Oakmont of Novato

Type of visit: Case Management - Incident

05/06/2026, Licensing Program Analyst (LPA) Loera arrived unannounced to conduct a Case Management - Incident visit and met with Executive Director, Scott Davis. The purpose of the visit was to follow up on self-reported incident that was submitted to Community Care Licensing (CCL). CCL received an incident report on 04/23/2026 stating on 04/16/2026 at approximately 6:00PM resident (R1) was observed to be missing from Memory Care. R1 was located at Novato High School by an individual and returned to the community. R1 was unaccounted for approximately one hour. Per conversation with Memory Care Director, R1 was wandering around when another resident who resides in assisted living was going to see their spouse who lives in memory care. When the resident opened the door to get into memory care, lead to R1 getting out as the door was momentarily open. Facility conducted an in-service training on elopement drills on 04/29/2026 for caregivers on AM and PM shift. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D, LIC811, and Appeal Rights provided to Executive Director.the state’s words, verbatim · CDSS document, May 6, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(d) · Plan of correction due date: May 15, 2026

87705 Care of Persons with Dementia:(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee did not ensure staff were aware when R1 left the building without assistance, This poses an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, May 6, 2026

Plan of correction: Facility conducted an elopement training for AM and PM shift on 4/29/2026. Licensee to ensure NOC shift receives elopement training with training topic, date, and signatures included. Training to be submitted to CCL by 05/15/2026.

Type of visit: Required - 1 Year

04/02/2026, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. There are currently 85 residents in care, of which 36 are in memory care. Facility has an approved fire clearance for 118 non-ambulatory, of which 8 can be bedridden. Facility has a hospice waiver for 15. LPA was greeted by Business Office Director, Deborah Smith. LPA and Maintenance Director toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. Facility has a dietary poster in the kitchens that states dietary restrictions for residents. Facility has multiple common areas such as activity rooms, reading room, a salon, theater room, and a gym. All rooms were furnished and in good repair. LPA observed a monthly activities calendar. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 116.2, 115.8, 110.3, and 106.2 which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected September 2025. Facility has combination smoke and carbon monoxide detectors as well as a sprinkler system that is serviced by an outside vendor. LPA observed evacuation chairs located at each of the two stairwells. Medications were found to be centrally stored. LPA is unable to finish inspection. Inspection will be continued at a later date. Exit interview conducted and copy of report was provided.the state’s words, verbatim · CDSS document, Apr 2, 2026

Type of visit: Case Management - Incident

LPA Loera conducted a case management visit to amend complaint 21-AS-20251104102911 to be findings of unsubstantiated and to issue a citation under personal rights. On 10/17/2025 Community Care Licensing (CCL) received an incident report regarding resident (R1) and resident (R2). Incident report states R1 was involved in an altercation with R2 on 10/11/2025. On 10/11/2025 around 4:15am, R1 was found yelling in the hallway for help and said R2 came into their room and “slapped them in the face”. Staff (S1) went into R1s room and found R2 still in the room and was still agitated and was not re-directable. Police were called to take a report and helped escort R2 back into their own room. No injuries were noted or visible. (Deficiency cited; 87468.1(a)(1)) Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC811(confidential names), LIC809D, Plan of Corrections, and Appeal Rights discussed and provided to Executive Director.the state’s words, verbatim · CDSS document, Dec 18, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jan 7, 2026

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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by Based on observation and document review, the licensee did not comply with the section cited above as R2 slapped R1 in the face which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 18, 2025

Plan of correction: Licensee to conduct training for all care staff regarding personal rights of residients. Licensee to provide scheduled training date to CCL by POC due date of 12/29/2025. Licencee to submit proof of completed training for all care staff to CCL by POC due date 01/07/2026.

Allegation investigated: Facility staff are not providing adequate supervision resulting in altercations between residents

On 12/18/2025, Licensing Program Analyst (LPA) Loera arrived unannounced to conduct a complaint investigation and delivering complaint findings. LPA arrived and met with Executive Director, Scott Davis. During the investigation, LPA reviewed records and made observations. Compliant alleges, facility staff are not providing adequate supervision resulting in altercations between residents. Based on LPAs observations and record reviews, the following determination had been made, resident (R1) was involved in an altercation with resident (R2) on 10/11/2025. Community Care Licensing (CCL) received an incident report on 10/17/2025, regarding R1 and R2, stating on 10/11/2025 around 4:15am, R1 was found yelling in the hallway for help and said R2 came into their room and “slapped them in the face”. Staff (S1) went into R1s room and found R2 still in the room and was still agitated and was not re-directable. Police were called to take a report and helped escort R2 back into their own room. No injuries were noted or visible. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. **Report amended as citation does not reflect allegation** Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 6, 2025 · control 21-AS-20251104102911

