor in the main office that alerts staff. Allegation: Staff did not answer resident's calls for assistance timely Continued on LIC9099-C Unsubstantiated Continued from LIC9099 Investigation Findings: It was reported to the department that the facility did not answer the resident’s call for assistance timely. The facility had issued a wearable emergency fob to R1 that did not function resulting in another resident having to seek assistance for R1. LPA spoke with R3, the resident that sought help for R1. R3 heard R1 fall, walked into the kitchen and saw R1 on the floor. R1 told R3 that R1 pressed the pendent, but it did not light up to indicate it made the call. R1 then asked R3 to call for help. R3 walked out of the apartment and to the front desk of the facility and asked S3 to call 911. S3 called 911, EMTs responded promptly. S3 also informed caregivers in the facility that R1 had fallen, and caregivers went to the room to assist. R3 reported staff acted immediately when informed of the fall, therefore the allegation of Staff did not answer resident’s calls for assistance timely is UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 30, 2026 · control 15-AS-20260126121040

Allegation investigated: Staff are not abiding to the admission agreement

This is an amended report. On 11/24/25 at 2:15 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver an amended report and findings in regard to the allegation above. LPA met with Anthony Garcia, Administrator, and explained the purpose of the visit. During the course of the investigation LPA interviewed the reporting Party (RP), S1, and R1. The Department reviewed the facility’s bed bug addendum to the admission agreement. LPA also toured R1’s apartment. The facility’s admission agreement dated December 2019 does not state that it is the resident’s responsibility to pay to keep the facility free from pests (i.e.: bed bugs). S1 confirmed that the bed bug addendum to the admissions agreement started getting rolled out in 2020 and is now part of the facility’s standard admissions agreement. It wasn’t until sometime in late January early February 2024 that the facility provided R1 the bed bug addendum. ***report continues on LIC9099*** Substantiated ***report continues from LIC9099*** R1 was told by S1 that they needed to sign an addendum to the admissions agreement to pay for the bed bug treatment or their lease would be terminated. R1 signed the addendum on 3/1/24 and hired a pest control company on 3/7/24 to treat the bug beds in their apartment. The Bed Bug Addendum stipulates that residents are responsible for paying for any bed bug treatment. Residents have a right to be accorded safe, healthful, and comfortable accommodations under HSC Code §1569.269(a)(5) and 22 CCR §87468.1(a)(2). Facilities must be maintained in clean, safe, sanitary conditions under 22 CCR 87303(a). Therefore, it is the facility’s responsibility to ensure that residents are provided with safe, healthful, and comfortable accommodations. This includes maintaining the facility in a clean, safe, and sanitary condition, which encompasses pest control and bed bug eradication. This cost cannot be transferred to the residents in care. This agency has investigated the complaint alleging that the staff are not abiding to the admission agreement. Based on interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Health and Safety Code of Code of Regulations (Chapter 3.2 Article 2.5), are being cited on the attached LIC 9099D. Exit interview conducted, a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 24, 2025 · control 15-AS-20240228122658

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(5) · Plan of correction due date: Dec 5, 2025

Enumerated rights: (a) Residents of residential care facilities for the elderly shall have all of the following rights: (5) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. Based on record review the licensee did not comply with the section cited above. Licensee added a bed bug addendum to the admissions agreement requiring residents to pay for bed bug eradication, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 24, 2025

Plan of correction: Licensee to send a notice to all residents notifying them of the removal of the bed bug addendum, licensee to reimburse any residents for costs of bed bug treatments and send letter of self-attestation of completion to LPA by POC date.

Allegation investigated: Facility is charging the resident for cost of pest treatment.

This is an amended report. On 11/24/25 at 2:15 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver an amended complaint investigation and deliver findings regarding the allegation above. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. During the course of the investigation LPA interviewed W1 and S1. The Department reviewed the Bed Bug Addendum that the facility added to their admissions agreement and was signed by R1 on 3/24/24. In March of 2024, R1 was required by the facility administrator to pay for half of the bed bug treatment to their apartment and sign a bed bug addendum requiring them to pay in full for all future bed bug treatments or face eviction. On 6/19/25, R1 paid for the full bed bug treatment for their apartment in the amount of $3,275. ***report continues on LIC9099C*** Substantiated ***report continues from LIC9099*** The Bed Bug Addendum stipulates that residents are responsible for paying for any bed bug treatment. Per statute and regulation, residents have a right to be accorded safe, healthful, and comfortable accommodations under HSC Code §1569.269(a)(5) and 22 CCR §87468.1(a)(2). Facilities must be maintained in clean, safe, sanitary conditions under 22 CCR 87303(a). Therefore, it is the facility’s responsibility to ensure that residents are provided with safe, healthful, and comfortable accommodations. This includes maintaining the facility in a clean, safe, and sanitary condition, which encompasses pest control and bed bug eradication. This cost cannot be transferred to the residents in care. This agency has investigated the complaint that the facility is charging the resident for cost of pest treatment. Based on interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted, a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 24, 2025 · control 15-AS-20250623113305

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(h)(2) · Plan of correction due date: Dec 5, 2025

(h) The admission agreement shall not contain the following: (2) Written or oral agreements to waive facility responsibility or liability for the health, safety or the personal property of residents, or the provision of safe and healthful facilities, equipment and accommodations. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above. Licensee added a bed bug addendum to the admissions agreement requiring residents to pay for bed bug eradication, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 24, 2025

Plan of correction: Licensee to send a notice to all residents notifying them of the removal of the bed bug addendum, licensee to reimburse any residents for costs of bed bug treatments and send letter of self-attestation of completion to LPA by POC date.

