Pacifica Senior Living Poway

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Correia conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted by the front lobby receptionist, identified herself, and met with Administrator Barajas, to whom the purpose of the visit was explained. According to the facility’s license, the facility has a maximum capacity of seventy two (72) residents, all of whom may be non-ambulatory. During today’s inspection, there were a total of fifty-nine (59) residents in care. LPA Correia conducted a partial tour of the facility. Pathways were free of obstruction and slip hazards. Client bedrooms that contain oxygen had the appropriate signage posted. LPA also observed the Community Care Licensing and Long-Term Care Ombudsman postings displayed prominently and in the correct dimensions. LPA observed several fire extinguishers, all up to date on inspections. The facility is hard wired to the local fire department. LPA observed and tested carbon monoxide detectors, noted evacuchairs at each staircase, and verified that the facility’s liability insurance was current. The facility’s last disaster drill was conducted on March 25, 2026. The facility was observed to be clean, sanitary, and in good repair. No trip hazards were observed in the inspected areas. Per Administrator Barajas, there are no firearms, weapons, or ammunition kept on the premises. The facility does not have any bodies of water on the grounds. The facility had sufficient space and equipment to facilitate laundry, visitation, meetings, and client activities. LPA Correia began the required annual inspection today; however, due to time constraints, the inspection will be continued at a later date. There were no deficiencies cited during today’s visit. An exit interview was conducted with Administrator Barajas, to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) will be provided during the visit. Signature below confirms receipt of the report.the state’s words, verbatim · CDSS document, Mar 27, 2026

Allegation investigated: Staff did not prevent the spread of gastrointestinal illness.

Licensing Program Analyst (LPA) Correia conducted an unannounced visit to conclude a complaint investigation. LPA Correia was met by Executive Director (ED) Azemikah, identified herself, and explained the purpose of the visit. On December 15, 2025, the Department received a complaint that alleged the Licensee did not prevent the spread of an illness. The Department’s investigation consisted of staff, resident, and outside source interviews, a facility tour, and a records review. It was alleged that shortly after reopening the facility’s communal dining room, after undergoing renovations, residents in care experienced an outbreak of a gastrointestinal illness. An outside source alleged the illness was related to the food served at the facility. On the same day the complaint was filed, December 15, 2025, the ED reported the outbreak to the Department. [Continued on LIC 9099 C] Unsubstantiated [Continuation of LIC 9099] The ED disclosed they contacted the County Health Department who came to the facility to ensure infection control procedures and protocols were in place. LPA conducted an interview with Outside Source 1 (OS1) who corroborated and confirmed the ED’s statement. Also, during a facility tour LPA observed infection control procedures and protocol were in place. A review of the facility log maintained of infected staff and residents revealed 6 staff and 26 residents were infected with the virus. Interviews conducted with one staff member (S1) revealed contracting the virus on December 9, 2025, 4 days before the facility re-opened communal dining on December 13, 2025, confirmed by a facility record review. An interview with Staff 2 (S2) revealed contracting the virus, however, they never ate at the facility. A record review and interview with Resident 1 (R1) revealed they went to the hospital after displaying symptoms and tested positive for Norovirus. Additionally, an interview with Resident 2 (R2) revealed they did not contract the virus and revealed they ate all three meals at the facility while the communal dining was open. Based on staff and resident interviews and records reviews the Department determined the allegation to be Unsubstantiated. An unsubstantiated finding means there was not a preponderance of evidence to prove the violation occurred. An exit interview was conducted with ED Azemikah to whom a copy of this report (LIC 9099), and the Licensee Rights (LIC 9058) was provided. Signature below confirms receipt of the reports. During today's visit LPA left for lunch and to conduct an additional visit.the state’s words, verbatim · CDSS document, Dec 31, 2025 · control 08-AS-20251215130522

Allegation investigated: Staff are not meeting the residents bathing needs. Staff are not properly maintaining the residents rooms. Staff are not meeting the residents catheter needs. Staff are not meeting the residents laundry needs. Staff are not meeting the residents transferring needs. Staff are allowing the residents to be soiled. Staff do not keep the facility free from mold. Staff do not provide adequate care and supervision of the residents. Facility is insufficiently staffed.