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Nov 13, 2025

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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on observation and document review, the licensee did not comply with the section cited above as R2 slapped R1 in the face which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee to conduct training for all care staff regarding personal rights of residients. Licensee to provide scheduled training date to CCL by POC due date of 11/13/2025. Licencee to submit proof of completed training for all care staff to CCL by POC due date 11/27/2025.

Allegation investigated: -Facility did not provide responsible party with refund.

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Scott Davis, Executive Director. There is an allegation regarding the facility did not provide the party responsible with a refund. Per Reporting Party, resident (R1) resided at the facility from May 23, 2025, until July 21, 2025, and the facility owes R1 part of the $8,000.00 community fee that R1 paid for services. However, it is their understanding that there is a refund amount owed to R1 that is unknown at this time due to lack of communication between R1’s responsible party and the facility staff. Based on LPA's interviews conducted with R1’s responsible party, they are aware that there is an outstanding amount of $8707 that R1 may owe to the facility for facility fees. On 10/21/25 LPA conducted a 10-day visit to the facility conducted interviews and reviewed records. Based on records review, it was corroborated with payment ledgers and R1’s admission agreement the dates and amounts mentioned above are accurate. Continue on LIC9099C... Unsubstantiated Continued from LIC9099... Although it is unclear if there is a lack of verbal communication between pertinent parties, the facility have been sending account statement letters dated 7/18/25, 8/6/25 and 9/8/25, which it was confirmed with R1’s responsible party that such statement letters were received, but when they attempted to discuss with the facility staff the details of the statements there was no answer received from the facility leading to confusion. During today’s visit the facility provided LPA with detailed payment ledger dated 10/21/25, the report generated by the facility specifies the following: balance dated 7/22/25 in the amount of $11,907.35, then 40% of community fee and assessment fee of $500 was waived resulting in community fee credit moved to deposit ledger in the amount of ($3,200), which applied to community fee deposit to charges due resulted in the amount of $8,707.35. Amounts detailed are in compliance with R1’s admission agreement regarding the length of stay and determining the amount of the refund as follow: “If you leave Oakmont during the third (3rd) month, you will receive a refund of 40% of the community fee (minus the $500 for the assessment)”. A finding that the complaint allegation of facility did not provide responsible party with a refund is unsubstantiated meaning that 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.the state’s words, verbatim · CDSS document, Oct 21, 2025 · control 21-AS-20251017113717

Type of visit: Required - 1 Year

04/16/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced Annual Required – 1 yr. inspection visit for this facility. Facility has an emergency disaster plan as required. Facility has an infection control plan as required. There are currently 92 residents in care. LPA started annual inspection with record reviews, and conducted a review of 8 resident records. 2 out of 8 resident records need an updated LIC602 (physician's report) (Technical Violation). LPA conducted review of 8 staff records/training. Upon a review of staff records, LPA found all staff to have required annual and initial training. LPA observed 7 out of 8 staff to not have current 1st Aid & CPR certification on file (Deficiency Cited). LPA and Executive Director toured the building and grounds. The facility was found to be at a comfortable temperature. LPA observed a 2 day supply of perishable and 7 day supply of non-perishable food. Refrigerated food was found to be stored in a safe manner being labeled and dated. Facility has snacks/fruit available for residents. Food is available to residents throughout the day. All rooms were furnished per regulation. All rooms were in good repair. Extra hygiene products and linens were available. Water temperature in sinks accessible to residents in care were measured at 114.4, 112.2 and 110.8 degrees F which is within the range of 105 to 120 degrees F. Fire extinguishers were last inspected 09/2024. Facility has combination smoke and carbon monoxide detectors as well as a sprinkler system that is serviced by an outside vendor. Facilities last emergency/fire drill was conducted 02/20/2025. continued on LIC809-C Medications were found to be centrally stored. LPA conducted spot medication count and found prescription medication to be properly recorded on the Centrally Stored Medication Record. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 05/17/2025: LIC500- Personnel Report LIC308- Designation of Responsibility Updated liability Insurance Exit interview conducted. Copy of report, LIC9099D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Executive Director.the state’s words, verbatim · CDSS document, Apr 16, 2025

Allegation investigated: Facility does not have adequate food service. Staff eat residents' food.