Allegation investigated: Facility staff are not properly addressing pests in the facility

On 8/06/25 at 12:30 p.m., Licensing Program Analyst (LPAs) Greg Clark and Luisa Fontanilla arrived unannounced to complete complaint investigation and deliver in regard to the allegations above. LPAs met with Anthony Garcia and explained the purpose of the visit. During the course of the investigation LPAs interviewed W1, facility staff (S1, S2, S3), and 4 of the 5 affected residents. 4 of the 5 live in the independent side of the facility Facility staff were all aware of the outbreak of scabies. S2 and S3 stated on 7/11/25 they were informed by a family member of R1 that R1 went to the doctor because of itching on her arms and legs and was diagnosed with scabies. Subsequent to R1 reporting that she had scabies 4 other residents also reported that they had been diagnosed with scabies. All residents received treatment from their primary physicians. The facility followed the treatment plans as prescribed by the physicians including isolation. As of 7/24/25 all were cleared of scabies by their physicians. ***report continues on LIC9099C*** Unsubstantiated ***report Continues from LIC9099*** S2 stated that she reported the outbreak to public health on 7/11/25 via phone and followed up with an email on 7/15/25. LPA reviewed the email documentation 7/15/25. Interviews with residents revealed that 4 of the 5 affected residents live in the independent side of the facility and as such do not receive any care. All 4 reported that when they started feeling symptoms they sought care from their physicians and once diagnosed they reported it to the facility. LPAs attempted to interview R5’s conservator but was unable to reach her. This agency has investigated the complaint alleging facility staff are not properly addressing pests in the facility. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 15-AS-20250722125059

Type of visit: Case Management - Other

On 8/06/25 at 2:30 p.m., Licensing Program Analyst (LPAs) Greg Clark and Luisa Fontanilla arrived unannounced to conduct a case management visit on this date to request documents. LPAs meet with Anthony Garcia, Administrator (ADM) and explained the purpose of the visit. LPAs requested that ADM send LPA documents from the past 6 months from the pest control company that indicate the scope of work, what treatment is being done, where it is being done by 8/07/25. No deficiencies cited. Exit interview conducted conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Aug 6, 2025

Allegation investigated: Wrongful Eviction

On 7/24/2025 at 10:35am, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the above allegation. LPA met with Anthony Gracia, Executive Director, and explained the reason for the visit. During the course of the investigation the LPA interviewed staff, witnesses, resident, reviewed and obtained records. Allegation: Wrongful Eviction Based on the investigation, the above allegation is substantiated. The licensee issued a 30-day notice to R1 on February 27, 2025, due to Continued on LIC9099C. Substantiated Continued from LIC9099. nonpayment. However, R1 became eligible for Social Security Income (SSI), with benefits retroactive to June 2024. The licensee was informed of this change by R1’s care manager. As such, R1 cannot be charged more than the SSI/SSP rate, and the 30-day notice issued is an illegal eviction based on nonpayment. R1 was initially admitted at a private pay rate but later became SSI-eligible. The licensee is required to continue providing basic services at the SSI/SSP rate and cannot evict R1 for failure to pay higher private rates. Based on LPA interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC 9099D. Exit interview conducted. A copy of the appeal rights and this report provided.the state’s words, verbatim · CDSS document, Jul 24, 2025 · control 15-AS-20250318163614

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(e) · Plan of correction due date: Jul 25, 2025

87464 Basic Services (e) If the resident is an SSI/SSP recipient, then the basic services shall be provided and/or made available at the basic rate at no additional charge to the resident. This requirement was not met as evidence by: Based on interviews and record review the Licensee did not comply with the section cited above in providing basic service at no additional rate for an SSI/SSP recipitent, which poses a potential risk to persons in care.the state’s words, verbatim · CDSS document, Jul 24, 2025

Plan of correction: Executive Director agreed to recind the eviction notice to R1 and submit proof to CCLD by POC date.

