Oceanview Living of San Pedro

Allegation investigated: Staff do not ensure care and supervision are provided to residents. Staff does not ensure medications are dispensed as prescribed. Staff does not ensure resident records are properly maintained. Staff do not ensure residents care plans are followed Staff do not ensure residnets are accorded private visits. Staff do not ensure residents dietary plan is followed.

On August 13, 2026, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced follow-up complaint investigation into the above allegations and met with the Administrator Anita Csukardi to explain the purpose of the investigation. The investigation consisted of the following: On 01/30 2026, the Department requested and reviewed the facility's Residents' roster and staff roster. The Department also requested the resident records for (R1), including the face sheet, physician report, admission agreement, Medication Administration Records (MAR), physician orders, care plan and facility menu. The Department obtained staff training records and facilities notes. The Department interviewed six residents (R2-R7), three staff members (S1-S3), three Med Techs (MT1-MT3), and the Administrator (A1). On August 13, 2026, the Department interviewed Med Tech (MT1). Report continued On LIC9099C Unsubstantiated Allegation #1: Staff do not ensure care and supervision are provided to residents. The complaint alleged that residents frequently walk around the facility without using their walkers and that the staff is not attentive to their needs. On January 30, 2026, the department interviewed the Administrator (A1), who denied the allegations. A1 stated that staff checks on residents and provides assistance based on their care needs. On the same day, the department also interviewed three Med Tech (MT1-MT3), all of whom denied the allegations. They emphasized that, like Med Tech, they prioritize the residents’ needs and address any changes in their conditions. Additionally, three other staff members (S1-S3) were interviewed and also denied the allegations. They asserted that, as caregivers, they ensure that all residents’ care needs are met. The department interviewed six residents (R2-R7), who all denied the allegations and expressed satisfaction with living at the facility, stating that the staff regularly checks on them. The department could not interview R1 because R1 declined to be interviewed, and later R1’s responsible party moved them out of the facility on February 15, 2026. 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. Allegation #2: Staff does not ensure medications are dispensed as prescribed. The complaint asserted that the medication order for resident R1 required the medication to be cut in half to reflect a change in dosage. On January 30, 2026, the department interviewed the Administrator (A1), who denied the allegation, stating that the Med Tech follow the medication records and physician’s orders. During the same visit, the department interviewed three Med Tech (MT1-MT3), all of whom also denied the allegation. On August 13, 2026, the department interviewed MT1 again, who confirmed that they comply with the doctor’s orders by cutting the pills in half as instructed. Additionally, three staff members (S1-S3) were interviewed, and they denied the allegation, stating that the Med Tech dispenses medication according to the doctor’s orders. On January 30, 2026, the department interviewed six residents (R2-R7), all of whom denied the allegation and reported receiving their medications on time. Unfortunately, the department was unable to interview resident R1, as R1 declined to be interviewed and was later moved out of the facility by the responsible party. Finally, on August 13, 2026, the department reviewed R1's Medication Administration Record (MAR) and found no discrepancies. 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. Allegation #3: Staff does not ensure resident records are properly maintained. The complaint alleged that the resident's records were not being properly maintained. On January 30, 2026, the department interviewed the Administrator (A1), who denied the allegation and stated that the facility used a table system to organize residents' records, making it easier to locate information. Concurrently, the department interviewed three Medication Technicians (MT1-MT3), all of whom denied the allegation and affirmed that they properly maintained records, including medication records, to ensure documentation was available to residents during emergencies. Additionally, the department interviewed three staff members (S1-S3), each of whom stated that the facility used face sheets for all residents to maintain accurate records. The department also interviewed six residents (R2-R7); while all expressed some uncertainty about whether the records were being properly maintained, they believed they were. One resident, R1, declined to be interviewed, and the responsible party moved R1 out of the facility on February 15, 2026. 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. Allegation #4: Staff do not ensure residents care plans are followed. The complaint alleged that the staff was not adhering to the R1 care plan. On January 30, 2026, the department interviewed the Administrator (A1), who denied the allegation, stating that the staff provides care based on each resident's needs and service plan. The facility staff is expected to follow the resident care plan and make any changes in residents' conditions. On the same day, the department interviewed three Medication Technicians (MT1, MT2, and MT3), all of whom denied the allegations, stating that they follow the doctor's care plan and adhere to family notes. Additionally, three other staff members (S1, S2, and S3) were interviewed, and they confirmed that they comply with the doctor's orders and follow the needs and services plans in the file. On January 30, 2026, the department interviewed six residents (R2, R3, R4, R5, R6, and R7), all of whom also denied the allegations and stated that the staff assisted them with their Activities of Daily Living (ADLs). On August 13, 2026, the department reviewed the care plan for resident R1. The care plan indicated that R1 required assistance from one person across three shifts. The department was unable to interview R1, as R1 declined to participate. Later, on February 15, 2026, the responsible party moved R1 out of the facility. 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. Allegation #5: Staff do not ensure residents are accorded private visits. The complaint alleged that staff members interrupted resident meetings with healthcare professionals when those meetings involved Resident 1 (R1). On January 30, 2026, the department interviewed the Administrator (A1), who denied the allegations. A1 stated that they ensured the privacy of all residents during healthcare visits and that staff would only enter the room to assist with resident safety. Additionally, the department interviewed three Med Tech (MT1, MT2 and MT3), all of whom also denied the allegations, asserting that residents were able to talk to their family, friends, and healthcare staff in their rooms. The department then conducted interviews with three other staff members (S1-S3), who similarly denied the allegations and confirmed that residents have the right to privacy, stating that meetings are held in the residents' rooms. On the same day, the department interviewed six residents (R2-R7), all of whom denied the allegations and stated that they feel their meetings are private. However, the department was unable to interview Resident R1 on January 30, 2026, because R1 declined the interview. Subsequently, on February 15, 2026, the responsible party moved R1 out of the facility. 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. Allegation #6: Staff do not ensure residents dietary plan is followed. The complaint alleged that the staff did not adhere to Resident 1's (R1) dietary plan. R1 was not permitted to consume caffeine products; however, caffeine was found in R1's room. On January 30, 2026, the department interviewed the Administrator (A1), who denied the allegation. A1 stated that all staff members communicated residents' dietary needs to the appropriate personnel, including kitchen and care staff. According to A1, staff members would follow special dietary guidelines based on residents' needs and physician orders. During the same investigation, the department interviewed three Medical Technicians (MT1, MT2, and MT3), all of whom denied the allegation. They stated that dietary needs are met in accordance with resident information, physician orders, and individual care plans. On August 13, the department conducted a follow-up interview with MT1, who noted that R1's care plan and the physician's report contained no dietary guidelines. Additionally, the department interviewed three staff members (S1, S2, and S3), all of whom denied the allegations and assured that they follow the residents' care plans. Furthermore, on January 30, 2026, the department interviewed six residents (R2 to R7), all of whom denied the allegation and confirmed that the staff follows their dietary plans. They also expressed that they have no concerns regarding their meals. On August 13, 2026, the department records reviewed for the R1 Physician report indicate there was no special diet. Additionally, the restricted Health condition Service Plan contained no dietary plan or caffeine instructions. The department reviewed the facility's menu, which offered a variety of food and drink options. 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. No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to the Administrator Anita Csukardi.the state’s words, verbatim · CDSS document, Aug 13, 2026 · control 11-AS-20260121105251

Type of visit: Required - 1 Year

On 08/11/26, the department conducted an unannounced annual required visit using the CARE Inspection Tool. The department met with Anita Csukardi, Executive Director, and the purpose of the visit was explained. The department was granted entry to the facility. The facility is licensed to serve (86) non-ambulatory elderly adults ages 60 and over, of which (9) maybe bedridden. The facility is approved for (12) hospice residents. The facility is a (3) floor building and consists of (96) bedrooms, (75) bathrooms, commercial kitchen, large dining room, auditorium, storage areas, nursing stations, activity rooms, exercise room, recreation room, medical supply room, craft room, conference rooms, shaded patio areas, side courtyard, and laundry rooms. The department toured the physical plant. There were no bodies of water or obstructions on the premises. Several rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be operational and within Title 22 regulations. The department inspected rooms: #101, #103, #110, #126, #205, #212, and #225. The water temperature properly measured between 105.0 - 120.0 degrees F. A comfortable temperature was observed throughout the facility. Call buttons, and smoke and carbon monoxide are all in operating condition. The department observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there was sufficient perishable and non-perishable food available maintained properly. Continued on LIC809-C The last emergency and fire drills were completed on 07/31/26. All fire extinguishers were charged. Several working landline phones are available on-site. First aid kit, along with manual was available. A review of Medication Administration Records found to be in order and accurate. The department conducted a review of service records for residents #1-#6 (R1-R6) and personnel records for staff #1-#5 (S1-S5) and found them to be complete and in order. Community Care Licensing annual fees are current. The facility has a current Administrator's Certificate for Anita Csukardi, certificate #7005419740, effective: 07/30/26, and expires: 07/29/28. The facility has a current liability insurance policy with Shomer Insurance Services an Alera Group, policy #H0076PK00613-01, effective: 05/01/26 through 05/01/27. During the visit, the department observed the facility's infection control practices. The department observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters, including the Activities Calendar and Food Menu, were posted. Deficiencies are being cited according to California Code of Regulation, see LIC809-D. An exit interview was conducted, and a copy of this report was provided to Anita Csukardi.the state’s words, verbatim · CDSS document, Aug 11, 2026

Allegation investigated: Staff do not ensure resident is bathed. Staff leave resident in soiled incontinence briefs.

On 07/28/26 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to further investigate the allegations listed above. The department met with Anita Csukardi, Executive Director, and the purpose of the visit was explained. The department was granted entry to the facility. The investigation consisted of the following: On 05/12/26, the department received the following documents: staff roster, resident roster, staff notes, and End of Shift Report’s. The department conducted interviews with staff #1-#5 (S1-S5), residents #2-#6, and witness #1 (W1). Continued on LIC9099-C Unsubstantiated On 07/28/26, the department reviewed resident #1’s (R1’s) service records and obtained copies of the following documents: Identification and Emergency Information, Preplacement Appraisal Information, Physician’s Report, Service Plan, Welbe Health Facility Assessment Determination Addendum, Monthly Shower Assistance Log (for the months of June-July 2026), and emails between staff and R1’s family member. Additionally, the department conducted an interview with R1 and resident #7 (R7). The investigation revealed the following: Allegation: “Staff do not ensure resident is bathed.” It is being alleged that a resident has not received assistance with bathing since they were admitted to the facility. On 05/12/26, the department conducted interviews with S1-S6. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff said residents are bathed at least twice a week and as needed. On 05/12/26, the department conducted interviews with R2-R6, and on 07/28/26, the department conducted an interview with R1 and R7. Of those interviewed, 7 out of 7 residents could not corroborate the allegation. 4 out of 7 residents said they do not require any assistance with bathing, while 3 out of 7 residents said staff assist them with bathing. 2 out of those 3 residents said staff assisted them with bathing twice a week. 7 out of 7 residents said they are satisfied with the services provided to them at the facility. An interview with S1 revealed that staff had been assisting R1 with bathing twice per week. However, R1's family recently requested that a third weekly shower be added. S1 stated that a meeting was held on 05/07/26 with R1's family and the Assisted Living Waiver (ALW) coordinator to discuss the request. According to S1, all parties agreed that R1 would receive bathing assistance three times per week. On 07/28/26, the department conducted a record review of R1’s Service Plan (dated: 05/07/26) which indicated that staff is to provide bathing assistance to R1 three times a week. An email dated 05/10/26 between R1's family member and facility staff revealed that the family member followed up to clarify the agreement reached during the meeting with facility staff. The email confirmed the understanding that R1 would receive showers three times per week. A review of R1’s Monthly Shower Assistance Log (dated: June/July 2026) revealed that R1 has been receiving a shower three times a week. Continued on LIC9099-C Based on record review and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Allegation: “Staff leave resident in soiled incontinence briefs.” It is being alleged that a resident is left in soiled incontinence briefs for hours at night. On 05/12/26, the department conducted interviews with S1-S6. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff said residents are changed every two hours and as needed. On 05/12/26, the department conducted interviews with R2-R6, and on 07/28/26, the department conducted an interview with R1 and R7. Of those interviewed, 7 out of 7 residents could not corroborate the allegation. 4 out of 7 residents said they do not require any assistance with incontinence care, while 3 out of 7 residents said they do. Of the 3 residents who require assistance, 2 reported that they had not been left in soiled incontinence briefs for an extended period of time, and 1 resident did not respond to the question. 7 out of 7 residents said they are satisfied with the services provided to them at the facility. Based on observation and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. An exit interview was conducted, and a copy of this report has been provided to Anita Csukardi.the state’s words, verbatim · CDSS document, Jul 28, 2026 · control 11-AS-20260506145244

Allegation investigated: Staff did not assist a resident in care.

On 06/10/26, at 12:30pm, the department conducted a subsequent complaint visit to the facility and was greeted by Maria Galvan, Administrator. The department explained the purpose of this visit was to gather facility files and deliver findings for the allegation mentioned above. On 5/6/26, at 9:38am, the department conducted an initial complaint visit to the facility and was greeted by Maria Galvan, Administrator (A1). The department explained the purpose of this visit was to gather information about the complaint, gather facility files, interview staff and residents, and deliver findings for the allegation mentioned above. The investigation consisted of the following: The department investigated the allegation mentioned in this complaint and conducted interviews with Maria Galvan, Administrator (A1), staff (S1-S4) and residents (R1-R7). The department received the following documents: Resident Roster (Date: No Date), Staff Roster (Dated: 05/01/2026), Identification and Emergency Information (Dated: 01/05/2026), Physician Report (Dated: 11/18/2025, 05/07/2026), Admission Record (Dated: 10/21/2025), Pre-Placement Appraisal (Dated: 01/04/2026), Admission Agreement (Dated: 01/05/2026), RCFE Service Plan (Dated: 06/10/2026), and After Visit Summary from Providence Emergency Center (Dated:04/05/2026) from the facility. Report Continued On LIC Unsubstantiated The investigation revealed the following: Allegation- Staff did not assist a resident in care. The details of the complaint alleged that the facility’s staff did not assist resident (R1) in care. It was reported that resident (R1) asked to be taken to the smoking area because they had a previous fall and staff refused and allegedly stated that R1 should be healed by now and can go by themselves. On 5/6/2026, from 9:30am-2:00pm, the department interviewed administrator (A1), staff (S1-S4) and residents (R1-R7) regarding the allegation. The administrator (A1) and staff (S1-S3) denied the allegation and stated that they have never refused to assist a resident in care. Staff (S4) stated that the resident was upset that they were asked to leave the non-designated smoking area and to go the smoking area because they were smoking at the front entrance. S4 stated that the resident flicked their cigarette into the bushes and stated, “then you are going to take me”. S4 explained the reason that they did not wheel the resident to the smoking area is because the resident is not on escorts, which is a service that some residents use who are not able to get around without assistance. S4 further stated that the resident did not need assistance and was capable of going to the smoking area without assistance. S4 stated that eventually R1 wheeled themselves to the smoking area by themselves without further incident in their electric wheelchair. The department interviewed residents (R1-R7) about the allegation and 6 of 7 residents that were interviewed stated that staff has never refused to assist them when they have asked. While R1 stated that they were recently released from the hospital and had a sprained shoulder and was still in pain and needed help, but staff did refuse to assist them. The department reviewed Pre-Placement Appraisal (Dated: 01/04/2026), Physician Report (Dated: 11/18/2025, 05/07/2026), RCFE Service Plan (Dated: 06/10/2026), and the After Visit Summary from Providence Emergency Center (Dated:04/05/2026) and observed that R1 has used an electric wheelchair independently since they arrived at the facility and had no motor impairment or paralysis. The department also observed that the resident had a fall that resulted in a shoulder sprain and was taken to the hospital on 04/05/26. The department did not observe any documentation from that visit that specified the resident needed additional assistance or suffered any motor impairment or paralysis after their last hospital visit. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Staff did not assist a resident in care. 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. No deficiencies were found and no citations were issued for this complaint investigation. An exit interview was conducted with Maria Galvan, Executive Director, and a hard copy of this Complaint Investigation Report was provided.the state’s words, verbatim · CDSS document, Jun 10, 2026 · control 11-AS-20260430150327