Licensing Program Analyst (LPA) Correia conducted an unannounced visit to conclude a complaint investigation regarding the above-mentioned allegations. LPA identified herself and met with Executive Director (ED) Azemikhah to discuss the purpose of the visit. The Department's investigation included facility and staff records reviews and interviews, and a facility tour. It was alleged staff were not meeting residents’ needs of assistance with Activities of Daily Living skills (ADLs). Specifically, it was alleged facility staff did not provide adequate assistance with bathing, transfers, and housekeeping. Interviews conducted with residents revealed no concerns or issues with assistance with ADLs as mentioned above. It was also alleged that staff did not provide adequate incontinence and/or catheter care, and residents had been left soiled. Similarly, interviews with residents that required incontinence and/or catheter care revealed no issues with services provided by staff. Unsubstantiated Additionally, it was alleged staff did not provide adequate care and supervision of the residents, and the facility was insufficiently staffed. Interviews conducted with some residents in care revealed they felt the facility was understaffed. However, when probed on how this affected them or other residents, they responded there was no effect on themselves and were not able to specify who or how it affected other residents in care. A review of staff records revealed staff received proper training for their role at the facility, and a review of resident records corroborated service provisions were being rendered as needed. Lastly, it was alleged that the facility was not free of mold. All resident interviews revealed no issues with mold at the facility, including one resident that revealed being allergic to mold. A facility tour revealed the facility had experienced some leaks that resulted in mold. The areas affected were observed to have been restored. Based on interviews, direct LPA observations and records reviews, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations were determined UNSUBSTANTIATED. An exit interview was conducted with Business Office Manager (BOM) Marisol Barajas, to whom a copy of this report and Licensee/Appeal Rights (LIC9058 03/22) will be provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 25, 2025 · control 08-AS-20250815104547

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced Case Management visit. LPA met with Executive Director (ED) Azemikhah and discussed the purpose of the visit. During today's visit LPA obtained a signatures on amended Community Care Licensing (CCL) report. An exit interview was conducted with ED Azemikhah to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) will be provide.the state’s words, verbatim · CDSS document, Aug 25, 2025

Allegation investigated: Licensee did not serve residents food of good quality.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced 10-day visit to initiate a complaint investigation and deliver findings regarding the above-mentioned allegation. LPA identified themselves and met with Executive Director Cameron Azemikhah, to discuss the purpose of the visit and elements of the complaint. On 05/05/2025 it was alleged that Licensee did not serve residents food of good quality. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Staff interviews revealed observations of various wait times, which were not observed to all be consistently long. Staff informed that two serving staff were out at the same time recently which resulted in staffing adjustments; while this affected wait times slightly, the times were not reported to be in excess of 15 minutes from when the resident ordered their food. Staff offered that possibly during high service times, plates of the daily special were prepared prior to being ordered which could have cooled down the temperature, however staff would immediately re-heat the food if a resident informed it was not warm enough for their preference. (Continued on LIC9099-C). Unsubstantiated (Continued from LIC9099 p.1) Staff interviews additionally revealed that the chef meets with residents each month to discuss food service, and the facility adjusts as much as reasonably possible to accommodate all requests. Staff informed that transport time could affect the temperature of room service trays, however all residents are supplied with a personal microwaves in their rooms to reheat food to their preference. Resident interviews were consistent regarding the quality of food and options served at the facility, but interviews varied regarding serving times. Residents consistently stated that the food was good or great, and that they had options to choose from. Some residents experienced no wait for their meals and some residents felt that they did have to long periods for their food to arrive once ordered. All residents emphatically informed that staff would re-heat their food promptly if asked. It should be noted that interviews revealed that the dining room doors were open at all times, and some residents came into the dining room up to 60-90 minutes prior to the scheduled meal time, skewing their perception of wait times. Records review showed that all kitchen staff had food handler's cards, and training titled, "Food and Kitchen Safety". Weekly facility menus showed a variety of food options, with a different special offered each day for each meal. The menus included a section titled, "Alternate Menu", with 13 options that could be ordered outside of the special main dish. Additional records included photos, with timestamps and location, of recent meals served at the facility. During an unannounced facility visit LPA directly observed the food service at the facility; all food was observed to be of good quality with no issues observed regarding food handling requirements or safety. LPA observed warming buffets with active steam as well as a hot box with warming trays set to 135 degrees. While the investigation revealed that sporadic issues regarding food temperatures and wait times had occurred, the instances were not shown to be consistent or common. Further, the investigation showed that the facility immediately corrected issues made known to them with increased training, staff support, or changes in procedure. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Executive Director Cameron Azemikhah, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, May 13, 2025 · control 08-AS-20250505153230

Allegation investigated: Staff did not give medications as prescribed.

Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced subsequent complaint visit regarding the above-mentioned allegation. LPA was met by, identified herself to, and discussed the purpose of the visit with Director Cameron Azemikhah. The Department's investigation consisted of record review and interviews with staff and outside sources. Resident (R1) was a total assist with medication and it was alleged that staff did not give medications as prescribed to (R1). Photographs from outside sources showed that there were two handwritten notes with the instructions to take “pills”. Review of facility email communications concluded that the event happened and a staff member was identified for placing medication with the notes in the resident room. Staff interviews revealed one job requirement for medication management is that staff are present with a resident during a medication pass. (Cont'd on 9099C) Substantiated (Cont'd from 9099C, page 2) (R1) did not subsequently contract for continued one hour checks in care plan or admission agreement. This allegation is unsubstantiated. It was alleged the facility did not provide (R1) basic laundry service. (R1) contracted with facility to launder (R1) laundry once a week. Staff said that (R) had a history of mixing clean clothing with dirty clothing. Staff set the laundry hamper outside the room so clothing would not get mixed up. Staff were reminded by an outside party, on occasion, to do (R1) laundry and they laundered the clothing. Therefore, this allegation is unsubstantiated. It was alleged that resident's call pendant was not working. Staff confirmed that resident call pendants were replaced immediately when staff became aware of the malfunction. Extra pendants are stored at the front desk. Staff interview and LPA observation indicated that staff have a call pager and walkie-talkie to respond to a resident call. Staff also have a master pendant to check on the operational status of the resident pendant before staff leave the resident unattended. Resident interviews confirmed that their pendants had never failed. Therefore, the allegation is unsubstantiated. An exit interview was conducted with Cameron Azemikhah to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. His signature on this form acknowledges receipt of these rights. (Cont'd from 9099A) Cameron Azemikhah confirmed caregiving staff are trained to get a battery from the front desk to change a battery in a chirping smoke alarm. He said there are always batteries at the front desk. The local fire department reported that a smoke alarm is still working when it chirps and that the smoke alarm would alarm in the event of a fire. This allegation is unsubstantiated. It was also alleged (R1) personal items were not safeguarded. (R1) listed items and signed an inventory list to indicate personal items brought into the facility. (R1) had possession of and controlled their personal items in their room. Cameron Azemikhah said facility is a cashless facility, meaning none of the services at the facility require cash. Cameron Azemikhah recommends nothing of real value be stored in resident rooms or the facility upon admission. Cameron Azemikhah conducts an internal investigation, contacts Community Care Licensing or the police as warranted, when a valuable item goes missing. According to residents and outside sources, lost linens and clothing were replaced or financially reimbursed. The allegation is therefore unsubstantiated. It was alleged that (R1) room was not sanitary related to staff not cleaning a refrigerator and floors. (R1) residential agreement did not state who is responsible to clean (R1) refrigerator. The facility supplied (R1) the refrigerator and upon request, staff cleaned out refrigerator. Resident interviews, along with LPA observation of resident refrigerators, confirmed that refrigerators were clean. One outside source did not ask staff to clean the refrigerator but rather cleaned out old food items themselves. Outside sources, residents, staff and LPA observations confirmed carpets and floors were clean and that spots on floors were cleaned by staff. Therefore, the allegation is unsubstantiated. It was also alleged that facility did not provide adequate supervision for (R1). (R1) admission agreement and care plan indicated staff would do status checks on (R1) four (4) times per shift. There are three (3) shifts at facility for eight (8) hours each. The resident was independent in toileting and standby assistance when transferring. When resident experienced a series of falls, the facility increased supervision to one hour checks. (Cont'd on 9099C page 2) (Cont'd from 9099C) The Department has investigated the above-mentioned allegation and has found that based upon record review and interviews, a preponderance of evidence exists to support the allegation. Therefore, this allegation is deemed substantiated. A deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Cameron Azemikhah, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided during the visit. His signature on this form acknowledges receipt of these rights.the state’s words, verbatim · CDSS document, Apr 17, 2025 · control 08-AS-20230728165332

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Apr 17, 2025

A plan for incidental medical and dental care...to provide for assistance in obtaining such care, by compliance with the following: The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews and a review of records, the licensee did not ensure staff assisted resident with administered medications as needed. This posed a potential health and safety risk to one (1) resident in care.the state’s words, verbatim · CDSS document, Apr 17, 2025