Allegation investigated: Illegal Eviction

On 7/24/25 at 2:45 PM Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings for the above complaint. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. During the course of the investigation LPA interviewed W1, S1 and S2. S1 and S2 stated that R1 moved into the facility’s memory care unit on 9/10/24 from Kaiser Hospital Oakland’s Emergency Department. Kaiser agreed to pay R1’s first month’s rent and Community Fee. S2 stated that she offered to help W1 find a contact at Kaiser who could authorize payment. To date Kaiser has not paid the outstanding balance. The facility issued a 30-day Notice to Quit to R1 and W1 per company policy. This agency has investigated the above complain and we have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 24, 2025 · control 15-AS-20250627133239

Allegation investigated: Illegal Eviction

On 7/24/25 at 2:30 PM Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct a 10- day compliant investigation and to deliver findings for the above complaint. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. During the course of the investigation LPA reviewed the eviction notice dated 7/9/25 issued to R1and have found that the notice is not valid. In part, it does not itemized what the outstanding balance of $24,751.51 is for. Therefore the allegation of illegal eviction is substantiated. California Health and Safety Code of Regulations are being cited see LIC9099D. Exit interview conducted, appeal rights and a copy of this report provided. Substantiatedthe state’s words, verbatim · CDSS document, Jul 24, 2025 · control 15-AS-20250717122810

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(22) · Plan of correction due date: Aug 1, 2025

1569.269 Enumerated rights; severability:(a) Residents of residential care facilities for the elderly shall have all of the following rights:(22) To be protected from involuntary transfers, discharges, and evictions in violation of state laws and regulations. Facilities shall not involuntarily transfer or evict residents for grounds other than those specifically enumerated under state law or regulations, and shall comply with enumerated eviction and relocation protections for residents. For purposes of this paragraph, “involuntary” means a transfer, discharge, or eviction that is initiated by the licensee, not by the resident.the state’s words, verbatim · CDSS document, Jul 24, 2025

Plan of correction: Administrator to review PIN 24-13 and send LPA self-attestation by 8/01/25.

Type of visit: Case Management - Other

On 7/24/25 at 2:50 PM Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct a case management visit. LPA met with Anthony Garcia, Administrator(ADM) and explained the purpose of the visit. LPA requested that ADM send LPA all invoices related bug bed treatment for the year 2025 by 7/30/25. Exit interview conducted, a copy of this report providedthe state’s words, verbatim · CDSS document, Jul 24, 2025

Allegation investigated: Staff did not keep the facility free from pest.

This is an amended report: On 7/02/25 at 11:30 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPA met with Anthony Garcia and explained the purpose of the visit. During the course of the investigation LPA interviewed W1 and S1. W1 stated that R1's apartment in the independent living side of the facility has been infested with bed bugs on and off for the past year. W1 feels that the facility isn’t doing enough to prevent the bed bugs from reoccurring. ***report continues on LIC9099C*** Unsubstantiated *** report continues from LIC9099*** S1 stated that the facility has a contract for routine pest management with Orkin who come out to the facility weekly. The facility also has maintenance staff on duty to treat issues as they arise on a daily basis. As soon as S1 is made aware of bed bugs in R1’s apartment he calls Orkin to come out to access and treat the apartment. The apartment was checked on 7/2/25 by Orkin and is clear of bed bugs. This agency has investigated the complaint alleging staff did not keep the facility free from pest. We have found that the complaint was unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Jul 2, 2025 · control 15-AS-20250623113305

Type of visit: Required - 1 Year

On 6/25/25, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Anthony Garcia and explained the purpose of the visit. LPA toured the facility including but not limited to 3 residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70 degrees F. The hot water temperature in a hallway bathroom was measured at 111.5 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 4/25/25. Emergency Disaster Plan was last signed on 7/29/24. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 6/24/25. LPA reviewed 5 residents records and 5 staff records, and all were complete. LPA also reviewed a sample of resident’s medications. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 25, 2025

Allegation investigated: Staff do not keep the facility free of rodents

On 6/05/25 at 12:00 p.m., Licensing Program Analyst (LPAs) Greg Clark and Ardalan Gharachorloo arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPAs met with Anthony Garcia, Executive Director, and explained the purpose of the visit. During the course of the investigation, LPAs interviewed S1,W1, and toured R1's apartment. S1 stated that the facility has weekly service from Orkin Pest Control. S1 further stated that when he was notified about R1 finding rodent dropings in R1's apartment S1 immediately alerted Orkin who came out and set glue traps and inspected the apartment for any places where rodents could enter the apartment. An issue with sliding glas doors was brought to S1's attention as the door is very difficult to open and close. R1 often cannot close the doors completely and Orkin felt that maybe an entrance point for rodents. S1 has agreed to get the door repaired. ***CONTINUE ON 9099C*** Unsubstantiated ***continues from LIC9099*** LPA's toured R1's apartment and observed that the sliding glass door is very difficult to operate. LPA's did not observe any rodents. This agency has investigated the complaint alleging staff do not keep the facility free of rodents. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 5, 2025 · control 15-AS-20250527130106