Licensing Program Analyst (LPA) Leibert arrived unannounced for the purpose of delivering findings on this complaint. During the course of this investigations statements were taken, unannounced site visits were made and food supplies inspected, documents obtained and reviewed as well as photographs taken. It has been alleged that facility has run out of food such as ice cream, milk, beef, and snacks and that staff eat food intended for residents. Complainant and Co-Complainant are Anonymous without contact information and have not been available for interview. LPA has made three unannounced visits to facility and found the kitchen to be well stocked with a variety of food that meets or exceeds the requirements of Title twenty-Two Regulations. Fresh fruit and other snacks were observed in plentiful supply and available to the residents. Administration has stated that staff are permitted to eat facility prepared food but only food considered "left over" when residents are finished and which would otherwise be thrown away. Although the allegations may be true, or valid, based upon the statements and observations, there is not a preponderance of evidence to prove, or disprove, the allegations. Therefore, the allegations are UNSUBSTANTIATED. No citations issued today. Report left. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 5, 2024 · control 21-AS-20241007152252

Type of visit: Case Management - Incident

At approximately 10:00 am, Licensing Program Analysts (LPAs) Loera and Leibert arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator Kimari Pinkney. The purpose of the visit was to follow up on self-reported incident that were submitted to Community Care Licensing (CCL). Incident Report: CCL received an incident report on 10/17/2024. Report states on 10/11/2024, R1 had eloped. R1 went out for a walk with a companion and was dropped off back to the community inside the lobby around 2:00 pm but was not checked in. Around 2:15 pm, R1 was unable to be located by staff. Staff were alerted and began searching the property and beyond. At 2:28 pm R1 was located behind in the community at a neighborhood park where R1's companion typically walks R1. There were no injuries and R1 was transported back to the community. (Deficiency Cited) See LIC809-D for Deficiency. Exit interview conducted with Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 14, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Nov 14, 2024

87411(a) Personal Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidence by: Based on incident report and interview, facility failed to provide supervision to R1 resulting in an elopement. The absense of supervision is an immediate risk to the Health, Safety and Rights of resident in care.***A Civil Penalty of $500.00 is being assessed.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Cleared at time of visit. Facility conducted an in-service training about elopement procedures and has been completed for all staff in the community.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst Leibert arrived unannounced for the purpose of amending the complaint report of 6/20/2024 and for the purpose of issuing a deficiency stemming from that investigation. Information developed during the course of the investigation of the complaint received on 4/15/2024, revealed that facility staff reported abuse of residents by a staff person to facility management on 4/12/2024 that had been occurring over the prior two weeks. A written report required to be made to this agency within 24 hours of observing, obtaining knowledge of, or suspecting, abuse was received on 4/15/2024 and, hence, was not timely. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, Aug 29, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 15630 · Plan of correction due date: Aug 29, 2024

W&I 15630(a) Elderly and Dependent adult abuse mandated reporting. Telephone and written report must be completed in compliance with time frames required by law. Based upon interviews and document review, this requirement has not been met as evidenced by: Upon obtaining knowledge of suspected physical abuse of residents by a staff person on and before 4/12, facility staff did not make required reports within 24 hours as required. This posed an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Aug 29, 2024

Plan of correction: Cleared at time of visit. Facility management has provided additional training to staff on the topic of required reporting.

Allegation investigated: Facility staff does not provide adequate food service to residents in care. Facility staff does not provide food of good quality to residents in care. Facility staff are not adequately meeting the residents needs.

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 1:35PM to deliver findings regarding the above allegations. LPA and Executive Director discussed the purpose of the visit. Complaint alleges that residents needs are not being met by not providing adequate food, and the food not being of good quality. Throughout the course of the investigation, LPA conducted interviews and made observations. LPA toured the facility kitchen on visits dated 6/20/24 and 7/19/24. LPA found food to be stored as per regulation and found quality perishable foods. During tour of kitchen on visit dated 6/20, LPA spoke with Regional Chef Specialist who confirmed that the facility was onboarding a new chef to implement positive changes within the facility kitchen. 6 of 6 staff and residents interviewed confirmed that food quality has improved since the onboarding of the new chef. Continued on LIC9099C Unsubstantiated Continued from LIC9099 Resident 1 (R1) confirmed that there is a food forum which contains a large number of residents. R1 explained that residents in the food forum come together to brainstorm ideas for the upcoming menus, and that their suggestions are usually found on the menu in the coming weeks. Based on interviews conducted, documents reviewed and observations made, and while the allegations may be valid, there is not a preponderance of evidence to prove the alleged violations did, or did not, occur. Therefore, the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Jul 23, 2024 · control 21-AS-20240611090420