Plan of correction: The licensee will conduct a one hour staff in-service with med techs to review policies and procedures in regards to medication pass and Title 22 Requirements. An inservice sign in sheet, and course outline will be submitted to CCL by the POC date of 05/15/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Executive Director Cameron Azemikhah . According to the facility’s license, the facility has a maximum capacity of seventy-two (72) residents, all of whom may be non-ambulatory. During today’s inspection, there were a total of forty-five (49) residents in care. LPA, accompanied by Cameron Azemikhah, toured the interior and exterior of the facility, and inspected resident rooms. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature at taps accessible to clients were all compliant. There was at least 2 days supply of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters observed available to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per the administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Confidential records were stored in locked areas. Azemikhah also presented proof of current/active business liability insurance. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Azemikhah, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Apr 4, 2025

Allegation investigated: Questionable Death. Staff did not notify residents authorized representative of incident.

Licensing Program Analyst (LPA), David Roman, conducted an unannounced complaint investigation visit. LPA D. Roman identified himself and disclosed the purpose of the visit to Executive Director, Cameron Azemikhah. On March 17, 2025, it was reported to the Department that there was a questionable death, and staff did not notify resident's authorized representative of the incident. During today's visit, LPA D. Roman reviewed records and interviewed staff which revealed the resident in question did not reside in the Assisted Living portion of the facility. This resident did reside in the 55+ Independent Living facility in a different address, adjacent and associated to the Pacifica Senior Living Poway. The Independent Living component is not licensed through California Department of Social Services, Community Care Licensing Division. Based on the information revealed during the visit, these allegations are deemed to be unfounded. An unfounded determination means that the allegation was false, could not have happened and/or is without a reasonable basis. (Cont. 9099-C) Unfounded An exit interview was conducted with Executive Director, Cameron Azemikhah, to whom a copy of this report, and licensee/Appeal Rights were provided. Their signature acknowledges a receipt of this report and their rights.the state’s words, verbatim · CDSS document, Mar 20, 2025 · control 08-AS-20250317160123

Allegation investigated: Facility did not ensure that residents had running water. Facility did not meet resident's hygiene needs. Facility did not follow reporting requirements

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above complaint allegations. LPA Correia met with Executive Director (ED) Azemikhah to whom was explained the purpose for the visit. The Department’s investigation included interviews with staff, residents, and outside sources, as well as facility records reviews. It was alleged the facility did not ensure that residents had running water and did not ensure residents hygiene needs were met. An interview with the Executive Director (ED) revealed the facility had a planned water outage scheduled for September 4, 2024, due to an upgrade in their water system. The interview also revealed several measures were put in place to ensure the residents care needs were met, including dedicated empty rooms with full water use, and offering showers a day before or after for residents whose care plan included showers during the day of the outage. Staff and resident interviews also confirmed water stations were placed throughout the facility during the day of the outage. Unsubstantiated It was also alleged the facility did not follow reporting requirements. Interviews conducted with staff, residents, and outside sources, as well as facility records reviews revealed the residents and/or their Responsible Parties (RPs) were notified of the date and times of the outage, and postings of the date and times were displayed throughout the facility. A facility records review and an interview with an Outside Source Agency confirmed the dates and times of the outage and receipt of notifications. Based on the interviews and records reviews the above listed allegations were determined to be Unsubstantiated, as the preponderance of evidence standard was not met. An exit interview was conducted with ED Azemikha who was informed that a copy of the reports will be provided at the conclusion of the visit. Signature below confirms receipt of the reports.the state’s words, verbatim · CDSS document, Mar 13, 2025 · control 08-AS-20240904154400

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Executive Director Cameron Azemikhah . According to the facility’s license, the facility has a maximum capacity of seventy-two (72) residents, all of whom may be non-ambulatory. During today’s inspection, there were a total of forty-five (45) residents in care. LPA, accompanied by Cameron Azemikhah, toured the interior and exterior of the facility, and inspected resident rooms. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature at taps accessible to clients were all compliant. There was at least 2 days supply of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters observed available to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per the administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Confidential records were stored in locked areas. Azemikhah also presented proof of current/active business liability insurance. No deficiencies were observed or cited during today's annual inspection. LPA issued one (1) technical violation and one (1) technical assistance. An exit interview was conducted with Azemikhah, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Mar 13, 2024