Allegation investigated: Staff are allowing residents to smoke in the facility

On 5/19/25 at 1:45 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. During the course of the investigation LPA interviewed W1, S1 and R1. W1 stated that when he visits the facility there is a “strong smell of cigarette smoke.” W1 further stated that he has spoken to other residents at the facility, and they stated they smell cigarette smoke as well. ***Report continues on LIC9099C*** Unsubstantiated ***Report continues from LIC9099*** LPA interviewed S1 who stated that there has been an issue with R1 smoking in his room that he and the corporate management of the facility have been dealing with the issue for several months. S1 also stated that R1 is currently on a smoking cessation program. R1 has nicotine gum and is on a nicotine patch. The facility has also issued R1 a later dated 5/14/25 that references that section of the admission agreement that R1 is in violation of and that if there is another incident of him smoking in his room he will be evicted. LPA reviewed the letter during the visit. LPA interviewed R1 in his room at the facility. LPA did not observe any cigarettes, ash trays or any other items that would indicate R1 was smoking in his room. R1 stated that he knows he must follow the rules or face eviction. R1 also stated that he like living at the facility and does not want to get “kicked out.” This agency has investigated the complaint alleging staff are allowing residents to smoke in the facility. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, May 19, 2025 · control 15-AS-20250512151537

Allegation investigated: Wrongful Eviction

*On 7/24/2025 LPA amended report to Substantiate complaint. Please see new LIC9099 attached that was delivered today.* On 5/1/2025 at 2:10pm, Licensing Program Analyst (LPA), L. Hall arrived unannounced to deliver complaint findings for the allegation above. LPA met with Anthony Gracia, Executive Director, and explained the reason for the visit. During the course of the investigation LPA interviewed staff, witnesses, resident, reviewed and obtained records. Allegation: Wrongful Eviction During interview with W1 it was stated that R1 was being evicted due to his financial situation had changed as of November 2024. W1 stated as of March 20, 2024, there Continued on LIC9099C. Unsubstantiated Continued from LIC9099. hadn't been any additional communication with any one at the facility regarding R1's financial change. S1 stated during initial interview the facility is a private pay facility only and do not accept SSI recipients. The rates for residents are set by corporate. During S1 interview on May 1, 2025, S1 stated he had heard that R1 was receiving SSI, and inquired with R1's guardian. LPA obtained email communication between S1 and R1's guardian dated February 4, 2025, regarding resources for R1, March 17, 2025, April 7, 2025, and April 17, 2025. S1 also stated there have not been any additional notices sent for the eviction process. S1 stated he has left messages with R1's family member, guardian, and ombudsman to meet and develop a plan to guide R1. On March 17, 2025, S1 inquired with the Oakland Regional Office regarding Provider Information Notice Summary 24-13 (PIN) and was given the incorrect information. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 1, 2025 · control 15-AS-20250318163614

Type of visit: Case Management - Other

On 5/1/2025, at 3:30pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Anthony Garcia, Executive Director and explained the reason for the visit. While LPA L. Hall was conducting a complaint investigation 15-AS-20250318163614 information was ascertained that on March 17, 2025, S1 inquired with the Oakland Regional Office regarding Provider Information Notice Summary 24-13 (PIN) and was given the incorrect information. LPA reviewed regulation 87464, specifically section (e), with S1, to provide information regarding residents that receive SSI after being admitted to the facility. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 1, 2025

Allegation investigated: Unlawful eviction Facility did not provide comfortable temperature Facility staff is retaliating against the resident

On 3/27/25 at 2:15 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPA met with Anthony Garcia, Executive Director and explained the purpose of the visit. During the course of the investigation LPA interviewed W1, S1 and S2 and toured the facility’s memory care unit and reveiwed documents related to R1's balance ledger. Allegation: Unlawful eviction S1 and S2 stated that R1 moved into the facility’s memory care unit on 9/10/24 from Kaiser Hospital Oakland’s Emergency Department. Kaiser agreed to pay R1’s first month’s rent and Community Fee. S2 stated that she offered to help W1 find a contact at Kaiser who could authorize payment. To date Kaiser has not paid the outstanding balance. The facility issued a 30-day Notice to Quit to R1 and W1 per company policy. ***report continues on LIC9099C*** Unsubstantiated ***report continues from LIC9099*** Allegation: Facility did not provide comfortable temperature S1 stated that from time to time the thermostats in the Memory Care Unit need maintenance to operate properly. Upon notice of an issue S1 calls a HVAC company and they come out with-in a day or two to address the issue. LPA toured the memory care unit and found that the temperature in the unit was at a proper level and the residents all looked comfortable. Allegation: Facility staff is retaliating against the resident LPA found that there is no evidence to support this allegation. LPA observed R1 to be comfortable in the Memory Care Unit dressed in sweats and a black hoodie. LPA also could not find any evidence of any complaints filed regarding R1. This agency has investigated the complaint alleging: Unlawful eviction, facility did not provide comfortable temperature and facility staff is retaliating against the resident. We have found that the complaints were unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 27, 2025 · control 15-AS-20250319085620