Allegation investigated: Staff abused resident in care ******** This is an amended version of the original document*******

At approximately 1:50PM, Licensing Program Analysts (LPAs) Helena Rummonds and Jacky Macias arrived unannounced to deliver findings regarding the above allegation and met with Executive Director, Ric Pielstick. Complaint alleges that staff abused resident in care. Per interviews and review of documentation, multiple facility staff reported to facility management on 4/12/2024 that they had witnessed Staff 1 (S1) physically abuse multiple residents in care over the previous two weeks. Abuse included, but not limited to, physically striking resident(s), with their hand or an object, grabbing a resident by the wrists and shaking them, holding a resident down by their neck and transferring a resident roughly. S1 was arrested and the Department issued an immediate exclusion order for S1 on April 23, 2024. Based on information obtained during the investigation, facility staff did not fulfill their mandated reporting requirements. Continued on 9099(C) Substantiated Continued from LIC9099 Based on interviews conducted, documents reviewed, and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.the state’s words, verbatim · CDSS document, Jun 20, 2024 · control 21-AS-20240415153642

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Jun 21, 2024

87468.2...Personal Rights..(a)...residents in... residential care facilities for the elderly shall have...following personal rights:(8)To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. Based on document review and interviews conducted, the licensee did not comply with the section cited above by S1 physically abusing multiple residents in care.the state’s words, verbatim · CDSS document, Jun 20, 2024

Plan of correction: Licensee agrees to submit proof of mandated reporting training completed by all staff. Proof of training to conisist of staff names, dates, topics covered, who conducted the training, etc.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Helena Rummonds and Jacky Macias arrived unannounced at approximately 9:30AM to conduct an Annual Required inspection and was greeted by staff. LPAs and staff discussed the purpose of the visit to Administrator Ric Pielstick. At approximately 9:45am, LPAs and staff initiated a tour of the facility which included resident apartments, kitchen, food storage, dining room and various common areas used by residents. Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in various restroom sinks accessible to residents in care were all within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cleaning supplies are locked in supply closet. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality, stored per regulation. There are residents with special diets needs that are being provided by the facility. Facility kitchen has a binder and posted on the wall with all resident’s names, pictures, and their needs. Food is available for residents any time of the day. There is also a daily activity schedule for residents. Upon touring the Memory care unit, LPAs observed a residents bed sheets to be wet and having an incontinence odor throughout the Memory Care unit. Medications are centrally stored in a secured room and were reviewed. Emergency food and water supplies are stored in a secured room. Personal Protective Equipment is stored in PPE closet. Fire extinguishers were last serviced September 22, 2023. Facility has combination smoke and carbon monoxide detectors as well as a sprinkler system that is serviced by an outside vendor that was last inspected on 06/12/2024. Most recent fire/disaster drill was conducted 06/20/2024. Continued on LIC809C... Continued from LIC809 Ten staff files and ten resident files were reviewed. Staff have required First Aid and CPR certificates. Training records were reviewed and staff have required training. Administrator Certificate for Administrator, Richard Pielstick (702666740) Exp 8/26/2024. Administrator to submit updates of the following documents by 05/12/2024: LIC 500 Personnel Summary Copy of Liability Insurance LIC 9020 Register of Residents Emergency Disaster Plan (If any changes) Infection Control Plan (If any changes) Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights given. Exit interview was conducted with Administrator and a copy with given. Signature on forms confirms receipt of documents...the state’s words, verbatim · CDSS document, Jun 20, 2024