Allegation investigated: Facility was not communicating their visitation policy.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Cameron Azemikhah, Executive Director. On 4/24/23 it was alleged that the facility was not communicating their visitation policy, due to residents not being given access inside the building at night. The Department’s investigation consisted of unannounced facility visits, review of facility records, interviews with facility staff, residents, outside sources, and LPA direct observations. Staff interviews corroborated the allegation, staff informing that timeliness in assisting residents with access to the building at night had been an ongoing issue. Staff interview further revealed that the facility's phone system was inconsistent, causing some calls to not go through, resulting in staff not being aware that someone was at the door. Staff interview, confirmed by records review, showed that residents brought the issue up during resident council meetings and communicated their concerns to staff, in writing. (Continued on LIC9099-C p.2) Substantiated (Continued from LIC9099 p.1) Resident interviews also corroborated the allegation, residents stating that they waited outside up to 1.5 hours for staff to answer the phone and come to the door to let them in. Outside source interview corroborated the allegation, confirming that residents were waiting for long periods of time after hours, unable to get into the building. Review of the Resident Handbook, Appendix E of the Residence and Care Agreement, revealed the following policy regarding access to the building after hours: "When visiting after hours, please call [facility phone number] and/or press the call button located on the front door to enter and exit the community after hours". On 4/27/23, 1/30/24, and 2/10/24, Department staff contacted the facility number after hours, which produced varied response times. On 4/27/23, one (1) call was made to the facility phone, which was answered within 18 seconds. On 1/30/24, the phone was answered within 3 seconds on two (2) separate after hours calls. On 2/10/24, six (6) calls were made after hours over the span of 43 minutes at 10:03pm, 10:05pm, 10:16pm, 10:25pm, 10:34pm, and 10:46pm. The phone was not answered on any call on 2/10/24 and went to voicemail each time. Based on relevant interviews and records review, the preponderance of evidence has been met that alleged violation occurred, and is therefore substantiated. Deficiencies are cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the Licensee. An exit interview was conducted with Cameron Azemikhah, Executive Director, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided. (Continued from LIC9099 p.1) Staff interview further revealed that the chef held monthly meetings with residents regarding the menu to discuss any issues with food service. The chef informed that they used low sodium broth in all soups and did not add salt to any dish, as salt and pepper were provided on each table. Menu items notated if an item/spice was included, such as garlic or onions. Resident interviews revealed that while residents had specific distastes of certain menu items, the facility offered other food options for all meals, and residents were able to choose alternative meals to their preference. Outside source interview did not corroborate the allegation of resident food preferences not being honored. Review of facility records showed that the Licensee held documentation of dietary restrictions for residents, which were adhered to by kitchen staff. The documentation showed communication about a vegan diets, lactose intolerance, coffee preferences, and a low sodium diet. LPA reviewed the menu offerings for the month of January 2024, which showed that residents had the option to choose from 16 alternate menu items in addition to the daily entrees. LPA observed options of at least 17 breakfast, 25 lunch, and 25 dinner entrees offered to residents. LPA directly observed the low sodium broth used to prepare soups, as well as salt and pepper shakers and other condiments on the dining room tables. Regarding the allegation, "Facility staff did not serve hot food", it was alleged that the Assisted Living residents food was served to them cold, due to the food being made in a separate building. Staff interview revealed that staff measured, monitored, and documented food temperatures during preparation. Staff interview revealed that the meals were prepared in the large main kitchen, and transported in steam trays on carts to the Assisted Living building. Staff interview further informed that the steam trays kept the food hot throughout the transport and serving process. Resident interviews did not corroborate the allegation, as residents did not express concern with food temperatures during meals. (Continued on LIC9099-C p.3) (Continued from LIC9099-C p.2) Outside source interview did not corroborate the allegation of resident food not being served hot. Records review corroborated staff statements regarding the monitoring and documentation of food temperatures. LPA observed a document in the main kitchen labeled, "Food Taste and Temperature Log", with each food item, date, temperature, and the initial of the kitchen staff who tested it. During an unannounced facility visit, LPA directly observed the steam trays used to transport and keep food warm. LPA did not observe any issues with the food temperatures. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Cameron Azemikhah, Executive Director, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 23, 2024 · control 08-AS-20230424144236

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Apr 1, 2024

87507(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. Based on records and interviews, Licensee did not comply with the terms set forth in the Admission Agreement regarding access to the building. This posed a personal rights and health and safety risk to 40 of 40 residents in care.the state’s words, verbatim · CDSS document, Feb 23, 2024

Plan of correction: Executive Director (ED) agreed to retrain all staff on the duties/expectations for resident access after hours. ED agreed to audit door response times for March to ensure timeliness for resident access into the building. ED will ensure all phones are in working order or replace them. ED agreed to update the door answering protocol, prioritizing pushing the button before calling the facility phone. ED will update the Resident Handbook, notify residents in the Town Hall meeting 2/27/24 and a community-wide letter. ED to submit documents by POC Due date.