Allegation investigated: Staff stealing resident's valuables

On 11/21/2024 at 1:30 PM, Licensing Program Analyst (LPAs) Greg Clark and Ardalan Gharachorloo arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings in regard to the allegations above. LPA met with Executive Director, Anthony Garcia and explained the purpose of the visit. During the course of the investigation, LPAs interviewed W1, facility staff and R1. LPAs interviewed S1 who stated that he was aware of an issue with R1’s walker being misplaced. S1 also stated that R1 frequently leaves her walker behind when she is exiting the building or an activity room. S1 further stated that facility staff found a walker they thought belonged to R1 and returned it to her. "CONTINUED ON LIC9099 C" Unsubstantiated **REPORT CONTINUES FROM LIC 9099** LPAs interviewed S2 who stated that she was the primary staff person assigned to investigate the missing walker S2 stated that she found a walker in the library that she believed belong to R1. When S2 went to R1’s apartment to return the walker, she found an identical walker folded up behind R1’s door. S2 suspected that R1 took the wrong walker when she was leaving the library. Upon further inspection, S2 discovered there were total of four walkers in R1’s apartment. S2 also stated that R1 frequently leaves the walker behind. LPAs interviewed R1 in her apartment in the independent living building. R1 told LPAs that she has lived at the facility for over 20 years, and she is very happy with the care that she receives stating “I love it here, they are all so kind”. When LPAs asked R1 specifically about any issues with the walker, R1 stated that she had none and did not recall ever misplacing it. This agency has investigated the complaint alleging staff stealing resident's valuables. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 21, 2024 · control 15-AS-20241112144413

Allegation investigated: Staff did not keep the facility free from cigarette odor

On 11/21/2024 at 1:30 PM, Licensing Program Analyst (LPAs) Greg Clark and Ardalan Gharachorloo arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings in regard to the allegations above. LPA met with Executive Director, Anthony Garcia and explained the purpose of the visit. During the course of the investigation, LPAs interviewed W1, facility staff and residents. LPAs also toured the independent living building at the facility. S1 stated that the facility has a zero-tolerance policy regarding smoking on site and violation of that policy could result in eviction. LPAs observed a letter posted on the billboard in the independent living’s hallway. The letter stated that the community is a non-smoking community by order of the fire marshal. Individuals who feel the need to smoke need to do it outside of the property. “If this continues this will be considered a rule violation and dealt with accordingly and could lead to eviction”. "CONTINUED ON LIC9099 C" Unsubstantiated **REPORT CONTINUES FROM LIC 9099** LPAs reviewed the letter dated 11/08/2024 that serves as a reminder to smoke off site. S1 stated that every residents received the letter on their doors. LPAs interviewed S2 who stated that she suspects a resident on the first floor of the independent living building is lighting his cigarette as he is living the building which is a violation of the rule as he is not off site. LPAs interviewed S3 who stated that she has never seen anybody smoking in the independent living building and she has never smelled smoke. LPAs also interviewed R1 who stated that she has seen a resident who uses a scooter lighting up his cigarette as he finds his way off of the site. R1 further stated that she has never seen anybody smoking in the building. This agency has investigated the complaint alleging staff did not keep the facility free from cigarette odor".We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report providedthe state’s words, verbatim · CDSS document, Nov 21, 2024 · control 15-AS-20241119125638

Allegation investigated: Staff did not keep the facility free from pest infestation Staff threatened the residents with eviction

On 11/08/24 at 12:45 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegations above. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. During the course of the investigation LPA interviewed the reporting Party (RP), S1, and R1. LPA also toured R1’s apartment. R1 has lived at the facility for over 5 years. R1 stated to LPA that there has been a chronic problem with bed bugs in her apartment “for years.” She also stated that she felt the facility management was making efforts to eradicate the problem, but it has persisted. Recently however she has not been pleased with facility management. She feels pressured to now pay for the bed bug treatment or “get kicked out.” ***report continues on LIC9099C*** Substantiated ***report continues from LIC9099*** Allegation: Staff did not keep the facility free from pest infestation The RP stated that for the third time in a year R1’s apartment at the facility is infested with bed bugs. LPA interviewed S1 who confirmed that the apartment in question had in fact been infested with bed bugs numerous times over the past year and that treatments from the pest control company work for a time, but the bed bugs return. R1 also confirmed that the bed bugs continue to be an issue. Allegation: Staff threatened the residents with eviction RP reported that residents at the facility were forced to sign an admission agreement addendum stating that all treatments for bed bugs would be paid for by the residents and that if the residents did not sign the addendum their lease would be terminated. S1 confirmed that the bed bug addendum to the admissions agreement started getting rolled out in 2020 and is now part of the facility’s standard admissions agreement. S1 further stated that residents were required to sign the addendum or face eviction. R1 stated that she signed the bed bug addendum because she was getting too stressed out by facing possible eviction. An email sent to the RP from S1 stated, "…the addendum we are asking to have signed has been a part of our leases since 2020. We are requiring all resident (sic) to sign it. It is a condition of R1 staying in the community.” Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted, a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 8, 2024 · control 15-AS-20240228122658

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 15, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. This requirement is not met as evidenced by the facility did not ensure the R1’s apartment was kept free of bed bugs.the state’s words, verbatim · CDSS document, Nov 8, 2024

Plan of correction: Facility administrator shall develop a plan for routine maintenance, including checks for bed bugs, and submit to CCL by POC date. LPA also requests all bed bug reports for R1's Apartment be sent to LPA by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Nov 15, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, This requirement is not met as evidenced by the facility threatening R1 with eviction if they did not sign the addendum to the admission agreement.the state’s words, verbatim · CDSS document, Nov 8, 2024

Plan of correction: Facility to conduct a Residents Rights training by POC date and submit proof to CCL by POC date.