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 10:00AM to conduct a non-compliance inspection. LPA followed up on the following areas which were initially addressed during a non-compliance meeting dated 07/21/2021. LPA met with Executive Director, Ric Pielstick. Medications: Facility had residents with unlocked medications in their possession who were not allowed to store and/or dispense medications according to physician's reports on file. During tour of Assisted Living tour, LPAs observed an unlocked cabinet in R1s apartment, which contained PRN medications. LPAs confirmed that R1 was allowed to dispense their own medications per their physicians report. Prohibited Conditions: Facility retained a resident with a prohibited condition. 10 of 10 files reviewed did not have evidence of any residents being retained with a prohibited condition. Timely Medical Attention: Facility failed to seek timely medical attention. LPA reviewed incident reports and confirmed that facility has been seeking timely medical attention. Medical Assessments: Facility failed to ensure that resident's medical assessments/physician's report is complete as required. LPAs reviewed 10 resident files that had all required documents. Resident Records: Facility wasn't able to provide CCLD with pre-appraisals for resident's files that were reviewed. LPAs reviewed 10 resident files that had all required documents. Continued on LIC809C Continued from LIC809 Staffing: Facility memory care didn't have adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs. LPAs reviewed staffing schedules for both Memory Care and Assisted Living. LPAs reviewed staff training records which indicated staff are receiving 20 hours of annual training as required per regulation. Facility Food Services: Facility kitchen area was toured by LPAs and Chef. LPA found that perishable foods were stored in covered containers, and the refrigerator and freezer were at a temperature within regulation. LPAs observed dry goods in boxes on the floor in walk in closet. Chef confirmed that staff was in the middle of reorganizing since their previous chef was terminated. Reporting Requirements: Facility failed to report refusal of medications, 911 calls, suspected abuse, etc. Incident reports reviewed revealed that facility has been reporting timely. No deficiencies cited during inspection.the state’s words, verbatim · CDSS document, Jun 20, 2024

Allegation investigated: Staff did not provide resident's responsible party with proper rate increase notice Staff not following terms of admission agreement

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 9:15AM to deliver findings regarding the above complaint allegations. LPA met with Executive Director, Ric Pielstick. Complaint alleges that staff are not following terms of admission agreement, and that staff did not provide resident's responsible party with proper rate increase notice. Review of documentation revealed that residents responsible party and facility came to the agreement of $3,095/month for standard rent. Review of documentation revealed that resident was assessed before move in on 08/24/2023 with 25 billable points leaving their cost of care at $855 a month, in addition to their base rate of $3,095 leaving their total monthly payment including rent and cost of care at $3,950. Continued on LIC9099C Substantiated Continued from LIC9099 However, facility personnel inquired to the responsible party on 12/8/2023 informing them that their rent was being charged at an incorrect base rate of $3,530 in the months of August and September and that it was being updated to reflect the proper agreed upon rate of $3,095. With these rates, the responsible party had been charged $435 more a month than what was outlined in the admission agreement. Facility conducted a reassessment on 10/02/2023 with 126 billable points leaving the residents cost of care at $2,520 a month. Review of documentation revealed that facility personnel were requesting backpay for a cost of care increase in the months of August and September despite the reassessment being dated 10/02/2023. Review of documentation revealed that there was a Cost of Care Communication created on 10/03/2023. However, facility was unable to prove that this was provided to the resident’s responsible party prior to 12/8/2023. Therefore, the above allegations are SUBSTANTIATED. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D, Plan of Corrections, and Appeal Rights discussed and provided to Executive Director. Signature on forms confirms receipt of documents.the state’s words, verbatim · CDSS document, Mar 28, 2024 · control 21-AS-20240105103001

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.657(a) · Plan of correction due date: Apr 9, 2024

(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative...written notice of the rate increase within two business days ... This requirement was not met as evidenced by: Based on document review, facility did not ensure a proper rate increase notice was provided within two days to resident and/or their responsible party as required by regulation.the state’s words, verbatim · CDSS document, Mar 28, 2024

Plan of correction: ED agrees to review the requirements of HSC1569.657 and submit to LPA a signed and dated declaration addressing how facility will comply with the regulation going forward. Declaration to be submitted to LPA by POC due date of 04/09/2024.