Type of visit: Office

On 06/02/26 Regional Manager (RM) Janae Hammond, Licensing Program Managers (LPM) Ulysses Coronel and Stephanie Cifuentes and Licensing Program Analyst (LPA) Mario Leon conducted a Noncompliance Conference meeting with Licensees Ben Berkowitz and Grace Mercado, Oceanview Regional Executive Director Brittany Kavanaugh and Oceanview Administrator Maria Galvan. During the conference RM Hammond discussed department concerns and offered Technical Support Program (TSP) which was accepted by Regional Executive Director Brittany Kavanaugh. No deficiencies were cited during today's meeting and a copy of this report and NONCOMPLIANCE CONFERENCE SUMMARY (LIC9111) was provided to Oceanview Administrator, Maria Galvan.the state’s words, verbatim · CDSS document, Jun 2, 2026

Allegation investigated: Staff did not provide timely medical care. Resident sustained a serious injury while in care Questionable death

On 04/24/2026 the Community Care Licensing Division (CCLD) staff conducted a subsequent complaint investigation at Oceanview Living of San Pedro to deliver the investigation findings for the allegations listed above. This facility was named Serenity Senior Village during the complaint investigation, the facility name changed as of 05/01/2025. CCLD staff met with administrator Maria Galvan, and the purpose of the visit was explained. The investigation consisted of the following: CCLD staff interviewed residents (R2-R5), Staff (S1-S10) and witness (W1). CCLD staff obtained and reviewed the following records: R1’s Physician’s Report (dated 08/07/2023, R1’s Medical Assessment (dated 06/26/2024). Incident Facility reports (dated 12/13/2024, 01/20/2025), Los Angeles Fire Department’s emergency response records dated 01/20/2025, R1’s Hospital Medical Records, and R1’s Death Certificate dated 02/08/2025. The investigation revealed the following: Substantiated Regarding the allegation: “Staff did not provide timely medical care. This complaint alleged that staff did not seek timely medical care for R1 who was in pain after an unwitnessed fall. Record reviews revealed the following: R1’s Physician Report (dated 08/07/2023) indicates that R1 was diagnosed with mild cognitive impairment, was non-ambulatory due to physical condition and requires a walker. The facility’s incident report indicates that on 01/20/2025 at 11:45 a.m., R1 was observed screaming in pain after an unwitnessed fall. Staff assessed R1, and that 911 was not called. The Los Angeles Fire Department emergency response records indicate that first responders arrived at the facility at 5:02p.m. on 01/20/2025. Hospital medical records indicate that on 01/20/2025 at 5:29 p.m. R1 arrived and was diagnosed with a Fractured Back, Urinary Tract Infection and Brain Bleed. Interviews revealed the following: On 01/20/2025 around 11:30 am S6 reported hearing R1 screams for help from R1’s room. S6 informed S7 of R1’s fall, S7 evaluated R1 and noted complaints of pain to R1’s back, S7 gave R1 Tylenol and staff lifted R1 from the floor and placed R1 on the wheelchair. At around 2:00 p.m. S8 called W1 to report that R1 was in pain and that the pain increased. On 01/20/2025 at around 4:30 pm W1 found R1 screaming in pain and asked staff to call 911. It took approximately five and a half (5 ½) hours for R1 to get medical attention. Based on the records review and interviews, the preponderance of evidence standard has been met. Therefore, the allegation that “staff did not provide timely medical care” is found to be SUBSTANTIATED. Regarding the Allegation: Resident sustained a serious injury while in care. This complaint alleged that R1 sustained serious injuries while in care. Record reviews revealed the following: R1’s Physician Report (dated 08/07/2023) indicates that R1 was diagnosed with mild cognitive impairment, was non-ambulatory and requires a walker. The incident reports dated 12/13/2024 indicate that on 12/13/2024, R1 had unwitnessed fall, and R1’s doctor ordered R1 to be taken to the hospital. The incident reports dated 01/20/2025 indicate that 0n 01/20/2025, R1 had a second unwitnessed fall. On 01/20/2025 Hospital medical records indicate that R1was diagnosed with a Fractured Back, Urinary Tract Infection and Brain Bleed. Interviews revealed the following: On 12/13/2024 after hospitalization following an unwitnessed fall, R1 was not assessed for fall risks, and a fall‑prevention plan was not developed. On 01/20/2025 at 11:30 a.m. S6 heard a loud commotion and screams from R1’s room. S6 was concerned about R1 back as R1 states that their back hurt. S6 informed S7 of R1’s fall and S7 evaluated R1 and noted complaints of pain to R1’s back. S7 gave R1 Tylenol and did not call 911. W1 indicates that R1 was transported to the hospital only after W1 told staff to call 911. On 01/20/2025 at 4:30 pm W1 found R1 screaming in pain and asked staff to call 911. Based on interviews and record reviews conducted by CCLD staff for R1 the preponderance of evidence standard has been met. Therefore, the allegation that “Resident sustained a serious injury while in care” is found to be SUBSTANTIATED. Regarding the Allegation: Questionable death. This complaint alleged that resident sustained a questionable death, due to staff’s failure to reassess and implement fall interventions after R1 fall on 12/13/2024 and staff’s failure to provide timely medical care after R1s fall on 01/20/2025. Record reviews revealed the following: The facility incident report dated (01/20/2025) approximately 11:30 am indicates that R1 had an unwitnessed fall and facility staff did not call 911 or transport R1 to the hospital. The Hospital records dated 01/20/2025 indicate that R1 was hospitalized after R1’s falls while at the facility on 12/13/2024 and on 01/20/2025. On 01/20/2025 R1 was diagnosed with Fractured Back, Urinary Tract Infection and Brain Bleed. On 01/31/2025 hospital records indicate that R1 died in the hospital, R1’s primary cause of death was listed as Acute Subdural Hematoma, which is a collection of blood under the skull's outer lining (dura), caused by severe head trauma, leading to rapid pressure on the brain. R1’s Death Certificate dated 02/05/2025 indicates Hemorrhagic Storke or bleeding inside the brain as cause of death. Interviews revealed the following: On 01/20/2025 around 11:30 am S6 reported hearing R1 screams for help from R1’s room. S6 informed S7 of R1’s fall, S7 evaluated R1 and noted complaints of pain to R1’s back, S7 gave R1 Tylenol and staff lifted R1 from the floor and placed R1 on the wheelchair. At around 2:00 p.m. S8 called W1 to report that R1 was in pain and that the pain increased. On 01/20/2025 at around 4:30 pm W1 found R1 screaming in pain and asked staff to call 911. Based on the reviewed records and interviews conducted, the preponderance of evidence standard has been met. Therefore, the allegation "Questionable death” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is cited on the attached LIC 9099D. An immediate civil penalty is being assessed please see LIC421IM. At this time, an additional civil penalty determination is pending in reference to Health & Safety Code 1569.49(e) For a violation that the department determines resulted in the death of a resident. “ An exit interview was conducted, and a copy of the Complaint Report and Appeal Rights was provided to Administrator Maria Galvan.the state’s words, verbatim · CDSS document, Apr 24, 2026 · control 11-AS-20250205101344

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Apr 30, 2026

87465 Incidental Medical and Dental Care: (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidence by: Based on records and interviews conducted the licensee did not ensure that staff immediately call 911 on 01/20/2025, staff did not immediately call 911 for R1 who was complaining of pain, this posed an immediate health, safety and personal risk to residents in care.the state’s words, verbatim · CDSS document, Apr 24, 2026

Plan of correction: The administrator agreed to provide additional training to staff on seeking timely medical assistance for residents in care, proof of correction will be submitted to jose.calderon@dss.ca.gov.

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

87463 Reappraisals (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. (b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement was not met as evidence by. Based on records review and interviews conducted, the licensee did not ensure that staff did a reappraisal of R1, after an unwitnessed fall that resulted in hospitalization on 12/13/2024. This poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 24, 2026

Plan of correction: The administrator agreed to create a plan to ensure that reappraisals are conducted for residents after falls resulting to hospitalizations, proof of correction will be submitted to jose.calderon@dss.ca.gov.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Apr 30, 2026

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gain or losses or deterioration of mental ability or physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person. This requirement was not met as evidence by: Based on records and interviews conducted, the licensee did not ensure appropriate assistance after R1’s initial fall on 12/13/2024. No fall prevention plan or intervention was implemented, resulting in a second fall on 01/20/2025 that caused serious injuries that led to R1’s death. This posed an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 24, 2026

Plan of correction: The administrator agreed to create a plan that includes documenting all changes in residents’ physical, mental, emotional, and social functioning, ensuring timely notification to physicians and responsible persons, and implementing a fall‑prevention assessment. And that staff will be provided with training on the said plan within 10-days, and proof of correction will be submitted to jose.calderon@dss.ca.gov.

Allegation investigated: Staff inappropriately spoke with resident Staff do not communicate with residents and responsible parties regarding residents' care Staff do not ensure that resident's needs are met

On 04/16/2026 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Oceanview Living of San Pedro and was greeted by Administrator Maria Galvan (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: LPA Calderon interviewed Staff S1-S3, residents R1-R6. LPA Calderon obtained the following records: Physician report (dated 07/24/2025), Needs and service plan (dated 04/16/2026) for R1. Received meeting schedule for April 2026 for administrator. Toured the facility with S1 The investigation revealed the following: Unsubstantiated Regarding the Allegation: Staff inappropriately spoke with residents. This complaint alleged that the facility staff yelled or spoke to residents in care inappropriately. LPA Calderon toured the facility with S1 and did not witness any staff interactions when staff were speaking to residents. LPA Calderon could not determine who the anonymous resident was. LPA Calderon pulled records for R1. Records review indicate the following: Physician report (dated 07/24/2025) indicates that R1 has no health issues and no cognitive issues. R1 also showed LPA a picture of 2 cats R1 lives with. Interviews indicate the following: R1 indicates that R1 has never had a staff member speak to R1 inappropriately. R2-R6 deny the allegation. S1 indicates that S1 would not allow staff to speak to a resident inappropriately. S2-S3 deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff inappropriately spoke with resident” is found to be UNSUBSTANTIATED. Regarding the Allegation: Staff do not communicate with residents and responsible and responsible parties regarding residents’ care. This complaint alleged that the facility staff did not communicate with residents and residents’ family members. LPA Calderon could not determine who the anonymous resident was. LPA Calderon pulled records for R1. Records review indicate the following: Physician report (dated 07/24/2025) indicates that R1 has no health issues and no cognitive issues. Reviewed April 2026 calendar for administrator meetings with residents and residents’ families. Interviews indicate the following: R1 indicates that R1 takes care of R1 medical issues and no family help. R2-R6 deny the allegation. S1 indicates that S1 and S1 staff communicate with residents in care and their families. S2-S3 deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “Staff do not communicate with residents and responsible parties regarding residents care” is found to be UNSUBSTANTIATED. Regarding the Allegation: Staff do not ensure that residents’ needs are met. This complaint alleged that the facility neglected to meet resident’s needs. Records review indicate the following: LPA Calderon could not determine who the anonymous resident was. LPA Calderon pulled records for R1. Records review indicate the following: Physician report (dated 07/24/2025) indicates that R1 has no health issues and no cognitive issues. Interviews indicate the following: S1-S3 deny the allegation. R1-R6 deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff do not ensure that residents needs are met” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Maria Galvan (S1).the state’s words, verbatim · CDSS document, Apr 16, 2026 · control 11-AS-20260406133714

Allegation investigated: Fire Clearance Alterations to Physical Plant

This report supersedes the reported dated 2/3/26 due to the date was incorrectly inputted by LPA, all findings remain the same. On 4/13/26 Licensing Program Analyst (LPA) Sparkle Day conducted a “Subsequent” visit to deliver findings of the above allegations on behalf of the Department of Social Services Community Care Licensing. LPA met with Maria Galvan, Administrator and explained the purpose of this visit. The investigation consisted of the following: On 1/9/26, the Department conducted a visit with the Los Angeles Fire Department present regarding the above allegations. The Department reviewed and obtained the following documents: Resident Roster (dated 12/08/2025), Staff Roster (dated 12/03/2025), Oceanview Living of San Pedro Plan of Operation, Change of Ownership Application Packet, Fire Safety Inspection Reports (dated 12/07/2023 and 12/23/2025), Fire/Life Safety Order (dated 12/22/2025), Emergency Disaster Plan (dated 09/09/2025), City of Los Angeles Tax Registration Certificate (dated 05/01/2025), Certificate of Liability Insurance (07/01/2025–07/01/2026), Mitigation Plan (dated 05/01/2025), Residential Infection Control Plan, Facility Sketches, RCFE Fire Unsubstantiated Watch Log (10/02/2025–12/10/2025), Fire Prevention Plan, and Designation of Facility Responsibility (dated 08/05/2025). The investigation revealed the following: ALLEGATION #2: Fire Clearance It is alleged that the facility does not maintain a fire clearance approved by the appropriate fire authority. The department conducted a tour of the physical plant and learned the facility had an annual visit from LAFD on 8/21/2025 and was issued several violations. The facility failed to comply with the violations issued by the Los Angeles Fire Department (LAFD). However, its fire clearance was neither revoked nor denied. The facility was placed on Fire Watch, requiring hourly patrols to identify hazards, detect fires early, alert occupants, and contact emergency services. This measure was implemented by LAFD while violations were being corrected. The Fire Watch concluded on 3/30/26, and all Fire Watch requirements were verified as corrected by LAFD. Based on the investigation, although the allegation may have occurred or may be valid, there is insufficient evidence to establish a preponderance of evidence. Therefore, the allegation is **UNSUBSTANTIATED** ALLEGATION #3: Alterations to Physical Plant It is alleged that the facility has added partitions, locks, or gates to separate spaces for other entities on the premises. On 1/9/26, the Department toured the facility, reviewed the facility sketch, and compared it to the pre-licensing report dated April 24, 2024 . Staff (#1 and #2) were interviewed and provided consistent statements indicating that no structural changes such as additional walls, doors, or locks had been made since the original 2023 facility sketch. Based on observations, document review, and staff interviews, the Department did not identify any alterations to the physical plant. Based on the investigation, although the allegation may have occurred or may be valid, there is insufficient evidence to establish a preponderance of evidence. Therefore, the allegation is **UNSUBSTANTIATED**. On 2/28/2026, all individuals residing int the sober living vacated the property. On 3/30/2026, all Individuals residing in the apartments vacated the property. Based on the Administrator’s admission and the Department’s direct observations confirming the presence of an unapproved entity operating on the premises, this allegation is **SUBSTANTIATED** Exit interview conducted with Administrator Maria Galvan A copy of this report was provided at time of visit.the state’s words, verbatim · CDSS document, Apr 15, 2026 · control 11-AS-20260108132437

From the deficiency page — Deficiency type: Type B · Section cited: CCR 82708 · Plan of correction due date: Feb 10, 2026

82708 The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49 This regulations was not met by the following evidence: Interviews and observations indicates the Licensee is operating a sober living entity on-site that is not part of the approved plan, posting a health and safety risk to residentsthe state’s words, verbatim · CDSS document, Apr 15, 2026

Plan of correction: Corrected at time of visit

Allegation investigated: Staff did not make resident's records readily available to emergency medical personnel

LPA Sparkle Day conducted a subsequent visit to the facility regarding the above allegation of this investigation. Upon arrival LPA met with Cody Wagner and explained the purpose of this visit. Administrator Maria Galvan arrived shortly after and was also informed of the purpose of the visit. The Investigation consisted of the following: ALLEGATION #1: Staff did not make resident's records readily available to emergency medical personnel It is alleged that facility staff did not provide emergency medical staff with emergency medical records of R#1 The investigation consisted of the following: On 02/24 /26 LPA Watson obtained copies of the following documentation: Personnel report dated 02/23/2026, Resident Roster dated 02/23/2026, Face Sheet for R1 dated 08/01/2025, Medical Assessment dated 07/25/25, Medication Discharge Report dated 07/25/25, Medication Administration Record dated,02/2026, and Training Sign in Sheets Care Tips for Professional Caregivers dated 11/13/2025. How to Handel Residents Having a Seizure. LPA Watson conducted Interviews with Residents #1-6 (R1-R6), and with Staff #1-6 (S1-S6). LPA toured the facility with Administrator Maria Unsubstantiated Galvan and found the facility to be clean and in good repair. During todays visit LPA Sparkle Day requested to speak with Staff # 3 who was present date of incident 2/14/26. Staff #3 did not recall specific incident, however states she always prints out residents face sheet and medication list during all emergency calls. LPA Day requested Special Incidents for R#1 , however none was found for R#1. LPA reviewed Facility SIR in Regional office from January, 2026 to February 2026 and did not observe any SIRs for R#1. Based upon this investigation, LPA finds that 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 UNSUBSTANTIATEDthe state’s words, verbatim · CDSS document, Apr 13, 2026 · control 11-AS-20260218183034