Allegation investigated: Staff did not keep the facility free from pest infestation Staff threatened the residents with eviction

On 11/08/24 at 12:45 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regard to the allegations above. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. During the course of the investigation LPA interviewed the reporting Party (RP), S1, and R1. LPA also toured R1’s apartment. R1 has lived at the facility for over 5 years. R1 stated to LPA that there has been a chronic problem with bed bugs in her apartment “for years.” She also stated that she felt the facility management was making efforts to eradicate the problem, but it has persisted. Recently however she has not been pleased with facility management. She feels pressured to now pay for the bed bug treatment or “get kicked out.” ***report continues on LIC9099C*** Substantiated ***report continues from LIC9099*** Allegation: Staff did not keep the facility free from pest infestation The RP stated that for the third time in a year R1’s apartment at the facility is infested with bed bugs. LPA interviewed S1 who confirmed that the apartment in question had in fact been infested with bed bugs numerous times over the past year and that treatments from the pest control company work for a time, but the bed bugs return. R1 also confirmed that the bed bugs continue to be an issue. Allegation: Staff threatened the residents with eviction RP reported that residents at the facility were forced to sign an admission agreement addendum stating that all treatments for bed bugs would be paid for by the residents and that if the residents did not sign the addendum their lease would be terminated. S1 confirmed that the bed bug addendum to the admissions agreement started getting rolled out in 2020 and is now part of the facility’s standard admissions agreement. S1 further stated that residents were required to sign the addendum or face eviction. R1 stated that she signed the bed bug addendum because she was getting too stressed out by facing possible eviction. An email sent to the RP from S1 stated, "…the addendum we are asking to have signed has been a part of our leases since 2020. We are requiring all resident (sic) to sign it. It is a condition of R1 staying in the community.” Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted, a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 8, 2024 · control 15-AS-20240228122658

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 15, 2024

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. This requirement is not met as evidenced by the facility did not ensure the R1’s apartment was kept free of bed bugs.the state’s words, verbatim · CDSS document, Nov 8, 2024

Plan of correction: Facility administrator shall develop a plan for routine maintenance, including checks for bed bugs, and submit to CCL by POC date. LPA also requests all bed bug reports for R1's Apartment be sent to LPA by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Nov 15, 2024

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, This requirement is not met as evidenced by the facility threatening R1 with eviction if they did not sign the addendum to the admission agreement.the state’s words, verbatim · CDSS document, Nov 8, 2024

Plan of correction: Facility to conduct a Residents Rights training by POC date and submit proof to CCL by POC date.

Type of visit: Case Management - Deficiencies

On 11/08/24 at 12:45 PM, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct a case management visit. LPA met with Administrator, Anthony Garcia and explained the purpose of the visit. During the course of the Investigation of complaint #15-AS-20240228122658 dated 2/28/24 LPA had the opportunity to review an addendum to the admissions agreement for the facility titled "bed bug addendum." LPA found that the addendum is not in compliance with regulation. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 8, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(H)(2) · Plan of correction due date: Nov 22, 2024

87507 Admission Agreements(h)The admission agreement shall not contain the following: (2) Written or oral agreements to waive facility responsibility or liability for the health, safety or the personal property of residents, or the provision of safe and healthful facilities, equipment and accommodations. This requirement is not met as evidenced by: the facility waiving it's responsibility to provide a safe and healthy facility by requiring residents to pay the cost of bed bug removal.the state’s words, verbatim · CDSS document, Nov 8, 2024

Plan of correction: Administrator to submit a revised bed bug addendum to CCL and residents by POC date.

Type of visit: Case Management - Deficiencies

On 10/24/24 at 1:15 pm, Licensing Program Analyst (LPA) Greg Clark conducted a case management visit pertaining to a letter received by the Oakland CCL ASC Regional Office from the facility. LPA met with Executive Director(ED), Anthony Garcia and explained the purpose of the visit. On July 9, 2024, the Oakland CCL ASC Regional Office received from the facility a letter of intent to de-license the third floor of the physical plant and convert those units for Independent Individuals who are 55 years of age and older. The letter did not specifically request approval from CCL and had insufficient detail pertaining to how the co-mingling of Independent aged 55+ renters, and licensed RCFE Assisted Living residents, would be managed to ensure the Health & Safety of the Assisted Living residents. LPA interviewed the ED who stated that the facility currently has seven(7) 55+ independent living residents at this time. On 10/16/24 LPM Jeremy Fong and on 10/24/24 LPA Greg Clark and ED confirmed that the facility’s website is advertising for independent renters aged 55 and older, which constitutes a change to the Plan of Operation without having obtained approval from Community Care Licensing. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 24, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Nov 4, 2024

87208(a) Plan of Operation…Any significant changes in the plan of operation…shall be submitted to the licensing agency for approval. This requirement is not met as evidenced by: Based on observations, interviews and record review, the licensee did not comply with the section cited above in by changing the plan of operation without CCLD approval which poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 24, 2024

Plan of correction: By POC date, the facility will submit to CCLD for review a new, detailed plan of operation describing the changes that the Licensee wishes to implement.