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 10:45AM to conduct a non-compliance inspection. LPA followed up on the following areas which were initially addressed during a non-compliance meeting dated 07/21/2021. LPA met with Executive Director, Ric Pielstick. Medications: Facility had residents with unlocked medications in their possession who were not allowed to store and/or dispense medications according to physician's reports on file. LPA observed medications to be double locked in medication room. LPA and Health Services Director (HSD) toured the Memory Care unit and conducted an inspection of 3 residents apartments. 3 of 3 apartments did not contain any unlocked medications. Prohibited Conditions: Facility retained a resident with a prohibited condition. LPA reviewed a sample of 3 Memory Care and 3 Assisted Living files. 0 of 6 resident files reviewed contained evidence of a resident being retained with a prohibited health condition. Timely Medical Attention: Facility failed to seek timely medical attention. LPA reviewed incident reports and confirmed that facility has been seeking timely medical attention. Medical Assessments: Facility failed to ensure that resident's medical assessments/physician's report is complete as required. LPA reviewed a sample of 3 Memory Care and 3 Assisted Living files. 6 of 6 files had medical assessments completed as required per regulation. Continued on LIC809C Continued from LIC809 Resident Records: Facility wasn't able to provide CCLD with pre-appraisals for resident's files that were reviewed. LPA reviewed a sample of 3 Memory Care and 3 Assisted Living files. 1 of 6 files reviewed did not have a pre-admission appraisal. Staffing: Facility memory care didn't have adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs. LPA reviewed LIC500 Personnel Report as well as facilities employee roster which indicates which department each individual works in. LPA confirmed with Memory Care Director that there are 4-5 Caregivers on shift during AM and PM shifts, as well as 2 Medication Technicians, and at least 4 NOC shift throughout the facility. Facility Food Services: Facility kitchen area was toured by LPA and Business Office Director. LPA found that perishable foods were stored in covered containers, and the refrigerator and freezer were at a temperature within regulation. Reporting Requirements: Facility failed to report refusal of medications, 911 calls, suspected abuse, etc. LPA reviewed regulation 87211 with HSD and discussed the importance of reporting accurately and within seven days as required per regulation. LPA reviewed incident reports and confirmed that there were four incident reports received since October of 2023 that were received by CCL past the required seven day limit. No deficiencies cited during inspection.the state’s words, verbatim · CDSS document, Mar 28, 2024

Allegation investigated: Staff did not administer resident's medications as prescribed. Staff did not ensure resident's medication is filled.

Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. Facility ran out of a medication for Resident (R1) resulting in missed administration of the medication on 10/29/2023 and 10/30/2023. Through statements and review of documents it has been determined that: Facility requested the medication refill 6 or 7 days before needed from the Medical Clinic; Facility Health Services Director states that the Medical Clinic delayed the refilling of the medication due to an internal communications issue and apologized for the delay but refused to put a statement in writing; Staff were unable to administer the medication on 10/29 and 10/30 due to the delay in obtaining the refill; Based upon statements and review of documents, it appears the facility made a reasonable attempt to obtain the medication before it was depleted; Although the allegations may be true or valid, there is not a preponderance of evidence to prove or disprove the allegations. Therefore, the allegations are UNSUBSTANTIATED. Repot left. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 11, 2024 · control 21-AS-20231120081148

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Jan 15, 2024

Personal Rights of Residents… Residents… shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services … Based on statements and documents, requirement not met, evidenced by: R1’s Representative not notified of medication issue timely. This posed an immediate violaltion of R1’s personal rights.the state’s words, verbatim · CDSS document, Jan 11, 2024

Plan of correction: Administration will provide refresher training to appropriate staff on the requirements of 87468. Proof of training to be submitted to CCL by POC date in order to clear the deficiency.

Allegation investigated: Failed to seek timely medical resulting in resident death Staff does not meet residents care needs Staff stole residents medication

At approximately 10:30AM, Licensing Program Analyst (LPA) Helena Rummonds and Licensing Program Manager (LPM) Victoria Bertozzi arrived unannounced to continue a Complaint Investigation regarding the above allegations and met with Executive Director, Liza Hix and Health Service Director, Kimari Pinkney. Complaint alleges a resident was vomiting and not feeling well but there was a delay in sending them to the hospital resulting in them passing away at the hospital. Per interviews conducted, resident did not show signs of illness preceding the vomiting episode. Interview revealed that following vomiting episode, the resident continued to be monitored until their symptoms escalated, requiring them to be sent to the hospital. Continued on LIC9099C Unsubstantiated Continued from LIC9099 Complaint alleges that medications have gone missing due to staff members stealing residents medications. Facility staff explained their destruction policy and provided LPAs with destruction record. LPAs observed receptacle that destroyed medications are in. Based on interviews conducted and review of destruction record, LPAs were unable to find evidence to support the allegation. Complaint alleges that a resident had a pressure injury that was not receiving medical attention and that staff are expected to assist with self administration of medication without training. Based on document review, resident had a blister on their foot that is not identified as a pressure injury. Document review showed that resident's doctor and responsible party were notified of the blister. Review of training does not support allegation that staff are not trained. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Dec 27, 2023 · control 21-AS-20231109142722