Allegation investigated: Licensee does not ensure there is adequate staff to meet residents' needs. Staff do not respond timely to residents' requests for assistance Licensee dissuades staff from reporting to Licensing

On 04/01/26 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the facility. California Department of Social Services (CDSS) was met by staff one, Maria Galvan - Executive Director, and the purpose of the visit was explained. The investigation consisted of the following: On 07/30/24 CDSS requested facility documents including Resident roster (dated 03/02/26) and Staff roster (dated: 03/23/26) along with Employee list of seven (7) PM shift and four (4) overnight (NOC) staff (dated 04/01/26) and relevant documents of the employee file audit (EFA). CDSS toured the facility. Between 09:45AM and 2:00PM CDSS interviewed seven (7) out of sixty-nine (69) residents and five (5) out of forty-five (45) staff. The investigation revealed the following: Regarding the allegation “Licensee does not ensure there is adequate staff to meet residents' needs.”, it is being alleged that the PM and NOC shift, there are not enough staff to meet residents’ needs. Report continues, please see LIC9099-C. Unsubstantiated Record reviews have revealed the following: Employee list indicates that all seven (7) PM shift and four (4) NOC staff remain active and are still working at the facility. Interviews have revealed the following: four (4) out of five (5) staff (S1-S4) and five (5) out of seven (7) residents (R1-R3 & R6-R7) have not agreed with the allegation. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation “Staff do not respond timely to residents' requests for assistance”, it is being alleged that because there are not enough staff, the staff cannot respond in a timely manner to chimes from residents seeking assistance. Record reviews have revealed the following: Employee list indicates that all seven (7) PM shift and four (4) NOC staff remain active and are still working at the facility. Interviews have revealed the following: four (4) out of five (5) staff (S1-S4) and six (6) out of seven (7) residents (R1-R6) have not agreed with the allegation. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation “Licensee dissuades staff from reporting to Licensing”, it is being alleged that administration will fire any staff who report complaints to Licensing. Record reviews have revealed the following; EFA contains the following documents: Personnel Action Form (indicates that all staff are to be trained in emergency situations and how to respond with residents), Equal Employment Opportunity (EEOC) Employee Notification (indicates all protected categories of staff and that retaliation is prohibited), Statement acknowledging Requirement to Report Suspected abuse of Dependent Adults and Elders (SOC341) that indicates that all hired staff are included as "Mandated Reporters" which include "Reporting Responsibilities and Time Frames" and Employee Rights which indicate that, "No employer shall discharge, demote, suspend or threaten to discharge, demote or suspend, or in any manner discriminate against any employee for taking any of the following actions: (1) Making an oral or written complaint against the employer to the CDSS...having statutory responsibility for enforcement of the law...for the violation of any licensing law or other laws.... Interviews have revealed the following: four (4) out of five (5) staff (S1-S4) and all seven (7) residents (R1-R7) have not agreed with the allegation. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with staff one, Maria Galvan - Executive Director (S1), and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Apr 1, 2026 · control 11-AS-20260327150013

Type of visit: Case Management - Health Checks

On 03/27/26 Licensing Program Analyst (LPA) Mario Leon conducted a case management - Health Checks visit. California Department of Social Services (CDSS) was met by staff one, Maria Galvan - Administrator (S1) and later by staff two, Cody Wagner (S2) and the purpose of the visit was explained. CDSS collected fire watch log (dated 03/18/26 through 03/27/26) and requested records related to fire panel repairs. Record reviews of fire watch log show a completed log of the dates of 03/18/26 through 03/27/26, conducted every 30 minutes by two (2) qualified staff. Further record reviews were provided which detailed fire system updates and status (dated 03/04/26). During today's case management visit, CDSS found zero (0) deficiencies. An exit interview was held with S1 and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2026

Type of visit: Case Management - Health Checks

On 03/18/26 Licensing Program Analyst (LPA) Mario Leon conducted a case management - Health Checks visit. LPA was met by staff one, Maria Galvan - Administrator (S1), and the purpose of the visit was explained. LPA was later met by staff two, Andy Buhain - Maintenance Supervisor (S2) and later by staff three, Jose Hernandez - Housekeeping Supervisor (S3) LPA toured the facility with S3. During today's case management visit LPA observed the facility and did not find any remaining sober-living residents. LPA collected fire watch log (dated 02/26/26 through 03/18/26) and records related to fire sprinkler test and repairs. Record reviews of fire watch log show a completed log of the dates of 02/26/26 through 03/18/26, conducted every 30 minutes by two (2) qualified staff. Further record reviews of fire sprinkler test and repairs show that on 03/16/26 GTO Fire Protection created an invoice which details replacement of numerous sprinklers in disrepair and expedited testing of remaining sprinklers. All work has been completed on 03/17/26. During today's visit, there have been zero (0) deficiencies cited. An exit interview was held with Maria Galvan - Administrator (S1) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Mar 18, 2026

Allegation investigated: Unlawful eviction Staff inappropriately evaluated resident without conservators knowledge Staff are not providing adequate food service to residents Staff are not allowing resident to have a camera in the room Staff are not answering the phones

On 03/17/2026, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Complaint Visit to the facility listed above. LPA met with Administrator, Maria Galvan, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: During today’s visit, LPA inspected the facility and interviewed Resident’s R2-R8. During the initial visit conducted on 12/11/2025, LPA observed the lunch service being served to the residents, interviewed Staff S1-S6, and received documents pertinent to the investigation. The following documents were received and reviewed: Staff Roster, Resident Roster, Eviction Notice dated 12/04/2025, Physician’s Report dated 04/11/2025, Service Plan dated 09/15/2025 , physician’s Instructions to Assisted Living Home (dated 10/01/2025), Initial Psychological Evaluation dated 12/03/2025, Admission Agreement dated 09/15/2025, Physician Visit Summary dated 07/07/2025, Los Angeles Police Department incident 3027 dated 12/02/2025, Resident and Responsible Person or Conservator copy of Personal Rights in Privately Operated Residential Care Facilities for the Elderly dated 09/15/2025, Consent for Emergency Unsubstantiated Medical Treatment dated 09/15/2025, Unusual Incident/Injury Report dated 12/06/2025, Incident Reports, Menus from 10/12/2025 through 12/13/2025, and Always Available menu. The investigation revealed the following: Allegation: Unlawful eviction The allegation alleges that a resident was unlawfully evicted. During record review, LPA received and reviewed the evection notice dated December 4, 2025. During review of the eviction LPA observed the 30-day Eviction Notice included the effective date, specific Facility House Rules being violated listed in the Resident Care and Agreement and the incidents, resources available to assist in alternative housing and care option, the right to file a complaint with Community Care Licensing’s and the Long-Term Care Ombudsman’s contact information, and the Health and Safety Code section 1569.683(a)(4). Additionally, LPA reviewed Staff Statements of interactions and incidents regarding violation of Facility House Rules dated 09/16/2025, 10/09/2025, 10/12/2025, 10/15/2025 at 9AM, 10/15/2025 at 1PM, 10/16/2025, 10/23/2025, 11/07/2025, 11/12/2025, 11/20/2025, 11/21/2025, 11/24/2025, 11/24/2025 at 7:55PM, 12/02/2025, 12/02/2025 at 2:15PM, 12/04/2025, 12/05/2025, and ongoing, repeat incidents from various dates. LPA received and reviewed Resident R1’s Initial Psychological Evaluation conducted on 12/03/2025, that states “Patient’s mental health activity, does not support the services that assisted living can provide.” Resident R1’s Residents and Care Agreement signed and dated on 09/15/2025, that states on page 10 to 11, “B. Termination by Us. 1. Upon thirty (30) Days’ Notice. We may terminate this Agreement upon thirty (30) days’ written notice to you if any of the following events occur: c. Your failure to comply with the general policies of the Community [These policies are as described in this Agreement and in the Resident Handbook].” During interviews with Residents R2-R8, were asked if they have been issued an eviction notice or have been threatened with an eviction, seven (7) out of seven (7) stated no, they have not been issued an eviction or been threatened with one. During interviews with Staff S1-S6, were asked if a resident was issued an unlawful eviction, six (6) out of six (6) stated no, no resident have been issued an unlawful eviction. Additionally, Staff S1-S6 stated Resident R1 was issued an eviction notice due to not following the policies of the community. Allegation: Staff inappropriately evaluated resident without conservators knowledge The allegation alleges that a resident was evaluated by a doctor without the resident’s conservator being notified. During record review, LPA received and reviewed Resident R1’s Residence and Care Agreement that states the following on page 4 “I. Observation and Consultation The staff at the Community will observe your health status to identify if you dietary, social and health care needs and will provide you with consultations regarding social and health-related issues. Additionally, LPA received and reviewed a Staff Note, signed by Staff S1-S3, and S5, dated 12/02/2025, that they met with W1 and discussed Resident R1 needing a Psychiatric Evaluation to evaluate if a medication adjustment was required. In the notes states W1 agreed and thanked them. LPA received and reviewed the Initial Psychological Evaluation report conducted on 12/03/2025. During interviews with Staff S1-S6, were asked if residents are evaluated without the conservator or responsible parties’ permission, six (6) out of six (6) stated no evaluations will be conducted without the permission of the conservator or responsible party. During interviews with Residents R2-R8, were asked if a medical professional has conducted an assessment without their prior knowledge or their responsible party’s prior knowledge, seven (7) out of seven (7) stated no, no assessments were conducted without their or their responsible party’s prior knowledge. During interview with Staff S1-S6, were asked if a residents conservator or responsible party is notified before receiving medical treatment or assessment, six (6) out of six (6) stated yes they are informed and it is discussed before unless it is an emergency. During an interview with Resident R1’s conservator W1, was asked if they requested R1 to be evaluated, W1 stated yes, I told the staff I wanted R1 evaluated. W1’s main concern was that they wanted to be present when R1 was evaluated. Allegation: Staff are not providing adequate food service to residents The allegation alleges the staff do not ensure a resident eats their meal, do not take residents a sandwich, do not serve fresh vegetables and chips are given as a snack. During the facility visit, LPA observed lunch being served. LPA observed the meal being served was what was listed on the weekly menu. LPA observed the following foods served green salad, beef brisket, red potatoes, creamed spinach, bread, and peach crisp. LPA observed an Always Available Menu posted that consist of cottage cheese with peaches, turkey sandwich, and soup du jour. In the kitchen, LPA observed a list of Diet/Restrictions that consisted of residents’ special diets and a Food Preference List that lists resident’s preference. During record review, LPA received and reviewed a Dietary Order (dated on 10/01/2025 and received on 12/03/2025) for R1 from their physician that indicates R1 has a diet restriction of no coffee or caffeine products. During interviews with Staff S1-S7, were asked if residents’ dietary orders, restrictions, and preferences are followed, seven (7) out of seven (7) stated yes, they are followed according to the orders provided to them. During interviews with Residents R2-R8, were asked if their dietary orders, restrictions and/or preferences are followed, seven (7) out of seven (7) stated yes, their dietary orders, restrictions, and preferences are followed. Allegation: Staff are not allowing resident to have a camera in the room The allegation alleges that a resident’s conservator was told they could not have a camera in a resident’s room and was told to remove it. During the facility inspection, LPA observed there are three (3) rooms that have a sign posted on the outside of their doors indicating surveillance monitoring is in progress. Additionally, LPA received and reviewed Resident R1’s Residence and Care Agreement, signed and dated on 09/15/2025, that states on page 17 “XI. MISCELLANEOUS B. Video Surveillance In order to protect the dignity and privacy of our resident, we do not permit the use of nanny cams or other video surveillance devices in resident apartments.” During an interview with resident R1’s conservator W1, stated the camera from R1’s room was disconnected by a family member and that W1 reinstalled them. W1 stated they posted a notice on the door that states “WARNING Premises Protected By 24-Hour Audio and Video Surveillance By entering You Agree To Be Audio & Video RECORDED.” During an interview with Staff S1-S6, were asked what the policy regarding cameras in a resident’s room, six (6) out of six (6) stated the facility does not allow video surveillance in resident’s rooms. During an interview with Residents R2-R8, were asked if they were made aware of the Video Surveillance policy prior to moving in, seven (7) out of seven (7) stated they were made aware of the policy while reviewing the Residence and Care Agreement prior to moving in. Allegation: Staff are not answering the phone. The allegation alleges that during the night staff do not answer the phones and that a residents family member called and was hung up on. During the facility visit, LPA worked in the main room and observed the front desk worker answering phone calls throughout the day. LPA called the facility number and had their call answered. LPA reviewed Staff Statements from 09/16/2025 through 11/24/2025 regarding phone calls and interactions with R1 and W1. During an interview with Staff S1 stated phones are monitored and answered by the front desk receptionist during business hours 9AM to 5PM. After hours, calls are forwarded to the Medication Room and are answered by Med Techs when they are available and not assisting residents. During interviews with Staff S1-S6, were asked if phones are answered the whole day, six (6) out of six (6) stated phones are answered by the receptionist during business hours and transferred to the Medication Room after hours and the med tech will answer calls or return call when they are available. During interviews with Residents R2-R8, were asked if their or their family’s calls are answered, four (4) out of seven (7) stated their phone calls are always answered. Additionally, three (3) out of seven (7) stated the receptionist leaves at 5 and the phone is transferred upstairs and if they are assisting a resident, it might take 5 minutes for the phone to be answered. During the course of the investigation, LPA was unable to find evidence to support the allegation(s). Although the allegation(s) may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) is/are unsubstantiated. During today’s visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Maria Galvan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 17, 2026 · control 11-AS-20251205145540

Allegation investigated: Facility staff are not ensuring that residents’ showering needs are being met. Facility staff are not treating resident with dignity and respect.