Allegation investigated: Staff did not ensure the facility walkways were not in disrepair

On 8/23/24 at 2:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Anthony Garcia and explained the purpose of the visit. During the course of the investigation LPA toured the Independent side of the facility and found the sidewalks were in good repair. LPA also noted that there is no 2351 E 29th St at this location. This agency has investigated the complaint alleging Staff did not ensure the facility walkways were not in disrepair.. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted, a copy of this report provided. Unfoundedthe state’s words, verbatim · CDSS document, Aug 23, 2024 · control 15-AS-20240814093716

Allegation investigated: Facility has pests

On 8/23/24 at 2:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Anthony Garcia and explained the purpose of the visit. During the course of the investigation LPA interviewed S1 and toured the Independent Living building. S1 stated that the facility has a contract for routine pest management with Orkin who come out to the facility weekly. The facility also has maintenance staff on duty to treat issues as they arise on a daily basis. LPA did not observe any pests in the independent Living building. This agency has investigated the complaint alleging the facility has pests. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 23, 2024 · control 15-AS-20240814093716

Type of visit: Required - 1 Year

On 7/16/24 at 10:30 AM, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. LPA toured the facility including but not limited to residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70 degrees F. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 5/01/24. Emergency Disaster Plan was last posted on 6/01/23. First aid kit was observed to be complete. LPA reviewed 5 residents records and 5 staff records, and all were complete. LPA also reviewed a sample of resident’s medications. ***report continues on LIC809C*** ***report continues from LIC809*** THE FOLLOWING DEFICIENCIES WERE OBSERVED: · LPA observed several days of medications pre-poured in a drawer in the med room. Hot water temperature in the hallway bathroom was measured at 147.2 degrees f. The above deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. LIC809D, Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 16, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff unlawfully evicted a resident

On 6/19/24 at 12:55 p.m., Licensing Program Analysts (LPAs) Greg Clark and A. Gharachorloo arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegations above. LPAs met with Anthony Garcia Administrator and explained the purpose of the visit. During the investigation LPAs reviewed R1's facility documents and also conducted an interview with S1 and R1. R1 was admitted to the facility on 12/ 05/23. R1 is currently on hospice. LPAs interviewed R1 in the memory care of the facility. R1 was able to engage in simple conversations but was not oriented to time or place. Report Continues on LIC 9099C*** Unfounded Continues from LIC 9099 S1 stated that the facility received the initial payment for the care, but no further payments were made. S1 started the eviction process on 03/01/2024. Eviction letter was sent to the person legally responsible via registered mail and a copy provided to the resident.LPAs reviewed the letter and found it to be compliant with the regulation. This agency has investigated the complaint alleging staff unlawfully evicted a resident. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 19, 2024 · control 15-AS-20240617120657

Allegation investigated: Neglect of Physical Care

On 4/30/24 at 11:15 a.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. During the course of the investigation LPA interview W1, S1, S2 and S3, reviewed R1’s file and toured R1’s apartment. LPA left numerous messages for the Reporting Party but never heard back from them. R1 was admitted to the facility on 8/09/18. R1 lives in the independent side of the facility in his own apartment. R1’s apartment was observed to be clean, minimally furnished, and somewhat cluttered. LPA did observed cans of cat food in the apartment closet. Interviews revealed that R1 liked to feed the stray cats that roam the grounds of the facility. ***report continues on LIC9099C*** Unsubstantiated ***report continues from LIC9099*** Review of R1’s file revealed that R1 has a diagnosis of schizophrenia. Review of R1’s medication administration record reveled that R1 is compliant with taking his medication on a daily basis. On 4/20/24 R1 called 911 on himself and was transported to Kaiser Hospital. R1 was subsequently moved to St. Helena Hospital for further evaluation of his mental health condition where he remains as of today. There is no discharge date at this point. Interview with W1 revealed that he is happy with the care R1 receives at the facility and is hopeful that he can return to the assisted living side of the facility. W1 stating that R1 can be difficult, at times, to deal with and he feels facility staff do a good job dealing with R1. W1 also stated that facility staff keep him information of any issues regarding R1’s care or medical condition. Interviews with S1, S2 and S3 revealed that R1 is sometimes non-compliant but staff can usually gain his compliance. Interviews also revealed that R1 would refuse housekeeping services for months at a time and also refuse to see his doctors. All three staff stated that although R1 had his issues, they feel they can work with him to keep him safe and healthy. This agency has investigated the complaint alleging neglect of physical care. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 30, 2024 · control 15-AS-20240423100115

Allegation investigated: Resident sustained unexplained bruises from suspected abuse. Facility staff neglected resulting in resident being severely dehydrated. Lack of supervision resulting in resident sustaining multiple fractures. Staff did not observe change of condition in resident