Type of visit: Case Management - Incident

At approximately 1:20PM, Licensing Program Analyst (LPA) Helena Rummonds and Licensing Program Manager (LPM) Victoria Bertozzi arrived unannounced and met with Executive Director (ED), Liza Hix and Health Service Director, Kimari Pinkney to conduct a Case Management on Incident Report received by Community Care Licensing (CCL) on 11/27/2023. Incident Report states that Resident was found wandering outside of facility grounds by local law enforcement at approximately 10PM. Based on conversation with ED and review of documents, Resident has a dementia diagnosis and is unable to exit facility unassisted. Resident has a history of exit seeking behavior. Resident returned to the community the same night. It is not clear why staff did not respond to the auditory device. Facility has since conducted staff retraining, placed a wanderguard/ alert device on resident, has increased supervision and resident has a 1:1 companion. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Dec 27, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(j) · Plan of correction due date: Dec 28, 2023

87705 Care of Persons with Dementia (j)The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by staff not responding to the auditory device on exit door in Memory Care Unit, allowing a resident to elope.the state’s words, verbatim · CDSS document, Dec 27, 2023

Plan of correction: Facility conducted a staff retraining, increased supervision was implemented, and a 1:1 companion has been put in place for resident. Proof to be provided to LPA by POC due date of 12/28/2023.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced at approximately 2PM and met with Executive Director (ED), Liza Hix to conduct a Case Management on Incident Reports received by CCL on 11/03/2023 and 11/08/2023. ED had to step away at end of visit due to a schedule conflict, Business Office Director, Tristan Amari went over report and signed. Incident Report dated 11/03/2023 Resident 1 (R1) was found by staff on floor face down stating that Resident 2 (R2) hit them. R1 sustained an injury on their left elbow and was taken to the hospital for an evaluation. Both residents reside in Memory Care. Per conversation with ED, R2 walks swiftly through facility to get exercise, and it is believed that R2 bumped into R1 causing R1 to fall down. R2 does not have a history of violent behavior and there have not been any altercations between the residents since this incident. Incident Report dated 11/08/2023 Resident 3 (R3) reported to staff that they were missing a watch valued at $200 and $50 in cash. Facility made a police report and helped R3 look for their missing items. The room was searched and missing items were not found. A phone call was made to R3s daughter who said that R3 loses things regularly and is known to find missing items in their pockets. LPA requested R3s Physicians Report that shows neither Mild Cognitive Impairment or a Dementia diagnosis. Per conversation with ED, R3 has plans to move out of facility. Should R3 decide to stay residing at facility, facility to arrange for R3 to receive an updated physicians report. No deficiencies cited during visit. Exit interview conducted, copy of report and confidential names (811) provided.the state’s words, verbatim · CDSS document, Nov 9, 2023

Allegation investigated: Staff violated residents personal rights

Licensing Program Analysts (LPAs) Cuadra and Rummonds arrived unannounced at the facility and met with Executive Director, Liza Hix to deliver findings regarding the complaint allegation above. It was alleged that Staff violated residents’ personal rights. Per Reporting party, Staff (S1) held up two fists like they were going to punch resident (R1). LPA was provided with facility internal communication records of various incidents including the incident dated 8/31/23, LPA obtained statements of incident staff (S1 and S2). S1 detailed in a daily summary report an incident that occurred on 8/31/23 around 8:05am. Per email from S1, R1 came into the lobby approached S1 to request their name. Per the statement responded, they were wearing their name badge. However, S1 inquired about the reason for R1 requesting their name, when R1 became very aggressive and S1 informed that they walked away, since R1 was making accusations about S1 that did not apply to them. Continued on LIC9099C... Unsubstantiated Continued from LIC9099... Per email from S2, R1 approached S2 stating that S1 came up to R1 with two fists in their face saying, “you better not and go tell anything to Liza”. S2 responded that they will notify their supervisor. LPA also obtained Novato Police Department service call records dated 9/1/23 at 12:45pm, there was a service call ADV – Advice to Citizen due to a possible assault from staff with a final disposition of Unfounded. However, LPA reviewed incident report logs for this facility, and it was determined that incident reports were not submitted to CCL. Administrator could not provide proof that incidents were reported to CCL. LPA will address reporting requirements on a case management inspection. Based on confidential interviews with staff and residents, LPA obtained contradictory information from the parties involved that confirmed that there was an incident that violated personal rights. Although, during LPA’s interviews with S1, LPA observed that S1 speaks in a loud tone of voice that could be interpreted as intimating for others. However, there was no supporting evidence that staff violated residents’ personal rights. A finding that the complaint allegation “Staff violated residents’ personal rights” is unsubstantiated meaning that 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.the state’s words, verbatim · CDSS document, Oct 13, 2023 · control 21-AS-20230901102047