On 03/12/26, at 9:00am, Licensing Program Analyst (LPA) Mario Leon conducted an initial complaint visit at this facility. LPA was met by Maria Galvan - Executive Director (S5) and the purpose of the visit was explained and LPA took a tour of the facility. The investigation consisted of the following: LPA requested staff roster, resident roster, shower logs and additional paperwork regarding Medication Administration Record (MAR). Resident one through resident two (R1-R2) face sheet, pre-appraisal and appraisal, medical assessment(s) (dated: various) and Medication Administration Record (MAR). LPA interviewed five (5) staff (S1-S5) and seven (7) residents (R1-R7). Report continues, please see LIC9099-C. Unsubstantiated The investigation revealed the following: Regarding the allegation “Facility staff are not ensuring that residents’ showering needs are being met." it is being alleged that a resident has not been showered for ten (10) days. Record reviews have revealed the following: Shower logs of residents in care confirm that residents are being showered which indicates residents are being kept clean. Interviews have revealed that four (4) out of five (5) staff (S2-S5) and four (4) out of seven (7) residents (R2-R3 & R5, R7) have denied the allegation has taken place, while one (1) resident was unsure (R4). Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation "Facility staff are not treating resident with dignity and respect." it is being alleged that staff have "play(ed) game(s)" with a resident's medication management. Record reviews have revealed the following: a resident in question MAR have been reviewed and no discrepancies have been found. Interviews have revealed that four (4) out of five (5) staff (S2-S5) and five (5) out of seven (7) residents (R2-R5 & R7) have disagreed with the allegation. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with Maria Galvan - Executive Director (S5) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Mar 12, 2026 · control 11-AS-20260306112113

Allegation investigated: Staff did not ensure resident was kept free of verbal abuse from other resident in care

On 03/11/2026 at approximately 9:00AM, Licensing Program Analyst (LPA) Jose Anguiano conducted an unannounced complaint visit. LPA met with Administrator Maria Galvan. The investigation consisted of the following: On 03/11/2026, LPA Anguiano collected the current staff and resident roster, as well as the roster from November 2025. LPA interviewed six residents (R1–R6), eight staff members (S1–S9), including caregivers and kitchen staff, and two outside witnesses (W1–W2). LPA also conducted observations in the facility dining room and reviewed available information regarding the alleged incident involving residents. LPA reviewed and collected R1 and R2 face sheets, admission records for R2, and R1’s physician’s report. The investigation revealed the following: Regarding the allegation “Staff did not ensure resident was kept free from verbal abuse by another resident in care,” it is alleged that a resident verbally harassed another resident in the dining room. Please see (LIC9099-C) for report continuation. Unsubstantiated Records review revealed the following: At the time of the investigation, no records were provided to LPA documenting the alleged verbal altercation. Additionally, no facility records reviewed contained documentation supporting the allegation. Observations revealed the following: During the dining room observation conducted by LPA between approximately 11:30 AM and 11:53 AM, approximately 10–15 residents were present in the dining room with two staff members serving meals. Residents appeared calm, and no verbal arguments, yelling, or resident-to-resident conflicts were observed during the observation period. Interviews conducted revealed the following: Five out of six residents interviewed reported they had not witnessed residents arguing or fighting in the dining room and did not recall any altercation occurring around Thanksgiving of 2025. One resident stated that arguments between residents occasionally occur but did not report witnessing the specific incident referenced in the allegation. Multiple staff members interviewed reported they did not witness the incident. One staff member reported recalling that resident (R2) verbally yelled at resident (R1) in the dining room on one occasion and stated the behavior did not occur again and was able to defuse the situation. Based on the evidence gathered, interviews conducted, observations made, and records reviewed, although the allegation “Staff did not ensure resident was kept free from verbal abuse by another resident in care” may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated. No deficiencies were cited during today’s visit. An exit interview was conducted, and a copy of this Complaint Investigation Report was provided to the facility.the state’s words, verbatim · CDSS document, Mar 11, 2026 · control 11-AS-20260302113842

Allegation investigated: The facility is in disrepair

On 2/27/26, at 9:30am, the department conducted an initial complaint visit to the facility and was greeted by Maria Galvan, Administrator. The department explained the purpose of this visit was to gather information about the complaint, gather facility files, interview staff and residents, and deliver findings for the allegation mentioned above. The investigation consisted of the following: The department investigated the allegation mentioned in this complaint and conducted interviews with staff (S1-S4) and residents (R1-R6). The department received the following documents: Resident Roster (Date: 02/04/2026), Staff Roster (Dated: 02/23/2026), West Coast Boiler Plumbing Work Order (Dated: 02/16/2026, 02/20/2026), West Coast Boiler Plumbing Work Invoice (Dated: 02/19/2026, 02/23/2026), and E.Z. Roth Plumbing/Heating Invoices (Dated: 02/05/2026,02/10/2026, 02/19/2026) from the facility. Report Continued On LIC9099-C Unsubstantiated The investigation revealed the following: Allegation- The facility is in disrepair. The details of the complaint alleged that the facility’s heating system is not working, including no heat in resident bedrooms. It was also reported that there are leaks throughout the 1st and 2nd floors. On 2/27/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R6) regarding the allegation. 3 of 4 staff denied the allegation that the facility is in disrepair. The majority of the staff stated that overall, the facility is not in disrepair but stated that they are constantly upgrading the facility as needed. Most staff (3 of 4) stated that they don’t have a heating problem in the facility, while all staff stated that there was a plumbing issue a few weeks ago, but a work order was submitted, and the problem was fixed immediately. The department interviewed residents (R1-R6) about the allegation and 4 of 6 residents that were interviewed stated that they believe the facility is not in disrepair. 4 of 6 residents stated that they do have heat in their rooms and denied any knowledge of having leaks in their rooms or seeing leaks on the 1st and 2nd floors. The department toured the rooms of residents who stated that they don’t have any heat in their rooms and found that the heater was working. The department reviewed the West Coast Boiler Plumbing Work Order (Dated: 02/16/2026, 02/20/2026), West Coast Boiler Plumbing Work Invoice (Dated: 02/19/2026, 02/23/2026), and E.Z. Roth Plumbing/Heating Invoices (Dated: 02/05/2026,02/10/2026, 02/19/2026) and observed that workorders for plumbing and heating problems were submitted and completed by both companies within days of the workorder being placed. The department toured the 1st and 2nd floors with maintenance, and observed rooms 107, 111, 129, 136, 137, 138, 141, 203, 205, 208, 219, and 223 and found that all rooms had heaters that functioned properly and found no evidence of leaks. The department also toured the hallways, the Beauty Parlor, the Ocean Room, and Reception area and observed that all rooms were heated and had no visible signs of leaks. Based on interviews, records reviewed, and observations there is insufficient evidence to support the allegation that the facility is in disrepair. 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. No deficiencies were found and no citations were issued for this complaint investigation. An exit interview was conducted with Maria Galvan, Administrator, and a hard copy of this Complaint Investigation Report was provided.the state’s words, verbatim · CDSS document, Feb 27, 2026 · control 11-AS-20260218144042

Allegation investigated: Staff did not make resident's records readily available to emergency medical personnel.

On 02/24/26 at 9:30 am Licensing Program Analyst (LPA) Troy Watson conducted an initial complaint visit regarding the allegation above. LPA met with Administrator Maria Galvan and the purpose of today’s visit was explained. The investigation consisted of the following: On 02/24 /26 LPA Watson obtained copies of the following documentation: Personnel report dated 02/23/2026, Resident Roster dated 02/23/2026, Face Sheet for R1 dated 08/01/2025, Medical Assessment dated 07/25/25, Medication Discharge Report dated 07/25/25, Medication Administration Record dated,02/2026, and Training Sign in Sheets Care Tips for Professional Caregivers dated 11/13/2025. How to Handel Residents Having a Seizure. LPA Watson conducted Interviews with Residents #1-6 (R1-R6), and with Staff #1-6 (S1-S6). LPA toured the facility with Administrator Maria Galvan and found the facility to be clean and in good repair. Unsubstantiated The investigation revealed the following: Allegation: Staff did not make resident records readily available to emergency medical personnel. This allegation alleges that staff failed to make the resident’s medical records readily available to emergency medical personnel during a medical emergency. LPA Watson conducted an interview with Administrator (A1) Maria Galvan. A1 stated that when staff are asked to make a resident’s records readily available to emergency medical personnel, staff are trained to immediately perform a quick assessment and stabilize the resident. A1 further stated that staff are trained to ask the residents if they are in pain, then contact the Med Tech and inform them of the situation. If the situation requires an immediate emergency response, staff are trained to call 911. A1 stated that after paramedics determine the resident needs to go to the hospital, staff notify the family and the Wellness Director and then monitor the resident while they are away at the hospital. A1 also stated that they plan for a discharge and reassessment to determine if there are any changes in care. A1 stated that they work with the family and/or residents to accommodate any new level-of-care needs. A1 stated that staff immediately call 911, gather the emergency packet, and provide it to paramedics. The emergency packet contains the face sheet, insurance information, and medical list. LPA Watson conducted Interviews with Residents #1-6 (R1-R6). Out of those interviewed 6 out of 6 Residents interviewed denied the above allegation. LPA Watson conducted Interviews with Staff #1-6 (S1-S6). Out of those 6 interviewed, 6 out of 6 staff members denied the above allegation. LPA Watson obtained and reviewed a Medication Discharge Report for R1 dated 07/25/2025 and it showed no new medications were administered, medications to continue taking that have changed, and medications to discontinue taking for R1. A1 also stated that since she started working at the facility 11/20/2025 the Administrator has not been informed or notified about a seizure concerning R1. LPA Watson requested and did not receive any documentation verifying that R1 was admitted to the hospital for any seizures. An exit interview was conducted with the Administrator Maria Galvan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 24, 2026 · control 11-AS-20260218183034

Allegation investigated: Facility staff are forcing residents to sign documents. Facility staff are relatiating on residents for filing comlaints. Staff does not ensure residents are spoken to in an appropriate manner. Staff does not ensure medications are dispensed in a timely manner. Staff falsifies records. Staff does not ensure food is of good quality and quantity.

On 02/24/26 at 9:30 am Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit to deliver findings for the allegation(s) above. LPA met with Administrator (staff #1/S1) as the purpose of today’s visit was explained. The investigation consisted of the following: On 02/18 /26 LPA Villegas obtained copies of the staff and resident rosters, facility menus for January 2026- February 2026, and a copy of eviction notice(s) issued on 12/4/25. On 02/18/26 from 10:00 am- 11:am LPA conducted Interviews with residents #1-6 (R1-R6), and from 11am - 12pm LPA conducted interviews with staff #1-6 (S1-S6). On 02/18/26 LPA observed lunch services, and conducted tour of facility kitchen, med rooms on the first and second floor, and the kitchenette located on the second floor. The investigation revealed the following: Allegation: Facility staff are forcing residents to sign documents. Unsubstantiated It is alleged that facility Administrator (S1) is forcing all residents to sign documents authorizing Administrator to speak to the social security office on resident’s behalf. On 02/18/26 from 10:00 am- 11:am LPA conducted Interviews with R1-R6 regarding the allegation above. 5 of the 6 residents interviewed denied the allegation above, 1 of the 6 residents interviewed confirmed the allegation above. Additionally, 2 of the 6 residents interviewed reported being their own payee, 2 of the 6 residents interviewed reported that a family member is their payee, and 2 of the 6 residents interviewed reported that they are unaware of who is their payee. On 02/18/26 from 11am - 12pm LPA conducted interviews with S1-S6 regarding the allegation above. During interview with S1, S1 denied the allegation above and reported that the facility Is not the payee for any of the residents at the facility. S1 continued the state that the facility has residents sign an ACH form which is a direct deposit form for the room and board. During interviews with S2-S6 regarding the allegation above, 5 of 5 staff denied the allegation above and reported they have not observed Administrator asking residents to sign any documents. Allegation: Facility staff are retaliating against residents for filing complaints. It is being alleged that facility Administrator (S1) has threatens to throw residents out if they complain about issues at the facility. On 02/18/26 from 10:00 am- 11:am LPA conducted Interviews with R1-R6 regarding the allegation above. 6 of the 6 residents interviewed denied the allegation above. 5 of 6 residents interviewed stated they have not expressed any concerns the Administrator or filed complaints about the care they are receiving, 1 of the 6 residents interviewed reported expressing concerns about the care being received directly to the Administrator. On 02/18/26 from 11am - 12pm LPA conducted interviews with S1-S6 regarding the allegation above. During interview with Administrator (S1), S1 denied the allegation above and reported that residents are spoken to and reminded of the facility rules rather than serving an eviction notice. During interviews with S2-S6 regarding the allegation above, 3 of the 5 staff interviewed denied the allegation above, 2 of the 5 staff interviewed reported that they do not have any knowledge regarding the allegation above. On 02/18/26 LPA reviewed a copy of eviction notice issued on 12/04/25, eviction notice was issued to a former resident who required a higher level of care, eviction notice appeared to be incompliance with title 22 regulation. Allegation: Staff does not ensure residents are spoken to in an appropriate manner. It is being alleged that facility Administrator bullies and speaks inappropriately to residents in care. On 02/18/26 from 10:00 am- 11:am LPA conducted Interviews with R1-R6 regarding the allegation above. 6 of the 6 residents interviewed denied the allegation above. Additionally, 3 of the 6 residents interviewed reported feeling respected by staff, 2 of the 6 residents interviewed reported they do not feel respected by staff, 1 of the 6 residents interviewed reported they sometimes feel respected by staff. On 02/18/26 from 11am - 12pm LPA conducted interviews with S1-S6 regarding the allegation above. During interview with Administrator (S1), S1 denied the allegation above and reported that residents have reported that staff are mean, but residents have not used the word “bully.” Per S1, S1 will investigate when residents make these reports. During interviews with S2-S6 regarding the allegation above, 5 of 5 staff interviewed denied the allegation above. Allegation: Staff does not ensure medications are dispensed in a timely manner. It is alleged that facility staff did not provide resident in care with nighttime medication(s). On 02/18/26 from 10:00 am- 11:am LPA conducted Interviews with R1-R6 regarding the allegation above. 5 of the 6 residents interviewed denied the allegation above and reported they are always provided with their medication. 1 of the 6 residents interviewed confirmed the allegation above, however resident stated being informed by staff that medications were not available due to insurance issues. On 02/18/26 from 11am - 12pm LPA conducted interviews with S1-S6 regarding the allegation above. 5 of the 6 staff interviewed denied the above allegation. 1 of the 6 staff interviewed confirmed the allegation above but stated it is only when the facility is waiting for medications to be delivered. Allegations: Staff falsify records. It is being alleged that the facility Administrator (S1) falsifies documents when licensing comes to inspect the facility. On 02/18/26 from 10:00 am- 11:am LPA conducted Interviews with R1-R6 regarding the allegation above. 5 of the 6 residents interviewed denied the allegation above. 1 of the 6 residents interviewed confirmed the allegation above and resident stated resident believes Administrator has altered residents’ records. On 02/18/26 from 11am - 12pm LPA conducted interviews with S1-S6 regarding the allegation above. 4 of the 6 staff interviewed denied the allegation above, 2 of the 6 staff interviewed reported they do not have any knowledge regarding the allegation above. Allegation: Staff does not ensure food is of good quality and quantity. It is alleged that the facility staff will serve a bowl of soup and half sandwich with no second helping. On 02/18/26 from 10:00 am- 11:am LPA conducted Interviews with R1-R6 regarding the allegation above. 6 of the 6 residents interviewed denied the allegation above and reported that second servings are provided when they request them. On 02/18/26 from 11am - 12pm LPA conducted interviews with S1-S6 regarding the allegation above. 6 of the 6 staff interviewed denied the above allegation and reported they have not observed any issues with the food being served. Additionally, 2 of those 6 staff reported there is an alternative menu residents can choose from if residents do not want to eat the items on the regular menu. 5 of 6 staff interviewed reported that second servings are provided upon request, 1 of the 6 staff interviewed stated being unaware if a second serving is provided when requested. On 02/18/26 LPA Villegas observed lunch service and conducted tour of facility kitchen. LPA Villegas observed meals provided to be of good quality and quantity, residents were provided with protein, vegetables, and a piece of bread. LPA Villegas observed the food to be fresh as LPA toured facility kitchen, LPA also observed pantries, refrigerators, and freezers to be well stock as facility just had a delivery during the time of visit. LPA Villegas reviewed the facility menus for January 2026-February 2026 as well as the alternative menu. LPA Villegas observed the menu to be different every day, LPA Villegas observed a list of items residents can choose from off the alternative menu. 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 allegations are unsubstantiated. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 24, 2026 · control 11-AS-20260209143909

Allegation investigated: Facility staff do not ensure that residents are provided with activities

On 2/24/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Administrator, Maria Galvan and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility. The investigation consisted of the following: On 2/24/26 LPA Shirley reviewed copies of the following records: Staff and Resident Roster, and facility Activity Calendar. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff- 7(S1 – S7), and Resident -1 – Resident - 6(R1-R6). Con'd on 9099-C Unsubstantiated The investigation revealed the following: Allegation: Facility staff do not ensure that residents are provided with activities It is being reported that staff has not provided daily activities for residents for the last several months. On 2/24/26, LPA Felisa Shirley observed and was given a copy of the Activity Calendar Flyer. LPA Shirley toured this facility with Administrator, Maria Galvan. Upon entry to the 1st Floor, Assisted Living, LPA Shirley observed the Ocean View Living Activity Calendar for February 2026 posted on the wall. Per interview, 2/24/26, the Administrator stated the former Activities Director has accepted a promotion, so S6 is assisting with activities while they await the final background clearance of the new Activity Director. During the tour of the facility on 2/24/26, LPA Shirley observed S6 in the Activity room chatting with a resident engaged in loom work. Per interview, on 2/24/26, S6 confirmed she provides on-request nail services, arts and crafts, and karaoke for residents. S6 also shared photos from last week’s Valentine’s dance and outlined plans for upcoming St. Patrick’s Day activities. Upon entry to the 2nd Floor, Memory Care, LPA Shirley observed residents sitting, watching and laughing at a television program. On 2/24/26, LPA Shirley observed a resident completely engrossed in a word search puzzle at a table. Per interview, 2/24/26, with staff member that was assigned to 2nd floor, S2 stated she recommends activities based on the residents abilities and interest. LPA interviewed staff 1 – staff 7 (S-1 – S-7). Of those interviewed 7 out of 7 denied the allegation. LPA interviewed resident 1 – resident 6 (R1 – R6). Of those who interviewed 6 out of 6 denied the allegation. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Facility staff do not ensure that residents are provided with activities,” therefore, the allegation is unsubstantiated. No deficiencies were cited for these allegations. An exit interview was conducted and a copy of this report was provided to the Administrator, Maria Galvan.the state’s words, verbatim · CDSS document, Feb 24, 2026 · control 11-AS-20260218154628

Type of visit: Case Management - Health Checks

On 2/24/2026, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct a health and safety check and obtained documents. LPA identified herself and met with Maria Bravo-Galvan, who was informed of the purpose of the visit. At 2:45 PM, LPA Bernadette and Cody Wagner conducted a tour of the facility, which included the lobby, 1st and 2nd floors. During the tour, LPA did not observe any health or safety concerns. LPA requested and was provided the following information/documentation: Fire Watch Log from Wednesday 2/17/2026–2/24/2026, and a copy of the Los Angeles Fire Department Fire Protection Equipment Performance Report – Re-Test date 2/5/2026.the state’s words, verbatim · CDSS document, Feb 24, 2026

Allegation investigated: Staff did not adequately supervise resident in care resulting in resident eloping from the facility.