On 4/04/24 at **:** . p.m. Licensing Program Analyst (LPA) Greg Clark conducted an unannounced visit to deliver findings for the above allegations . LPA met with Anthonh Garcia, Administrator and explained the purpose of the visit. During the course of investigation, the Department interviewed R1’s conservator (W1), W2, 6 facility staff (S1, S2, S3, S4, S5 and S6) and 4 facility residents (R1, R2, R3 and R4). The Department also reviewed R1’s medical records. On 5/30/23 R1 was admitted to the assisted living side of Pacifica. At the time of admission R1 refused to let Pacifica staff perform a body check. Several small scratches were noted on R1’s elbow. W1 stated that he thought R1 was abused at his previous facility but didn’t provide any further details. Due to R1’s declining mental and physical condition he was moved to Pacifica’s memory care unit on 6/22/23. ***report continues on LIC9099C*** Unsubstantiated ***report continues from LIC9099*** On 7/02/23 R1 was observed to be below baseline behavior and was noted to have not eaten anything for 2 days. Facility staff called 911 and R1 was taken to San Leandro Hospital where he remained until returning to the facility on 7/08/23. Allegation: Resident sustained unexplained bruises from suspected abuse. Interviews with memory care staff revealed that while giving R1 his “bed baths” none of the staff observed any bruises, marks, or burns on R1. Staff also stated that R1 did not show any signs of pain from any type of fracture. Allegation: Facility staff neglected resulting in resident being severely dehydrated. Based on interviews and records R1 became depressed when W1 told him that he would be going out of town. Memory care staff attempted to feed R1 for 2 days (6/30 and 7/01/23) but he refused. On 7/02/23 R1 appeared weak and lethargic and refused to get up out of bed. 911 was called and R1 was sent out to the hospital. R1 was discharged back to the facility on 7/08/23. Allegation: Lack of supervision resulting in resident sustaining multiple fractures. At the time of admission R1 refused to let Pacifica staff perform a body check. Several small scratches were noted on R1’s elbow. W1 stated that he thought R1 was abused at his previous facility but didn’t provide any further details. While R1 was hospitalized (July 2-8, 2023) an x-ray was done. The x-ray revealed several fractures: a recent to semi-recent fracture on the right side of R1’s pelvis. This could have been caused by an incident at the facility where R1 slid down out of his wheelchair and ended up on the floor in a seated position. No hospital visit was made on that date, so the injuries are unknown. The x-ray also revealed that there was an old fracture to R1’s left collarbone and an older fracture to his lower back (T12 vertebra). The fractures were noted as “age indeterminate” meaning it was unclear how old these fractures were. ***report continues on LIC9099C*** ***report continues from LIC9099C*** Allegation: Staff did not observe change of condition in resident Staff notes from R1’s file indicate that staff were documenting R1’s declining condition in late June and early July 2023. Staff also attempted to reach W1 to inform him but staff reported that W1 was difficult, at times, to get in touch with. The Department has investigated the complaint alleging resident sustained unexplained bruises from suspected abuse, facility staff neglected resulting in resident being severely dehydrated, lack of supervision resulting in resident sustaining multiple fractures and staff did not observe change of condition in resident. We have found that the complaint was unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 4, 2024 · control 15-AS-20230713131710

Allegation investigated: Illegal eviction

On 12/20/23 1:45 p.m. Licensing Program Analyst (LPA) Greg Clark conducted an unannounced visit to conduct an initial 10 day complaint investigation and deliver findings for the above allegation. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. During the course of investigation, LPA interviewed S1 and reviewed R1's eviction notice and payment ledger. LPA’s interview with S1 revealed that at the time when the "notice to quit" was issued (8/16/23) R1's power of attorney (POA) was his son. LPA reviewed the certified mail receipt sent to the POA at his address in Texas, it was never returned. LPA also reviewed the Notice to Quit, and it meets regulatory guidelines. As of 8/16/23 the facility had not received payment for rent for several months and R1 owed the facility $76.233.65. ***report continues on LIC9099C*** Unsubstantiated ***report continues from LIC9099*** On 9/08/23 R1’s POA was changed via court order to a public guardian. The public guardian is currently working with the facility to arrange payment of back rent and the “Notice to Quit” is on hold. This agency has investigated the complaint alleging illegal eviction. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 20, 2023 · control 15-AS-20231212163336

Allegation investigated: Facility elevator is in disrepair Staff did not keep facility free from pests

On 12/20/23 1:00 p.m. Licensing Program Analyst (LPA) Greg Clark conducted an unannounced visit to deliver findings for the above allegations. LPA met with Anthony Garcia, Administrator and explained the purpose of the visit. Facility elevator is in disrepair. This issue was previously investigated as part of Complaint #15-AS-20230403155305 dated 4/03/23 and was found to be unsubstantiated. Staff did not keep facility free from pests ***report continues on LIC9099C*** Unsubstantiated ***report continues from LIC9099*** LPA interviewed S1 who stated that the facility has a maintenance staff person on duty available to spray rooms upon request. There is also a monthly service contract with a pest control company also available to treat residents’ apartments for pests. The reporting party was not able to provide LPA with information if R1 ever requested treatment for pests. This agency has investigated the complaints alleging facility elevator is in and staff did not keep facility free from pests. We have found that the complaints were unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 20, 2023 · control 15-AS-20231002154019