Allegation investigated: Staff did not meet resident's incontinence care needs

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA met with Resident Services Director, Cheyenne Tillman, and shared findings. The Department investigated the above-listed complaint allegation. The investigation consisted of observations, multiple interviews with staff, residents, and outside sources and a detailed review of relevant records. On September 29, 2023, Community Care Licensing (CCL) received a complaint alleging that staff did not meet a resident’s (R1) incontinence care needs, [an LIC 811 Confidential Names List was provided to staff to identify the resident]. (continue at LIC 9099C) Substantiated continue from LIC 9099 During multiple interviews with staff, residents, and outside sources, it was consistently indicated that the facility did not have sufficient staff to meet resident’s needs. During interviews with multiple residents with total assistance needs for all activities of daily living including toileting, it was consistently indicated residents were left with soiled briefs for extended periods of time. The residents consistently stated that there were times they did not get incontinence care for 4 to 5 hours during the day shift, and at times even longer. The same concerns were voiced during interviews with outside sources. In addition, interviews with outside source medical providers indicated that some total assist residents who were bedbound and needed to be repositioned every two hours, as required in their service care plans, did not get repositioned or changCed from 10 p.m. until 5 or 6 a.m. the following morning. During the investigation, an incident when a total assist resident was left in a soiled brief for more than 13 hours was disclosed. On Thursday, October 12, 2023, at 10:24 a.m. an outside source found a resident with an extremely soaked brief marked with “9:00 p.m.” and the staff member's initials. The staff member who marked and initialed the brief confirmed the information was correct. A picture of the resident’s soiled brief was reviewed during the investigation. Multiple interviews with staff and residents indicated there was a high level of employee turnover since the facility change of ownership that took place on March 7, 2023. Management indicated that seven (7) care staff left the facility in early September 2023. In addition, during interviews, staff indicated that although they were working double shifts to provide adequate coverage to meet the needs of residents, at times there were no available caregivers to work during unforeseen callouts. Based on the review of the work schedule for the months of September and October 2023 it appeared that for the most part, there were enough caregivers scheduled to work per shift. However, there were times when caregivers called out and it wasn't clear which caregiver provided coverage on that day or if coverage was provided. The Executive Director indicated that the facility had a current contract with a temporary agency for caregivers. However, according to management, the facility did not employ caregivers from the temporary agency because they were able to meet the needs of the residents with the current staff working double shifts. Management indicated that October 13, 2023, was the first time the facility did not have enough caregivers and employed caregivers from the temporary agency to provide coverage during the night shift. (continue at LIC9099C) Continue from LIC 9099C Based on observations, records review, and interviews with staff, residents, and outside sources, there was sufficient evidence to support the allegation that staff did not meet the resident’s incontinence care needs. The Department has investigated the above-mentioned allegations and has found that there was sufficient evidence to corroborate the allegations. Therefore, this allegation is deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. A Deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D. A plan of correction was developed with the Resident Services Director, Tillman. A copy of this report, LIC 9099D, LIC811 Confidential names along with Licensee/Appeal Rights (LIC 9058 03/22) was provided to Resident Services Director, Tillman, at the end of the visit.the state’s words, verbatim · CDSS document, Oct 20, 2023 · control 08-AS-20230929161749

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Nov 24, 2023

87411(a) Personnel Requirements – General - Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents’ needs. This requirement was not met as evidenced by: Based on interviews and a review of records, the licensee did not ensure the facility was sufficiently staffed to meet the needs of five (5) residents. This posed an immediate health and safety risk to five (5) residents in care.the state’s words, verbatim · CDSS document, Oct 20, 2023

Plan of correction: The licensee agreed to review their personnel/staffing requirements and update the plan of operations to ensure facility personnel is sufficient in number and competent to meet residents' needs. The licensee will submit a revised plan of operations to CCL by the POC date of 11-24-2023. In addition, the licensee agreed to develop and implement internal procedures to ensure accountatbility that care staff are providieng services to residents according the the needs and services plans. The plan will be submitted to CCL by POC date of 11/24/2023.