On 2/23/2026, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to investigate and deliver findings for the alleged allegation. LPA identified herself and met with Cody Wagner who was informed of the purpose of the visit. The investigation consisted of the following: On February 23, 2026, at 9:00 AM, LPA Allen requested the following documents: staff roster and resident roster dated February 23, 2026. LPA also requested the file for Resident 1 (R1), which could not be provided because there is no resident with the name listed in the complaint that resides at the facility and interviews with three (3) staff members. The investigation revealed the following: Allegation 1: Staff did not adequately supervise resident in care resulting in resident eloping from the facility Unfounded LPA conducted interviews with three (3) staff members, who stated that there is no resident currently residing at the facility with the name listed in the complaint. LPA was also was permitted to review facility records for a resident and based on the review of admissions agreement dated 12/17/2025, physicians report dated 11/6/2025 and LIC624 dated 2/14/2026 which did not list the resident in question within the complaint. Based on interviews conducted and evidence gathered during the investigation, the above allegation is found to be Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted where this report was discussed with Maria Bravo- Galvan- Administrator and provided a copy the conclusion of the visit with appeal rights.the state’s words, verbatim · CDSS document, Feb 23, 2026 · control 11-AS-20260220081322

Allegation investigated: Facility sink is clogged.

On 02/18/26 at 9:20 am Licensing Program Analyst (LPA) Villegas conducted a initial complaint visit regarding the allegation(s) above. LPA met with Administrator (staff #1/S1) as the purpose of today’s visit was explained. The investigation consisted of the following: On 02/18 /26 LPA Villegas obtained copies of the staff and resident rosters, facility menus for January 2026- February 2026, and a copy of eviction notice(s) issued on 12/4/25. On 02/18/26 from 10:00 am- 11:am LPA conducted Interviews with residents #1-6 (R1-R6), and from 11am - 12pm LPA conducted interviews with staff #1-6 (S1-S6). On 02/18/26 LPA observed lunch services, and conducted tour of facility kitchen, med rooms on the first and second floor, and the kitchenette located on the second floor. The investigation revealed the following: Allegation: Facility sink is clogged. Substantiated It is being alleged that the sinks located in the second floor kitchen and second floor medication room has been clogged for weeks. On 02/18/26 from 10:00 am- 11:am LPA conducted Interviews with R1-R6 regarding the allegation above. 6 of the 6 residents interviewed reported having no knowledge about kitchen or medication room sinks being clogged as they are not experiencing issues with the sinks located in their restroom. On 02/18/26 from 11am - 12pm LPA conducted interviews with S1-S6 regarding the allegation above. 3 of the 6 staff interviewed reported being unaware of the allegation above, 1 of 6 staff interviewed denied the allegation above, 1 of 6 staff interviewed confirmed the allegation above and reported 1 side of the kitchen sink appears to be clogged, 1 of 6 staff interviewed denied the allegation above and stated there were no reports on 02/17/26 that the sink was clogged. On 02/18/26 LPA conducted a tour of the facility kitchen, the med rooms on the first and second floor, and the kitchenette located on the second floor. LPA did not observe any sinks located in the med rooms, LPA observed the sink in the kitchenette located on the second floor to be clogged on the right side. Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D. Exit interview conducted, appeal rights explained, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 11-AS-20260209143909

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 25, 2026

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. Based on observation and interviews the conducted the right side of the sink in the 2nd floor kitchenette is clogged and draining slowly. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 18, 2026

Plan of correction: Facility maintenance staff used snake to unclog the right side of the 2nd floor kitchenette sink, citation was cleared while LPA was still at the facility.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

On 02/18/2026, Licensing Program Analyst (LPA) Villegas conducted a case management Health Check visit. LPA met with Administrator, Maria Galvan as the purpose of the visit was explained. During the visit LPA collected and reviewed fire watch logs dated 02/05/2026 through 02/18/2026, record review revealed that fire watches have been conducted every hour by two staff members. Fire Watch logs are dated and document the start time, end time, conditions observed, issues noted if any, and are initialed by both staff members. No deficiencies were observed during the visit. An exit interview was conducted, and a copy of this report was provided to the Administrator Maria Galvan.the state’s words, verbatim · CDSS document, Feb 18, 2026

Type of visit: Case Management - Health Checks

On 02/05/2026, Licensing Program Analyst (LPA) Socorro Leandro conducted a case management Health Check visit. LPA met with Administrator, Maria Galvan and explained the purpose of the visit. LPA was allowed entry to the facility. During the visit, LPA collected and reviewed fire watch logs dated 01/29/2026 through 02/05/2026. Record review revealed that fire watch was conducted every 30 minutes by two staff members as required. No deficiencies were observed during the visit. An exit interview was conducted, and a copy of this report was provided to the Administrator, Maria Galvan.the state’s words, verbatim · CDSS document, Feb 5, 2026

Allegation investigated: Fire Clearance Alterations to Physical Plant

On 4/13/26 Licensing Program Analyst (LPA) Sparkle Day conducted a “Subsequent” visit to deliver findings of the above allegations on behalf of the Department of Social Services Community Care Licensing. LPA met with Maria Galvan, Administrator and explained the purpose of this visit. The investigation consisted of the following: On 1/9/26, the Department conducted a visit with the Los Angeles Fire Department present regarding the above allegations. The Department reviewed and obtained the following documents: Resident Roster (dated 12/08/2025), Staff Roster (dated 12/03/2025), Oceanview Living of San Pedro Plan of Operation, Change of Ownership Application Packet, Fire Safety Inspection Reports (dated 12/07/2023 and 12/23/2025), Fire/Life Safety Order (dated 12/22/2025), Emergency Disaster Plan (dated 09/09/2025), City of Los Angeles Tax Registration Certificate (dated 05/01/2025), Certificate of Liability Insurance (07/01/2025–07/01/2026), Mitigation Plan (dated 05/01/2025), Residential Infection Control Plan, Facility Sketches, RCFE Fire Watch Log (10/02/2025–12/10/2025), Fire Prevention Plan, and Designation of Facility Responsibility (dated 08/05/2025). Unsubstantiated The investigation revealed the following: ALLEGATION #2: Fire Clearance It is alleged that the facility does not maintain a fire clearance approved by the appropriate fire authority. The department conducted a tour of the physical plant and learned the facility had an annual visit from LAFD on 8/21/2025 and was issued several violations. The facility failed to comply with the violations issued by the Los Angeles Fire Department (LAFD). However, its fire clearance was neither revoked nor denied. The facility was placed on Fire Watch, requiring hourly patrols to identify hazards, detect fires early, alert occupants, and contact emergency services. This measure was implemented by LAFD while violations were being corrected. The Fire Watch concluded on 3/30/26, and all Fire Watch requirements were verified as corrected by LAFD. Based on the investigation, although the allegation may have occurred or may be valid, there is insufficient evidence to establish a preponderance of evidence. Therefore, the allegation is **UNSUBSTANTIATED** ALLEGATION #3: Alterations to Physical Plant It is alleged that the facility has added partitions, locks, or gates to separate spaces for other entities on the premises. On 1/9/26, the Department toured the facility, reviewed the facility sketch, and compared it to the pre-licensing report dated April 24, 2024 . staff (#1 and #2) were interviewed and provided consistent statements indicating that no structural changes such as additional walls, doors, or locks had been made since the original 2023 facility sketch. Based on observations, document review, and staff interviews, the Department did not identify any alterations to the physical plant. Based on the investigation, although the allegation may have occurred or may be valid, there is insufficient evidence to establish a preponderance of evidence. Therefore, the allegation is **UNSUBSTANTIATED**. On 2/28/2026, all individuals residing int the sober living vacated the property. On 3/30/2026, all Individuals residing in the apartments vacated the property. Based on the Administrator’s admission and the Department’s direct observations confirming the presence of an unapproved entity operating on the premises, this allegation is **SUBSTANTIATED**the state’s words, verbatim · CDSS document, Feb 3, 2026 · control 11-AS-20260108132437

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208 · Plan of correction due date: Feb 10, 2026

87208 The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49 This regulations was not met by the following evidence: Interviews and observations indicates the Licensee is operating a sober living entity on-site that is not part of the approved plan, posting a health and safety risk to residentsthe state’s words, verbatim · CDSS document, Feb 3, 2026

Plan of correction: Corrected at time of visit

Allegation investigated: Staff spoke to residents in an inappropriate manner. Staff threatened residents with eviction.

On January 30, 2026, Licensing Program Analyst (LPA) Pamela Bunker conducted an initial visit to gather information regarding the above allegations. LPA met with Maria Galvan, Administrator, and explained the purpose of the visit. LPA was granted entry to the facility. The investigation consisted of the following: On January 30, 2026, the following documents were reviewed and obtained as part of the investigation: Personnel Report (dated 01/30/2026), Resident Roster (dated 01/30/2026), Eviction Notice (dated 12/04/2025), Incident Report (01/07/2026), and Resident Smoking Outside of Designated Smoking Area (dated 01/19/2026). On January 30, 2026, between 10:00 a.m. and 3:30 p.m., LPA Pamela Bunker conducted interviews with staff members #1–5 (S1-S5), residents #1–2 and #4–R8 (R1-2 & R4-8), and witnesses #1-2 (W1-W2) between 1:00 p.m. and 3:10 p.m. Resident #3 (R3) declined to be interviewed. See continued LIC9099-C page 2. Unsubstantiated Continued LIC812-C page 2. Investigation Findings Allegation: Staff spoke to residents in an inappropriate manner. On January 30, 2026, between 10:00 a.m. and 3:30 p.m., LPA Bunker interviewed Staff S1–S5. All five staff members stated that staff do not speak to residents in an inappropriate manner and do not mistreat any residents. 5 out of 5 staff members stated that residents are provided with a safe, healthful, and comfortable environment, and that staff offer the necessary care and supervision to meet each resident’s needs. S1–S5 emphasized that the facility maintains a zero-tolerance policy toward intimidating, inappropriate behavior, and unprofessional conduct. All five staff members denied the allegation. On January 30, 2026, between 10:00 a.m. and 3:30 p.m., LPA Bunker interviewed residents #1-2 and #4-8 (R1–R2 & R4–R8). 7 out of 8 residents stated that staff do not speak to residents in an inappropriate manner, nor do they verbally abuse or intimidate residents. They also reported that they have never heard staff say they came to the facility “to clean house.” 7 out of 8 residents indicated that staff are not mean or rude to residents and that they do not feel threatened or frightened by staff or other residents. Residents stated that they are provided with a safe, healthy, and comfortable environment, and that staff offer the necessary care and supervision to meet each resident’s needs. 7 out of 8 residents denied the allegations. On January 30, 2026, LPA interviewed Witnesses W1 and W2 (W1-W2) together between 1:00 p.m. and 3:10 p.m. 2 out of 2 witnesses stated that they visit the facility often and have observed that staff do not speak to residents in an inappropriate manner, nor do they verbally abuse or intimidate residents. W1-W2 also reported that they have never heard staff say they came to the facility “to clean house.” Both witnesses stated that staff are not mean or rude to residents and expressed that they are satisfied with the care and supervision provided at the facility. See continued LIC9099-C page 3. Continued LIC9099-C page 3. Allegation: Staff threatened residents with eviction. On January 30, 2026, between 10:00 a.m. and 3:30 p.m., LPA Bunker interviewed Staff S1–S5. 5 out of 5 staff members stated that staff have never threatened residents by saying they would issue a 30-day eviction notice or “kick them out” for any reason. All five staff members denied the allegation. S1 stated that one resident was issued a 30-day eviction notice on December 4, 2025, due to requiring a higher level of care because of serious mental and emotional disorders. S1 confirmed that the resident is still residing at the facility and that the eviction notice was approved by the Department. S1 emphasized that the resident was never threatened by staff with eviction or told they would be “kicked out” for any reason. S1 denied the allegation that staff threatened the resident with eviction. On January 30, 2026, between 10:00 a.m. and 3:30 p.m., LPA interviewed residents R1–R2 and R4–R8. 7 out of 8 residents stated that they have never heard staff threaten a resident with eviction or mention issuing a 30-day notice for any reason. 7 out of 7 residents denied the allegation. On January 30, 2026, between 1:00 p.m. and 3:10 p.m., LPA interviewed Witnesses W1 and W2 (W1-W2) together. Both witnesses 2 out of 2 stated that they visit the facility often and have never heard staff threaten residents with eviction or mention a 30-day notice. Both W1-W2 denied the allegation. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099 and LIC9099-C was provided to Maria Galvan, Administrator. No deficiencies were cited. An exit interview was conducted.the state’s words, verbatim · CDSS document, Jan 30, 2026 · control 11-AS-20260127152449

Allegation investigated: Staff do not have adequate record keeping for the residents

On 01/29/2026, Licensing Program Analyst (LPA) Jose Anguiano conducted an unannounced complaint visit regarding the allegation mentioned above and met with Administrator Maria Galvan. Investigation consisted of the following: LPA interviews with 7 staff members (S1–S7), staff and resident roster, review of 3 resident files (R1–R3), and 6 face sheets (R1–R6) along with their physician’s reports. Three incident reports regarding residents who were hospitalized were reviewed along with internal logs, fire drill reports, staff in-service training records, training on when to call physicians, and orders from printouts. In-service trainings dated 10/13 to 10/16 were also reviewed and collected. The investigation revealed the following: Regarding the allegation “Staff do not have adequate record keeping for the residents,” it is being alleged that residents’ records were incomplete. Observations revealed: On 01/29/2026, LPA observed that resident face sheets and files were incomplete, missing essential information such as emergency contacts, diagnoses, and other required documentation. Please see report continuation on (LIC9099C) Substantiated These gaps were noted across multiple records reviewed during the visit. Interviews with staff (S1–S7) were conducted and revealed the following: (S1) stated that while resident records such as face sheets and medication logs exist, the current system is disorganized and lacks standardization. S1 acknowledged dissatisfaction with the existing filing system and reported that a new process is being implemented to improve accessibility and completeness. (S2–S3) confirmed they primarily handle record printing during emergencies, while (S4–S7) indicated they have limited access to records, which could delay response times during critical situations. Records review revealed the following: Face sheets for R1–R6 included basic information such as date of birth, name, gender, allergies, and primary care provider (PCP); however, they lacked essential details including personal information, diagnoses, diet, social security number, insurance information, emergency contacts, and provider details. All six face sheets were inconsistent and incomplete. Additionally, file reviews for R1–R3 showed further deficiencies, with R1’s pre-placement appraisal not completed and R2 and R3 missing required documentation. Based on the evidence gathered, records reviewed, observations, and interviews conducted, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED. This is a violation of California Code of Regulations, Title 22, Division 6, Chapter 8. A citation is being issued on the attached (LIC-9099D). An exit interview, a copy of this report, and appeal rights were provided to the Administrator.the state’s words, verbatim · CDSS document, Jan 29, 2026 · control 11-AS-20260126231538

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Feb 26, 2026

87468.1 (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: The licensee did not ensure residents are accorded safe and healthful accommodations, as record review and interviews revealed incomplete resident face sheets and records for R1-R6 and that staff S1 was unable to provide complete health information to first responders, posing a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 29, 2026

Plan of correction: Licensee agreed to submit a plan by the due date to ensure all resident records are complete and consistent and submitted to LPA: at Jose.Anguiano@dss.ca.gov