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analysts (LPAs) Cuadra and Rummonds arrived at the facility to conduct an unannounced case management Legal/ Non-compliance inspection and cite deficiencies discovered during a complaint investigation met with Executive Director/acting Administrator Liza Hix. LPA was following up on items that were concerning and ensure compliance with Non-Compliance Conference dated 7/2/21: Medications – Facility had residents with unlocked medications in their possession who were not allowed to store and/or dispense medications according to physician's reports on file. At the time of inspection Medications were stored and locked at all times. During facility tour, LPAs/Executive Director observed staff (S1) crushing medications for residents in care. LPAs were informed that there are physician's crush orders on file to crush medications for some residents (R1, R2, R3, R4, R5 & R6). However, there is no crush order from a physician in R1 & R4's file. Administrator requested LPAs time to locate crush orders and email them to for review. Administrator agreed that failure to provide physician's crush order to CCL will result in a citation. LPAs need to conduct further investigation and review prior to make a final determination. Prohibited Conditions: Facility retained a resident with a prohibited condition. Facility provided resident's care notes to document daily resident's care notes and they are not maintained current month of October 2023. LPAs/Executive Director discussed the importance of documenting resident's care notes timely. Medical Assessments: Facility failed to ensure that resident's medical assessments/physician's report is complete as required. LPA reviewed 6 resident (R1, R2, R3, R4, R5 & R6) medical records including their Physician’s reports (LIC602) had been updated within 12 months as indicated per regulation. Timely Medical Attention: Facility failed to seek timely medical attention. LPA reviewed incident report logs received and residents have been assisted with timely medical attention as indicated per regulation. Continued on LIC809C... Continue from LIC809... Facility Food Services: Facility kitchen area was toured by LPA/Executive Director and LPA found that perishable foods were stored in covered containers, and the refrigerator and freezer were at a temperature within regulation. Resident Records: Facility wasn't able to provide CCLD with pre-appraisals for resident's files that were reviewed. LPA reviewed and learned that residents (R1, R2, R3, R4 and R5) records indicated that residents have been assessed for change of condition within the last 12 months per regulation. Staffing: Facility memory care didn't have adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs. LPA/Executive Director reviewed LIC500 Personnel Summary and staff schedule for the month of October 2023. Facility has in Memory Care currently 4 care staff and 1 med tech, along with dining staff helping with meal service but not care. LPA reviewed staff training records and 2 out of 6 staff (S1 & S2) needs to receive 20 hours annual of additional training including medication training required per regulation. Reporting Requirements: Facility failed to report refusal of medications, 911 calls, suspected abuse, etc. LPA reviewed incident report logs that revealed that facility has been reporting incidents to CCL within regulations. LPAs learned through records review and interviews with Administrator that incident report logs received and found incidents not submitted timely to CCL. Per investigation conducted of complaint #21-AS-20230901102047. Also, incident report, the incident occurred on 9/20/23, but it was received at CCL on 10/4/23 which is not within 7 days of occurrence as indicated per regulation. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights given. Exit interview conducted with Executive Director and a copy of this report was given.the state’s words, verbatim · CDSS document, Oct 13, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Oct 27, 2023

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require…(1) A written report shall be submitted to the licensing agency & person responsible for the resident within 7 days of the occurrence of any of the events…(B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement has not been met as evidence by: Based on LPA’s records review and interviews conducted Administrator did not ensure that CCL was notified of incidents involving R1 and R7, which poses a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 13, 2023

Plan of correction: Administrator to ensure all incidents that threaten the safety of residents are reported to CCL per regulation. Signed statement that the regulation was reviewed and sign in sheet for all staff trained to be submitted by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.69(a)(1) · Plan of correction due date: Oct 27, 2023

§1569.69 Employees assisting residents with self-administration of medication; training requirements (a) Each RCFE licensed under this chapter shall ensure...the following training requirements: (1)...the employee shall complete 16 hours of initial training. This training shall consist of eight hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and eight hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Based on record review & interview, the licensee did not comply with the section cited above in 2 out of 6 staff which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 13, 2023

Plan of correction: Facility to submit written plan for all staff training including medication prior to assist with medications to ensure that staff has required training by POC due date.