Type of visit: Case Management - Health Checks

On 01/29/2026 at approximately 9:00 AM, Licensing Program Analyst LPA Jose Anguiano conducted a case management Health Check visit. LPA met with Administrator Maria Galvan & House Keeping Supervisor Jose Hernandez. During the visit, LPA collected and reviewed fire watch logs dated 01/23/2026 through 01/29/2026. Record review revealed that fire watch was conducted every 30 minutes by two staff members as required. Additional records reviewed from 01/23/2026 through 01/29/2026 revealed: On 01/25/2026 between 1:00 PM and 2:00 PM, a smoke alarm issue was documented as Issue #8. A copy of the service call from Tri-Signal Integration Inc. dated 01/22/2026 confirmed that technical support cleared the sounder base and restored all systems to normal. Work Order #108799 was provided. On 01/28/2026 and 01/29/2026, two conditions were observed indicating kitchen water flow issues. Per maintenance staff (Jose), a quote was requested to identify the problem; as of today, the issue remains unresolved. An image of the fire panel from Little Sisters System shows system normal as of 01/29/2026 at 2:23 PM. No deficiencies were observed during the visit. An exit interview was conducted with Administrator Maria Galvan, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 29, 2026

Type of visit: Case Management - Health Checks

On 01/16/26 Licensing Program Analyst (LPA) Regina Cloyd conducted a case management - Health Checks visit. LPA was met by Maintenance Staff Andy Buhain and the purpose of the visit was explained. During today's case management visit LPA collected fire watch log (dated 01/15/26 through 01/16/26). Record review of fire watch log revealed fire watch was conducted every 30 minutes by two people. No deficiencies were observed. An exit interview was held with Maintenance Andy Buhain and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jan 16, 2026

Type of visit: Case Management - Health Checks

On 01/14/26 Licensing Program Analyst (LPA) Mario Leon conducted a case management - Health Checks visit. LPA was met by staff one, Maria Galvan - Executive (S1), and the purpose of the visit was explained. LPA was later met by staff two, Jose Hernandez - Housekeeping Supervisor (S2) and LPA toured the facility with S2. During today's case management visit LPA collected fire watch log (dated 01/12/26 through 01/14/26) Record reviews of fire watch log show a completed log of the dates of 01/12/26 through 01/14/26, conducted every 30 minutes by two (2) qualified staff. During today's visit, there have been zero (0) deficiencies cited. An exit interview was held with Jose Hernandez - Housekeeping Supervisor (S2) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: Office

On 01/14/2026 the El Segundo Adult and Senior Care Program Regional Office conducted an office meeting with Oceanview Living of San Pedro representatives via conference call, present during the meeting was Regional Manager Benita Yates, Licensing Program Manager Ulysses Coronel, Licensing Program Manager Stephanie Cifuenes, Licensees Grace Mercado of 9 GEM ENTERPRISES LLC; Ben Berkowitz of OCEANVIEW LIVING OF ET AL, and Brian Dror owner of 9 GEM CAPITAL GROUP LLC. The following were discussed during the meeting: - Licensee’s status - The facility's compliance with Los Angeles Fire Department requirements as of Friday 01/16/2026. - Sober Living Community operating within the property. - Control of Property. - Change of Ownership status. No citations were issued, a copy of this report was provided to Ben Berkowitz.the state’s words, verbatim · CDSS document, Jan 14, 2026

Type of visit: Case Management - Health Checks

On 01/12/26 Licensing Program Analyst (LPA) Mario Leon conducted a case management - Health Checks visit. LPA was met by staff one, Maria Galvan - Executive (S1), and the purpose of the visit was explained. During today's case management visit LPA collected fire watch log (dated 01/10/26 through 01/12/26) and toured the facility with staff two, Melina Orozco. Record reviews of fire watch log show a completed log of the dates of 01/10/26 through 01/12/26, conducted every 30 minutes. During today's visit, there have been zero (0) deficiencies cited. An exit interview was held with Maria Galvan - Executive Director and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jan 12, 2026

Type of visit: Case Management - Health Checks

On 01/10/26 Licensing Program Analyst (LPA) Regina Cloyd conducted a case management-health check visit. LPA met with Receptionist Melina Orozco and the purpose of the visit was explained. During case management visit LPA interviewed two staff members and received copies of the fire watch log (12/01/25 - 12/10/25, 01/09/26 - 01/10/26), personnel report (12/12/25), and caregiver work schedule (January 2026). Record review of fire watch log (01/09/26 - 01/10/26) revealed fire watch patrol was conducted every 30 minutes from 7:00 AM - 12:30 AM by one staff member. From 10/10/25 1:00 AM - 6:30 AM, the fire watch log does not include an initial that someone completed the patrol. One out of two interviews indicated fire watch patrol by caregiving staff occurs every hour. Deficiencies are being cited and will be issued at a later date. An exit interview was conducted a copy of this report was provided to Receptionist Melina Orozco.the state’s words, verbatim · CDSS document, Jan 10, 2026

Type of visit: Case Management - Other

On 01/08/26 Licensing Program Analyst (LPA) Villegas conducted a case management visit. LPA met with Administrator Maria Galvan as the purpose of the visit was explained. During case management visit LPA Villegas conducted a Health & Safety visit which consisted of the following of a tour of the physical plant. LPA observed that the building consist of (3) floors: the first floor has 53 residents, and 48 bedrooms, the second floor is a memory care unit that has 12 residents and 20 bedrooms, the third floor is currently empty and consist of 24 bedrooms. LPA observed that there is a bridge that serves as a walkway to the left side of the building. LPA observed that there is a key pad that needs to be used in order to gain access to the left side of the building. The left side of the building consist of a rehab and a sober living. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 8, 2026

Allegation investigated: Staff do not ensure resident's room is clean and sanitized. Staff does not ensure resident is provided clean linen. Staff does not ensure facility elevator is in good repair. Staff does not ensure to emergency drills are being conducted.

On 01/06/26 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent complaint visit at this facility. LPA was met by staff one, Maria Galvan - Executive Director (S1) and the purpose of the visit was explained. The investigation consisted of the following: On 12/29/25 LPA requested staff roster, resident roster, in-staff trainings (dated: 10/01/25 through 11/13/25), private email between the facility and a responsible person(s) (dated: 12/28/25) and resident five through resident six (R5-R6) face sheet, pre-appraisal and appraisal, medical assessment(s) (dated: various). LPA interviewed four (4) staff (S1-S4) and four (4) residents (R1-R4). On 01/06/26 LPA requested further documents regarding any cleaning schedule or in-staff trainings that have been held. LPA interviewed three (3) residents (R5-R7). Report continues, please see LIC9099-C. Unsubstantiated Regarding the allegation “Staff do not ensure resident's room is clean and sanitized.”, it is being alleged that items in a resident’s room were discovered dirty. Record reviews have revealed the following: a cleaning log was provided, which indicates that staff members have completed their housekeeping work. Housekeeping work includes cleaning the restroom, taking any dirty dishes that may have accumulated in a resident's room and sanitizing the mattress before fitting a new sheet. Interviews have revealed that all seven (7) residents (R1-R7) and all four (4) staff (S1-S4) have disagreed that the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation “Staff does not ensure resident is provided clean linen.”, it is being alleged that staff do not change bedsheets within residents’ room. Record reviews have revealed the following: a cleaning log was provided, which indicates that staff members have completed their housekeeping work. Housekeeping work includes sanitizing bed mattresses prior to fitting any new sheets, cleaning the restroom and taking any dirty dishes that may have accumulated in a resident's room. Interviews have revealed that all seven (7) residents (R1-R7) and all four (4) staff (S1-S4) have disagreed that the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation “Staff does not ensure facility elevator is in good repair.” It is being alleged that the elevator is in disrepair. LPA observed there are two (2) elevators in the facility, one (1) of them in disrepair while the other elevator assists residents to ambulate through the facility. Record reviews have revealed the following: the elevator went out of service on 12/23/25. Prior to this date, the elevator had given prior notice as the elevator would shudder to a stop there have been two (2) inquiries and two (2) quotes provided to repair the broken elevator. Interviews revealed that all seven (7) residents (R1-R7) and three (3) out of four (4) staff are aware of the elevator in disrepair. While one (1) out of two (2) elevators are out of service, there is still one (1) out of two (2) elevators in working condition. Based on observation, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Report continues, please see LIC9099-C. Regarding the allegation “Staff does not ensure emergency drills are being conducted.” It is being alleged that emergency drills have not been conducted. Record reviews have revealed the following: quarterly in-staff training regarding fire (kitchen fire), Disaster drill (gas leak w/ fire) and Evacuation Drill (natural gas explosion (dated: 05/15/25). LPA requested most recent quarterly drill, but Fire Safety Service has relocated offices and the files will not be available during today's visit. S1 provided all-staff quarterly training's on Shingles / 911 Calls (dated 09/16/25) / Physician's orders & Facesheet (to ambulance driver(s)) (dated 11/13/25), which indicates the facility is conducting quarterly staff training's under a variety of conditions. Interviews revealed that two (2) out of seven (7) residents have indicated that they know where to go during an emergency drill, yet according to Health and Safety code (HSC) 1569.695(c), "An actual evacuation of residents is not required during a drill.". All four (4) staff have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with staff one, Maria Galvan - Executive Director (S1) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jan 6, 2026 · control 11-AS-20251222160301

Allegation investigated: Staff did not administer medication as prescribed to a resident in care. Staff did not ensure that medications were inaccessible to a resident in care.

On 01/06/26 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent complaint visit at the facility to deliver an updated report on the allegations listed above. LPA was met by staff one, Maria Galvan - Administrator (S1) and the purpose of the visit was explained. The visit consisted of the following: On 12/05/25 LPA requested resident and staff roster(s), medication administration record (MAR) for four (4) residents, as well as their most current physician's report (R1-R4), LPA also received a copy of a police report (dated 12/02/25). LPA took a tour of the facility with staff five, Jose Hernandez - Housekeeping supervisor (S5) and observed a resident's medication and four (4) rooms of residents in care. LPA interviewed six (6) residents (R1-R6) and four (4) staff (S1-S4). R1 refused LPA's interview. R2-R4 were not available for interview due to their resting status. On 01/06/26 LPA interviewed three (3) residents (R7-R9). Report continues, please see LIC9099C. Unsubstantiated The investigation revealed the following: Regarding the allegation "Staff did not administer medication as prescribed to a resident in care", it is being alleged that a resident is not receiving a medication in a timely manner. LPA's record reviews revealed that two (2) out of 4 residents have showed that they have denied their medication during the month of December. Police report notes no evidence of elder abuse/crime against a resident in care. LPA observed a resident's behavior, which did not allow LPA to interview a resident. Interviews revealed that four (4) out of five (5) residents (R6-R9) and all four (4) staff (S1-S4) have denied the allegation has taken place. Based on record reviews, interviews, and LPA observation conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation "Staff did not ensure that medications were inaccessible to a resident in care.", it is being alleged that staff leave medication accessible to residents in care. LPA's observation of 4 rooms, number (#) 203, #201, #226, #208, did not reveal any medication being left accessible to residents in care. LPA's interviews revealed that 4 out of 4 staff (S1-S4) and four (4) out of five (5) residents (R6-R9) have denied the allegation has taken place. Based on LPA's observation and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with staff one, Maria Galvan - Executive Director (S1) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jan 6, 2026 · control 11-AS-20251202161311

Allegation investigated: Staff did not seek medical treatment for resident Staff did not observe resident's significant weight loss

On 12/29/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial unannounced complaint visit at the facility. LPA was met by staff one, Maria Galvan - Administrator (S1) and the purpose of the visit was explained. The investigation consisted of the following: LPA requested staff roster, resident roster, in-staff trainings (dated: 10/01/25 through 11/13/25), private email between the facility and a responsible person(s) (dated: 12/28/25) and resident five through resident six (R5-R6) face sheet, pre-appraisal and appraisal, medical assessment(s) (dated: various). LPA interviewed four (4) staff (S1-S4) and four (4) residents (R1-R4). The investigation revealed the following: Regarding the allegation “Staff did not seek medical treatment for resident”, it is being alleged that a resident was discovered with pre-existing medical condition(s) Report continues, please see LIC9099C. Unsubstantiated Record reviews revealed the following: a resident (R5) was admitted on 10/14/25 and was assessed on 07/15/25. Nowhere on the appraisal or pre-appraisal does it mention of any pre-existing medical condition for R5. Due to R5's behavior, staff have not set a baseline for R5. Upon R5 being transported to the hospital, hospital staff had then observed R5 to have a change of condition. The only way the facility is made aware of a change in condition, while R5 has resided at the facility, was the fact that R5's responsible person drove R5 to the hospital, as R5 denied transportation via Ambulance. This led the hospital to note changes in medical condition. Interviews revealed the following: three (3) out of four (4) residents and all four (4) staff have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation "Staff did not observe resident's significant weight loss" it is being alleged that staff did not observe a change in weight. Record reviews revealed the following: During the previous administrator's stay, the facility had no longer kept a weight log of residents in care. Staff one's, Maria Galvan, plan is to weigh residents once per month to keep a resident log. Log of residents weight (dated: 12/01/25) have not logged R5, as R5 denied conducting the weight log. The only log of R5's weight is from their physician's report, (dated: 04/11/25) noting R5 at one-hundred pounds (100Lbs). Interviews revealed the following: all four (4) residents and all four (4) staff have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with Maria Galvan and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Dec 29, 2025 · control 11-AS-20251222105521

Allegation investigated: Staff did not seek medical treatment for resident Staff did not observe resident's significant weight loss

On 12/29/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial unannounced complaint visit at the facility. LPA was met by staff one, Maria Galvan - Administrator (S1) and the purpose of the visit was explained. The investigation consisted of the following: LPA requested staff roster, resident roster, in-staff trainings (dated: 10/01/25 through 11/13/25), private email between the facility and a responsible person(s) (dated: 12/28/25) and resident five through resident six (R5-R6) face sheet, pre-appraisal and appraisal, medical assessment(s) (dated: various). LPA interviewed four (4) staff (S1-S4) and four (4) residents (R1-R4). The investigation revealed the following: Regarding the allegation “Staff did not seek medical treatment for resident”, it is being alleged that a resident was discovered with pre-existing medical condition(s) Report continues, please see LIC9099C. Unsubstantiated Record reviews revealed the following: a resident (R5) was admitted on 10/14/25 and was assessed on 07/15/25. Nowhere on the appraisal or pre-appraisal does it mention of any pre-existing medical condition for R5. Due to R5's behavior, staff have not set a baseline for R5. Upon R5 being transported to the hospital, hospital staff had then observed R5 to have a change of condition. The only way the facility is made aware of a change in condition, while R5 has resided at the facility, was the fact that R5's responsible person drove R5 to the hospital, as R5 denied transportation via Ambulance. This led the hospital to note changes in medical condition. Interviews revealed the following: three (3) out of four (4) residents and all four (4) staff have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation "Staff did not observe resident's significant weight loss" it is being alleged that staff did not observe a change in weight. Record reviews revealed the following: During the previous administrator's stay, the facility had no longer kept a weight log of residents in care. Staff one's, Maria Galvan, plan is to weigh residents once per month to keep a resident log. Log of residents weight (dated: 12/01/25) have not logged R5, as R5 denied conducting the weight log. The only log of R5's weight is from their physician's report, (dated: 04/11/25) noting R5 at one-hundred pounds (100Lbs). Interviews revealed the following: all four (4) residents and all four (4) staff have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with Maria Galvan and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Dec 29, 2025 · control 11-AS-20251222105521

Allegation investigated: Staff did not administer medication as prescribed to a resident in care. Staff did not ensure that medications were inaccessible to a resident in care.

On 12/05/25 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced complaint visit at the facility to address the allegations listed above. LPA was met by staff one, Maria Galvan - Administrator (S1) and the purpose of the visit was explained. The visit consisted of the following: LPA requested resident and staff roster(s), medication administration record (MAR) for four (4) residents, as well as their most current physician's report (R1-R4), LPA also received a copy of a police report (dated 12/02/25). LPA took a tour of the facility with staff five, Jose Hernandez - Housekeeping supervisor (S5) and observed a resident's medication and four (4) rooms of residents in care. LPA interviewed six (6) residents (R1-R6) and four (4) staff (S1-S4). R1 refused LPA's interview. R2-R4 were not available for interview due to their resting status. The visit revealed the following: Regarding the allegation "Staff did not administer medication as prescribed to a resident in care", it is being alleged that a resident is not receiving a medication in a timely manner. LPA's record reviews revealed that two (2) out of 4 residents have showed that they have denied their medication during the month of December. Police report notes no evidence of elder abuse/crime against a resident in care. Report continues, please see LIC9099C. Unsubstantiated LPA observed a resident's behavior and was not allowed to interview a resident. Based on record reviews interviews and LPA observation conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation "Staff did not ensure that medications were inaccessible to a resident in care.", it is being alleged that staff leave medication accessible to residents in care. LPA's observation of 4 rooms, number (#) 203, #201, #226, #208, did not reveal any medication being left accessible to residents in care. LPA's interviews revealed that 4 out of 4 staff (S1-S4) and 2 out of 2 residents (R5-R6) have denied the allegation has taken place. Based on LPA's observation and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with staff one, Maria Galvan - Administrator (S1) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Dec 5, 2025 · control 11-AS-20251202161311

Allegation investigated: Staff do not provide activities for the residents in care. Facility is unkempt.

On 11/24/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, visit to investigate the allegations listed above. LPA was met by staff one, Maria Galvan (S1) and the purpose of the visit was explained. The investigation consisted of the following; On 11/24/25 LPA requested and reviewed resident and staff rosters as well as October and November activities list and invoices from landscaping services. LPA interviewed six (6) residents (R1-R6) and two (2) staff (S1-S2). The investigation revealed the following: Regarding the allegation, “Staff do not provide activities for the residents in care.", it is being alleged that residents can only watch TV in the hallway. Report continues, please see LIC9099C. Unsubstantiated Record reviews revealed the following; on 11/24/25 LPA reviewed October and November activities list, which pertained to dates listed as follows: 10/25/25, 10/26/25, 10/27/25, 10/28/25, 10/29/25, 10/30/25, 10/31/25, 11/10/25, 11/11/25, 11/12/25, 11/13/25 and 11/14/25. The dates provided include, but not limited to, indoor and outdoor activities. During LPA's tour, LPA observed an exercise activity that had began on 10/27/25 from 09:30AM to 10:00AM; also known as "Easy Fitness Exercise". At 10:38AM, LPA observed three (3) individuals conducting hair treatments, including hair coloring and cutting. On 11/24/25, starting at 2:30PM, there is a community meeting to discuss residents smoking outside of designated smoking areas in order to address smoke alarms that have been triggered. All two staff (S1-S2) and four (4) out of six (6) residents (R1-R3, R6) have not agreed the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. 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. Regarding the allegation, "Facility is unkempt", it is being alleged that the outdoors of the facility is unkempt. Upon LPA's arrival, from 09:00AM through 1:30PM, LPA observed a team of landscapers pruning shrubbery and trimming the lawn of the facility. LPA also observed the indoors of the facility to be kept in clean, safe and sanitary fashion. Record reviews revealed the following: An invoice from the landscaping company, dated 10/15/25 and 11/24/25 by Star Garden Supply, have been marked as "clean-up" and "prune and trim" with respective dating. All two staff (S1-S2) and four (4) out of six (6) residents (R1-R3, R6) have not agreed the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. 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. An exit interview was held with staff one, Maria Galvan (S1) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Nov 24, 2025 · control 11-AS-20251114132041

Type of visit: Case Management - Deficiencies

This report serves as an amendment to clarify findings. It does supersedes the findings reflected on report created on the licensing report dated 10/17/25. We will move forward with dismissing the citation issued to Ocean View on Plan of Operation as facility is currently working with the department to further clarify their policies and procedures related to video surveillance and because there is no clear evidence to a health and safety concern. On October 17, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced case management visit to the facility. The LPA met with Regional Director Brittany Kavanaugh and explained that the purpose of the visit was to follow up with an inquiry from the facility on October 9, 2025, regarding the use of surveillance equipment. On October 16, 2025, the Department became aware that the facility had authorized the use of surveillance equipment with audio without notifying the Department or updating the Plan of Operation, in violation of Title 22 Regulations. Based on interviews, observations, and record reviews, the licensee was found to have violated the California Code of Regulations (CCR) under Title 22, Division 6, Chapter 8. Deficiencies were issued. An exit interview was conducted with Brittany Kavanaugh, and a copy of this report, along with the appeal rights, was provided.the state’s words, verbatim · CDSS document, Oct 17, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(1-10) · Plan of correction due date: Oct 31, 2025

We will move forward with dismissing the citation issued to Ocean View on Plan of Operation as facility is currently working with the department to further clarify their policies and procedures related to video surveillance and because there is no clear evidence to a health and safety concern.the state’s words, verbatim · CDSS document, Oct 17, 2025

Allegation investigated: Facility staff failed to ensure proper wound care for a resident with multiple open wounds.

On 09/25/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, visit to investigate the allegations listed above. LPA was met by staff one, Gloriella Jara - Administrator (S1) and the purpose of the visit was explained. The investigation consisted of the following; On 09/25/25 LPA requested and reviewed resident and staff rosters and two (2) residents’ face sheet(s) and physician’s report (R1-R2). LPA also requested staff training(s) and personnel record(s) of two (2) staff (S2-S3) who are to provide care management. LPA reviewed crossover notes for the dates of 09/19/25 through 09/25/25. LPA interviewed three (3) residents (R1-R3) and two (2) staff (S1-S2). The investigation revealed the following: Regarding the allegation, “Facility staff failed to ensure proper wound care for a resident with multiple open wounds.”, it is being alleged that a resident is not receiving proper wound care during their stay. Report continues, please see LIC-9099C. Substantiated Record reviews revealed the following; all residents' medical assessment (R1-R3) have been marked not to have any infectious disease. S2 and S3 have conducted required training for their specific job role, yet there are no crossover notes regarding a resident in care nor any notes as having a resident being relocated to any hospital. LPA interviewed three (3) residents (R3-R5) and all three (3) residents feel their medical needs have not been met. LPA interviewed two staff who were unaware of the current status of a resident (R1). Based on LPA's interviews conducted and records review, there is enough evidence to support the above allegation. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title twenty-two (22), chapter six (6) is being cited on the attached LIC9099D. Please see LIC9099D. There has been one (1) deficiency cited during today's visit, please see LIC9099D. There has been one (1) technical assistance provided, please see LIC9102TA. An exit interview and a copy of this report, appeals rights and the deficiency cited have been provided to Gloriella Jara - Administrator (S1).the state’s words, verbatim · CDSS document, Sep 25, 2025 · control 11-AS-20250918085423

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Sep 30, 2025

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical,..needs. When changes in...physical health..., the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician...if any. This has not been met as evidenced by LPA's interviews and record review, the licensee did not ensure that a change in R1's physical need(s) have been reported to R1's physician which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Sep 25, 2025

Plan of correction: Administrator and LPA have agreed that documentation in crossover notes are to be recorded for any changes in physical, mental, emotional and social functioning of the residents in care. LPA has also requested the facility to forward any special incidents (LIC624) that take place during residents' stay at this facility. Administrator will forward all relevent documentation of this training, signed and dated by staff present, including those who presented the information, via email, to MARIO.LEON@DSS.CA.GOV

Allegation investigated: Facility does not ensure that residents' dietary needs are met. Food provided to residents lacks nutritional value. Residents are not treated with dignity and respect.

On 09/11/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted a complaint investigation regarding the allegations listed above. LPA met with the Administrator, Gloriella Jara and the purpose of the visit was explained. The LPA was allowed entry to the facility. Unsubstantiated The investigation consisted of the following: On 08/20/2025, interviews were conducted, facility tour was conducted, and records were reviewed. Interviews conducted consisted of Resident 1 (R1) to Resident 8 (R8) and Staff 1 (S1) to Staff 6 (S6) were interviewed. The facility tour consisted of the kitchen and dining room. Facility records reviewed consisted of Personnel Report dated 09/09/2025, Register of Facility Residents dated 09/08/2025; Staff Training dated 08/27/2025; Weekly Menus from 08/31/2025 to 10/11/2025; Resident Meeting Minutes from July to August 2025; Daily Kitchen Checklist from 06/02/2025 to 09/07/2025; Resident Diabetic List; Resident List of Food Preferences; Resident List of Diets / Restrictions. Resident 1’s records reviewed consisted of Admission Agreement dated 06/24/2025; Physicians Report dated 06/02/2025; Preplacement Appraisal Information dated 06/28/2025; Personal Rights dated 06/24/2025; Identification And Emergency Information dated 06/24/2025. The investigation revealed the following: Allegation: “Facility does not ensure that residents' dietary needs are met”, it is being alleged that the facility does not provide residents with their special diet, thus not meeting residents’ dietary needs. Interviews conducted with R1 to R8 revealed the following: 7 out of 8 residents denied the allegation; 1 out of 8 residents agreed with the allegation. Interviews conducted with S1 to S6 revealed the following: 6 out of 6 staff denied the allegation. Observations on 09/11/2025 revealed the following: the kitchen entrance has several postings which include Resident Diabetic List, Resident List of Food Preferences, and Resident List of Diets / Restrictions. At around 11:32 AM lunch time was observed, and it demonstrated that some residents receive special diet meals and all residents receive well balanced meals; the dining room has a buffet style set up where residents are able to choose the foods they would like to eat and request for seconds. Over 10 pictures were observed of well-balanced specialized diet meals. Records of Weekly Menus from 08/31/2025 to 10/11/2025 revealed the following: the menus offer well balanced meals with a variety of dishes with 3 to 4 options that are vegetarian options. Based on the department’s interviews, observations, and records reviewed this allegation is unsubstantiated. 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. Allegation: “Food provided to residents lacks nutritional value”, it is being alleged that the facility food is not of good quality. Interviews conducted with R1 to R8 revealed the following: 7 out of 8 residents denied the allegation; 1 out of 8 residents agreed with the allegation. Interviews conducted with S1 to S6 revealed the following: 6 out of 6 staff denied the allegation. Observations on 09/11/2025 revealed the following: the kitchen freezers, fridges, and dry goods storage room had good quality meats, dairy products, vegetables, fruits, grains, etc. The lunch provided to residents was of good quality food. Records reviewed of Daily Kitchen Checklist from 06/02/2025 to 09/07/2025 revealed the following: kitchen staff are maintaining areas clean and maintaining food in good quality. Based on the department’s interviews, observations, and records reviewed this allegation is unsubstantiated. 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. Allegation: “Residents are not treated with dignity and respect.” Interviews conducted with R2 to R8 revealed the following: 7 out of 7 residents denied the allegation. Interviews conducted with S1 to S6 revealed the following: 6 out of 6 staff denied the allegation. Observations on 09/11/2025 revealed the following: residents were observed being treated with dignity and respect. Records reviewed of Staff Training dated 08/27/2025 revealed the following: staff were trained in Resident Personal Rights. Based on the department’s interviews, observations, and records reviewed this allegation is unsubstantiated. 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. No citations were provided. An exit interview was conducted and a copy of this report was provided to Administrator, Gloriella Jara.the state’s words, verbatim · CDSS document, Sep 11, 2025 · control 11-AS-20250905120240

Allegation investigated: Staff did not follow proper eviction protocol Staff confines residents inside of the facility Staff do not maintain facility in good repair Staff do not ensure that doors are free of obstruction Staff do not assist residents with obtaining medical care Staff do not monitor residents for change in condition

On 09/05/25 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced initial complaint visit at the facility. LPA was met by staff two Salina Cruz, Care director (S2) and later by staff one Gloriella Jara, Executive director (S1) and the purpose of the visit was explained. The investigation consisted of the following: On 09/04/25, between 08:20AM and 12:05PM, LPA requested facility documents, including resident and staff roster (dated 08/22/25), Facility sketch (dated: 05/29/25) and toure the facility. LPA interviewed two (2) out of thirty-seven (37) staff. On 09/05/25, between 08:20AM and 2:15PM, LPA interviewed one (1) witness (W1), two (2) staff and five (5) residents and requested records of three (3) staff and any crossover notes. The investigation revealed the following: Regarding the allegation, “staff did not follow proper eviction protocol”, it is being alleged that the facility has not provided actual eviction letters to residents. Interviews revealed that all four (4) staff (S1-S4) have confirmed that the tenants who are living in the "Old Serenity Village" are living independently of the care and supervision of staff at the facility. Report continues, please see LIC9099-C. Unsubstantiated All five residents (R1-R5) have confirmed they have not received any eviction notice. Witness one (W1) has revealed two (2) names of the reporting parties. Record reviews revealed the following: Eviction notice(s) were requested of any eviction to resident(s) in care. When requested these alleged document(s) were not available during today's visit. Furthermore, the names provided by W1 were not present on the resident roster (LIC9020) nor on the in-house resident roster. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation, “staff confines residents inside of the facility”, it is being alleged that the facility places chairs, indoors, against entrance and exit door knobs which prevents residents to depart from the facility. Interviews have revealed the following: three (3) out of four (4) staff (S1-S2, S4) and all five residents (R1-R5) have denied the allegation has taken place. On 09/05/25, at 10:39AM, LPA's observation revealed the following: LPA observed chairs placed in front of the "original front entrance" (OFE). Staff three (S3) agreed that they have seen chairs placed in front of OFE, yet also stated the following, "Whoever has done that MUST be a resident. I know it was a resident because I saw (revealed name) putting the chairs there 'to help keep the facility safe'. Theyhave since moved out, but there is no way a staff is doing that. I can guarantee you it is still a resident doing that, because we have all been trained not to block any entrance/exit door(s)." Based on LPA's interviews and LPA's observation(s) conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation, “staff do not maintain facility in good repair”, it is being alleged that the fire alarm goes off at least twice a week, for no reason. Interviews have revealed the following: all four staff (S1-S4) have confirmed that the fire alarm was emitting an alarm quite often. S2 stated the following, "We have had that repaired, but we’re waiting to receive the report from the fire department who had come on the same day as our annual visit by LPA Dabuet.". LPA Leon attempted to contact LPA Dabuet to confirm this statement. LPA Dabuet was not available for contact. Record reviews were not available to confirm this statement. All five residents (R1-R5) have confirmed that the fire alarm system has not bothered them; that since the fire department has visited, the alarm has not gone off again and that they are prepared to leave the facility in case of fire. During LPA's one-and-a-half (1.5) days at the facility, LPA has not heard nor observed the fire alarm. Report continues, see LIC9099-C. Based on interviews conducted and LPA's observation(s), the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation, “staff do not ensure that doors are free of obstruction”, it is being alleged that the facility places chairs, indoors, against entrance and exit door knob(s). Interviews have revealed the following: three (3) out of four (4) staff (S1-S2, S4) and all five residents (R1-R5) have denied the allegation has taken place. On 09/05/25, at 10:39AM, LPA's observation revealed the following: LPA observed chairs placed in front of the "original front entrance" (OFE). Staff three (S3) agreed that they have seen chairs placed in front of OFE, yet also stated the following, "Whoever has done that MUST be a resident. I know it was a resident because I saw (revealed name, date unknown) putting the chairs there “to help keep the facility safe”. Theyhave since moved out, but there is no way a staff is doing that. I can guarantee you it is still a resident doing that, because we have all been trained not to block any entrance/exit door(s). Record reviews have revealed the following: While LPA reviewed the resident roster, the revealed nameis no longer listed which indicate revealed namehas since moved out of the facility. While LPA's observation confirms the alleged violation has taken place, LPA has decided this observation has not been conducted by a staff member, as S3 has confirmed "Staff six (S6) even asked me, 'What's up with the chairs at the door?'. So, no, it was not the staff who had done that. It was some resident who ‘wanted to help'." Based on interviews, LPA observation(s) and record reviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation, “staff do not assist residents with obtaining medical care”, it is being alleged that residents have fallen and there is no staff available to assist residents after their fall. Interviews have revealed the following: All four (4) staff (S1-S4) and four (4) out of five (5) residents (R1, R2, R4, R5) have denied the allegation has taken place. On 09/05/25, from 11:30AM through 12:00PM, LPA observed servers providing all care to residents during today's barbeque in the outdoor, shaded, patio. Record reviews have revealed the following: All four staff (S1-S4) are associated to the facility and have conducted sufficient hours under Title 22, Division 6, Chapter 8, Article 07. Personnel. 87407, 87411 and 87412. Based on interviews, LPA observation(s) and record reviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Report continues, see LIC9099-C. Regarding the allegation, “staff do not monitor residents for change in condition”, it is being alleged that staff do not seek medical care for residents in care. Interviews have revealed the following: All four (4) staff (S1-S4) and four (4) out of five (5) residents (R1, R2, R4, R5) have denied the allegation has taken place. Record reviews have revealed the following: All four staff (S1-S4) are associated to the facility and have conducted sufficient hours under Title 22, Division 6, Chapter 8, Article 07. Personnel. 87407, 87411 and 87412. Crossover notes (dated 08/15/25 through 09/04/25) have presented numerous crossover notes in order to ensure the health and safety of residents in care have been provided to residents in care. Based on interviews, LPA observation(s) and record reviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with staff one, Gloriella Jara - Executive Director and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Sep 5, 2025 · control 11-AS-20250828152822

Type of visit: Required - 1 Year

On August 14, 2025, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Gloriella Jara. LPA explained the purpose of today’s visit. The facility is licensed to serve (86) non-ambulatory elderly adults ages 60 and above of which (9) maybe bedridden. The facility is approved for (12) hospice residents. Currently, the facility has (1) resident on hospice care. The facility is a (3) floor building and consists of (96) bedrooms, (75) bathrooms, commercial kitchen, large dining room, auditorium, storage areas, nursing stations, activities rooms, exercise room, recreation room, medical supply room, craft room, conference rooms, shaded patio areas, side courtyard, and laundry rooms. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected rooms: #105, #107, #120, #126, #127 and #148. The water temperature range from 105.0 - 111.5 degrees F. and room temperature range from 74 - 75 degrees F., call buttons, and smoke and carbon monoxide are all in operating condition. LPA observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Evaluation Report continues on LIC 809C A review of Fire & Emergency Drills were completed on 07/20/25 and 07/25/25. All fire extinguishers were charged. Several working landline phones are available on-site. A review of Medication Administration Records found to be in order and accurate. During the visit LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters, including the Activities Calendar and Food Menu, were posted. An audit of resident's service records for resident #1-#5 (R1-R5) and staff personnel records for staff #1-#5 (S1-S5) were accurate and complete. The facility is current on Community Care Licensing annual fees. The facility has a current Administrator's Certificate for Gloriella Jara: #7033168740 Exp: 10/08/25. The facility has a current liability insurance policy # H0076K00613-00 effective 05/01/25 through 05/01/26. No deficiencies cited during this visit. An exit interview was conducted, and a copy of this report was provided to Gloriella Jara.the state’s words, verbatim · CDSS document, Aug 14, 2025

Allegation investigated: Facility does not ensure that residents' dietary needs are met. Food provided to residents lacks nutritional value.

On 05/22/25 Licensing Program Analyst (LPA) Mario Leon conducted an initial complaint visit at the facility. LPA was met by staff one, Gloriella Jara - Administrator (S1) and the purpose of the visit was explained. The investigation consisted of the following: On 05/22/25 LPA requested and reviewed facility documents, including resident and staff rosters and five (5) drmodified diet orders, weekly food menu from February the twenty-fourth (02/24/25) through June the first (07/01/25) of this year. LPA toured the ground floor and first (1st) level of the facility, including the kitchen, dining room and six (6) resident rooms. LPA interviewed six (6) out of thirty-two (32) clients and four (4) out of thirty-three (33) staff. The investigation revealed the following: Regarding the allegation, “Facility does not ensure that residents' dietary needs are met.”, it is being alleged that residents are not being provided alternative meals. Between 09:30AM and 1:30PM LPA interviewed six (6) out of thirty-two (32) residents (R1-R6) and five (5) out of thirty-three (33) staff (S1-S5). Report continues, please see 9099-C. Unsubstantiated During today's visit, LPA toured the kitchen and observed at least three (3) days of perishable foods and seven (7) days non-perishable foods. All food is being stored correctly, and dated, which meet Title 22 regulations. LPA also observed a salad bar, with items being provided which include two (2) types of salad and fresh fruit. LPA observed lunchtime schedule, as at least six (6) residents were assisted by at least three (3) serving staff and LPA observed a resident being provided a second serving after their request. Record reviews revealed that residents with a modified diet are posted in staff two, Carlos Gonzales' Kitchen Supervisor's (S2) office. LPA also observed modified diet meals for the residents presenting both a Dr.'s order modified diet and the facility also follows resident preference(s), which indicates staff are providing modified diets prescribed by a resident's physician as a medical necessity to residents in care. Interviews revealed that five (5) out of six (6) residents and all five (5) staff do not agree with the allegation. Based on LPA's observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation, “Food provided to residents lacks nutritional value.”, it is being alleged that residents’ dietary restrictions are not being met. During today's visit, LPA toured the kitchen and observed at least three (3) days of perishable foods and seven (7) days non-perishable foods. All food is being stored correctly, and dated, which meet Title 22 regulations. LPA toured the dining room during lunch hours, which run from 11:30AM - 1:30PM and observed some residents being delivered food at each resident's assigned seating, while residents who are ambulatory (can walk) lined up at the lunch buffet to be served their food. LPA also observed a salad bar, with items being provided such as two (2) types of salad and fresh fruit. Residents were assisted by at least three (3) serving staff and LPA observed a resident being provided a second serving upon request. Record reviews revealed that residents with a modified diet are posted in staff two, Carlos Gonzales' Kitchen Supervisor's (S2) office. LPA also observed modified diet meals for the residents presenting a Dr.'s order modified diet and the facility also follows resident preference(s), which indicates facility staff are providing modified diets prescribed by a resident's physician as a medical necessity are being provided to residents in care. Interviews revealed that all six (6) residents and all five (5) staff do not agree with the allegation. Report continues, see LIC9099-C. Staff two (S2) stated that "we learn who each resident is and follow their Dr's order and their requests..." and resident one (R1) stated "Promises made, promises kept." and has verified they are now satisfied with the changes that have occurred over the past seven (7) days. Based on LPA's observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with staff one, Gloriella Jara Administrator (S1), and a copy of this report has been provided.the state’s words, verbatim · CDSS document, May 22, 2025 · control 11-AS-20250514084434

Allegation investigated: Facility does not ensure sufficient staffing to meet resident needs. Staff does not ensure residents are provided a comfortable environment.

On 01/09/25 The Department of Social Services, Community Care Licensing Division (CCLD) staff conducted an unannounced, subsequent, complaint visit at the above-mentioned facility. CCLD was met by Gloriella Jara, Administrator (S9), and the purpose of the visit was explained. The investigation consisted of the following: 01/09/25 CCLD staff interviewed two (2) staff (S7, S9) and requested and reviewed a personnel roster, updated 09/02/24, and staff roster(s) from the dates of 12/01/24 - 01/10/25. On 10/04/24 CCLD staff interviewed an additional four (4) staff (S3-S6) and six (6) residents (R1-R6) and acquired facility documents, which included in-service training and which ranged from 06/03/24 through 09/12/24 covering topics pertinent to caring for residents receiving services. On 10/03/24 CCLD staff interviewed two (2) staff and acquired facility documents, which included incoming administrator certificate and email communication(s) between CCLD and the above-mentioned facility. Report continues, see LIC9099-C Unsubstantiated On 9/13/24 CCLD staff were met with Emmanuel Ruiz, Licensee, and CCLD obtained the following documents: Client’s roster, Personnel roster, Staff schedule, Shower schedule or change schedule and (R#1-R#5) Medication Administration Records-(MARs) for 3 months. The investigation revealed the following: Regarding the allegation, “Facility does not ensure sufficient staffing to meet resident needs.”, it has been alleged that the facility does not have sufficient overnight staffing ratios. CCLD staff interviewed six (6) residents and six (6) staff. Interviews revealed that five (5) out of six (6) residents and three (3) out of six (6) staff have denied the allegation has taken place. Record reviews have revealed that on 09/01/24, 09/07/24, 09/14/24, 09/21/24, and 09/22/24 there was one (1) overnight staff between the hours of 10:00PM – 06:00AM, with one (1) staff living on-site and on-call. On 01/09/25 CCLD staff further interviewed staff seven (S7) who has confirmed NOC shift has been covered by at least one staff member and also confirmed one (1) staff is on call through the evening. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation, “Staff does not ensure residents are provided a comfortable environment.”, it has been alleged that, during the month of August, the facility internal temperature was too high for residents in care. Record reviews did not reveal any health related incidents related to the increase in temperature. CCLD staff interviewed six (6) residents and six (6) staff. Interviews revealed that five (5) out of six (6) residents and five (5) out of six (6) staff have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There has been zero deficiencies cited during today’s visit. An exit interview was held with Gloriella Jara, Administrator (S9), and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jan 10, 2025 · control 11-AS-20240911112822

Allegation investigated: Staff did not reorder residents medications timely causing resident to miss medications.

On 11/14/2024, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced subsequent complaint visit at this facility and was greeted by the Director of Operations, Emmanuel Ruiz. LPA explained the purpose of the visit is to deliver findings for the allegation listed above and was allowed entrance into the facility. The investigation consisted of the following: On 08/14/2024 and 09/11/2024 LPA Troy Watson interviewed staff #1-#6 (S1-S6) and interviewed residents #1-#4 (R1-R4). LPA Watson requested, received, and reviewed Resident Census – August 2024 & List, EMAR, Admission Records, Clinical Physician's Orders, Medication and Nutritional Status, Personnel Report, Employee Roster & List, Policy and Procedures, Drug Information Sheet, Medication Administration Records (MARs) and Admission Agreements for R1-R4. The investigation revealed the following: CONTINUED ON 9099-C Substantiated Allegation: Staff did not reorder medications timely causing residents to miss medication. On 09/11/2024 the Department audited the facilities Medication Administration Records (MAR) dated September 2024. The facility uses an electronic Mar (eMar). Documents were reviewed for 4 residents, and 4 out of 4 eMAR’s showed blank spaces throughout the record. Per the charting codes given on the eMar, there is a code for each action, so there should be no blanks spaces for daily medications. On 08/14/2024 and 09/11/2024 LPA Troy Watson interviewed staff #1-#6 (S1-S6). The question asked of the staff was, have any residents run out of medications? Of those interviewed 1 out of 6 staff interviewed stated that they knew of only one resident who ran out of medicine since they have been working there. On 09/11/2024 LPA interviewed residents #1-#4 (R1-R4). Of those interviewed 4 out of 4 residents confirmed that medication was intermittently distributed to them because of a change in staff. Additionally, LPA interviewed resident 1 – 4, and asked them who reordered their medications. Of those interviewed 2 out of 4 stated their doctors reordered their medications, one out 4 stated that a family member reorders their medications, and one stated that the med-tech reorders their medications. An Interview with the administrator Sabina Nayberg revealed that one of the residents ran out of medication. The administrator stated that the residents’ doctor was called twice to refill depleted medication but did not respond. The resident whose medication had ran out, received their missing medication later. CONTINUED ON 9099-C Based on evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the allegation is found to be SUBSTANTIATED. California code of regulations title 22, division 6, chapter 8 are being cited on the attached LIC 9099D. An exit interview has been conducted and a copy of the Complaint Report and Appeal Rights was provided to the Director of Operations Emmanuel Ruiz.the state’s words, verbatim · CDSS document, Nov 14, 2024 · control 11-AS-20240809085534

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Nov 22, 2024

87465 Incidental Medical and Dental Care ...The licensee shall assist residents with self-administered medications as needed. This requirment has not been met as evidenced by: On 09/11/2024 LPA Troy Watson observed on eMAR that medications had been missed for residents 1-4 for the month of September 2024. This is a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 14, 2024

Plan of correction: Administrator will conduct staff medication training. Facility will provide copies of transcripts to CCL via email/fax by POC due dates.

Type of visit: Post Licensing

On 9/13/2024, Licensing Program Analysts (LPAs) Alfonso Iniguez and Deborah Lee conducted an unannounced post-licensing required visit using the CARE Inspection Tool. LPA met with Emmanuel Ruiz /Licensee. LPA explained the purpose of today’s visit. The facility is licensed to serve (86) elderly adults ages 60 and above, of which (86) can be non-ambulatory and (9) Bedridden on rooms 201-209. The facility has an approved hospice waiver for (12). The facility is a (3) floor building and consists of (96) bedrooms, (75) bathrooms, commercial kitchen, large dining room, auditorium, storage areas, nursing stations, activities rooms, exercise room, recreation room, medical supply room, craft room, gift shop, conference rooms, shaded patio area, side courtyard, patio, and laundry rooms. LPA Iniguez and the licensee toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (5) bedrooms and (5) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 109.5°F to 114.2°F, and the room temperature ranged from 76°F to 78°F. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 9/10/24. A review of (5) residents' service files and (5) staff personnel files was maintained in order. LPA reviewed (5) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance will be email to LPA. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies; therefore, no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Emmanuel Ruiz / Licensee.the state’s words, verbatim · CDSS document, Sep 13, 2024

Type of visit: Prelicensing

On 4/22/24 LPM Eva Alvarez and LPA Alfonso Iniguez conducted an unannounced pre-licensing change of ownership visit at this facility. LPM and LPA were met by Robert Aguilos (Administrator) and Grace Mercado (Licensee). The purpose of today’s visit was explained. There are currently (27) residents residing in the facility. The facility is a (3) floor building and consists of (96) bedrooms, (75) bathrooms, commercial kitchen, large dining room, auditorium, storage areas, nursing stations, activities rooms, exercise room, recreation room, medical supply room, craft room, gift shop, conference rooms, shaded patio area, side courtyard, patio, and laundry rooms. The facility has applied for a total of (86) residents of which (77) non-ambulatory and (9) bedridden. Bedridden rooms are: 201, 202, 203, 204, 205, 206, 207, 208 and 209. A tour of the entire facility was conducted: basement floor, first floor, second floor, third floor, kitchen, common areas, outside of facility, medication room, records room, generator bathrooms, activity program, weekly menus. The following was observed during this visit: MEDICATIONS There is a locked centralized storage area for Resident medications. PHYSICAL PLANT Facility is clean, sanitary, and in good repair. Protective devices are in place. Indoor and outdoor passageways, stairways, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68°F. degrees and 73°F. degrees. Open porches, and areas of potential hazard are well-lit. Smoke alarms operate properly. Carbon monoxide detectors operate properly. Report continues LIC 809C. BEDROOMS There is a bed for each client with a mattress, mattress pad, bedsprings, and pillow(s) which are clean and in good repair. Mattresses and pillows are flame-retardant. There is dresser and closet space for each client that includes at least two (2) drawers or eight (8) cubic feet of dresser space per client. There is a chair and lamp for each client and at least one (1) nightstand per two (2) clients. BATHROOMS There is at least one (2) toilet and washbasin per six (6) clients, family, and personnel. There is at least one (2) shower or bathtub per ten (10) clients, family, and personnel. Hot water temperature is 113° Fahrenheit. Bathroom is located near client bedrooms. There are night-lights in the hallways outside non-private bathrooms. SUPPLIES There are client personal hygiene supplies to include soap, toothpaste, toilet paper, and comb. There is a sufficient supply of clean linens to permit weekly changing or more of client top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE Dining room is near kitchen. Refrigerator(s) and freezer(s) are clean and large enough for the storage of at least two (2) days of perishable foods. Freezer is 0° Fahrenheit. Refrigerator is a maximum of 45° Fahrenheit. A seven (7) day supply of non-perishable food is present. There are enough tableware, tables, dishes, and utensils. There is enough equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. Report continues LIC 809C. RECORDS There is confidential storage of personnel records at the facility. There is confidential storage of client records at the facility. ADMINISTRATION The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES There is an outdoor activity space with a shaded area and furnished for outdoor use. There is at least one common room available to clients for visitors. MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. A review of (2) residents' service files (R1-R2) and (4) staff personnel files (S1-S4) were maintained in order. LPA reviewed (2) Medication Administration Records (MARs) and no discrepancies were found. During this pre-licensing inspection, LPAs did not find corrections were needed. LPA Iniguez conducted the Component III Orientation with the Licensee and copy of this report was provided. A copy of the facility evaluation report will be available to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with their assigned CAU Analyst. Exit interview conducted with Grace Mercado /Licenseethe state’s words, verbatim · CDSS document, Apr 22, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 86 Census (if any clients in care): 27 Interview Method: Telephone interview On 4/8/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 8, 2024