Paintbrush Assisted Living and Memory Care

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Anna Porter and Mai Yang arrived at the facility unannounced to conduct the Annual Inspection. LPAs met with Regional Executive Director (RED) Heidi Charette. LPAs and RED toured the facility inside and out and observed multiple resident rooms. The rooms contained required furniture, bedding and personal items. Bathrooms were in good repair with safety requirements in place. Water temperature was checked in several resident bathrooms. Hygiene items, cleaning and disinfecting supplies were properly stored and inaccessible to the residents in Memory Care. LPAs conducted Medication Audits in Assisted Living and Memory Care. Residents were seen throughout the facility in their apartments, as well as common areas, participating in an activities and having lunch in the dining room. LPAs toured the main facility kitchen with the Chef and RED. Flooring was in good repair; necessary food preparation items were properly stored. Appliances were clean and in working order. The walk-in refrigerator and freezer were observed including temperature logs in place. LPA observed required food supplies, emergency food, water as well as paper products. LPAs found the grounds to be well kept with walkways, sitting areas and gardens. Doors and passageways are unobstructed throughout, including outdoors. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D. An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were provided to Regional Executive Director (RED) Heidi Charette. LPA requested the following updated forms faxed to CCLD by 9/4/2026: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Proof of current Liability Coverage.the state’s words, verbatim · CDSS document, Aug 19, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Katie Brown conducted a Case Management in conjunction with a complaint investigation. LPA and Administrator (AD) Deanne Edwards discussed the reason for the Case Management. During the course of the investigation of complaint Control Number 24-AS-20251126112941, it was discovered that the facility did not ensure that all terms and conditions of the Admission Agreement were followed. When R1 moved into the facility, there was a discount applied to the Admission Agreement, signed 3/29/2022. R1's rate was increased 12/1/2024 and the discount (or modification) was not reflected into the new rate. R1 paid the full rate until moving out of the facility on 7/13/25. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D. The Deficiency is CLEARED DURING THIS VISIT due to reimbursement in full being provided to R1. An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Jun 4, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Jun 4, 2026

87507 Admission Agreements (f)The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by: Licensee did not comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. After 12/1/24 rate increase, R1's promised 10% Veterens discount from 3/29/22 admission was not applied to the revised rental agreement. This poses a potential health & safety risk.the state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: DEFICIENCY CLEARED DURING VISIT Proof of R1's reinbursement from the facility in full has been provided to CCLD.

Allegation investigated: Illegal Eviction

On 4/3/26 at 10:00am Licensing Program Analyst (LPA) J. Leffall conducted an initial complaint visit to open and to deliver findings on the above allegation. LPA met with Administrator (A1) Deanne Edwards. The Department received and reviewed facility records, and conducted interviews with staff Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies were issued. Exit interview conducted. A copy of this report was distributed to Administrator which confirms signature of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 3, 2026 · control 24-AS-20260401074658

Allegation investigated: Staff did not administer medications to a resident in care Staff did not ensure that residents rooms are being cleaned

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to deliver complaint findings to the facility. LPA met with Administrator (AD) Deanne Edwards. LPA and AD reviewed the allegations. Interviews and record reviews were conducted by this Department. It cannot be determined which resident(s) the Reporting Party (RP) is alleging did not receive medication. LPA reviewed selected resident Medication Administration Records (MAR) for the date stated. Not enough information was provided. During the investigation, residents apartments in Assisted Living and Memory Care were selected and found to be clean with required furnishings. Housekeeping schedules were provided and reviewed. The RP did not identify a resident name or apartment. See page 2 for continuation of this report Unsubstantiated Page 2 Based on interview, record review and observation the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. There were no citations issued. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 12, 2026 · control 24-AS-20250910145648

Allegation investigated: Staff did not provide activities to residents in care

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the initial complaint visit. LPA met with and discussed the allegation with Administrator (AD) Deanne Edwards. During this visit, LPA conducted interviews and reviewed facility documentation. The facility hosted a holiday celebration on 12/31/25 which included residents, staff and family members. On 1/1/26 though an activity calendar had been posted, Activity Department staff had scheduled time off resulting in the schedule for the day needing to be modified. Other facility staff were available to assist residents with alternative activities. Based on interview and record review the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. There were no citations issued. An exit interview was conducted and a copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 12, 2026 · control 24-AS-20260102100338

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Katie Brown conducted a Case Management in conjunction with delivering complaint findings. LPA met with Administrator (AD) Deanne Edwards and discussed the reason for the Case Management. While investigating the complaint Control Number 24-AS-20250910145648 it was reported by the facility that a medication error occurred on 9/3/2025 involving Resident (R1). The facility submitted a Special Incident Report to CCLD on 9/4/25 as required. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D. A Civil Penalty is being assessed on the attached LIC421M for a Repeat Violation An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD.the state’s words, verbatim · CDSS document, Jan 12, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jan 13, 2026

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed…. (4) The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidenced by: Licensee did not ensure resident was assisted with self administered medications as needed. On 9/3/25, R1 was given another residents medication resulting in a medication error. This poses an immediate health and safety risk tp persons in carethe state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: AD has agreed to provide the evidence of Med Tech In-Service that was provided after the Medication occurred to CCLD by poc date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Administrator (AD) Deanne Edwards. This visit began by touring Memory Care. LPA, AD and Memory Care Director (MCD) observed multiple resident rooms. The rooms were found to be clean and contained required furniture, bedding and personal items. Bathrooms were in good repair with safety requirements in place. Hygiene items, cleaning and disinfecting supplies were properly stored and inaccessible to the residents in Memory Care. Residents were observed in common areas and in the dining room. LPA conducted a Medication Audit in Memory Care. LPA and AD toured Assisted Living. Apartments were found to be clean, containing required furniture, bedding and personal items, Bathrooms were in good repair with safety requirements in place. Residents were seen throughout the facility in their apartments, as well as common areas, participating in an activity or waiting for lunch in the dining room. LPA toured the facility kitchen with the Chef and AD. The kitchen was found to be clean and organized. Flooring was in good repair; necessary food preparation items were properly stored. Appliances were clean and in working order. The walk-in refrigerator and freezer were observed including temperature logs in place. LPA observed required food supplies, emergency food, water as well as paper products. Resident medications are centrally stored and locked in both Memory Care and Assisted Living. The facility has multiple visitation and common areas available. LPA walked the outdoor areas to find the grounds to be well kept with walkways, sitting areas and gardens. Doors and passageways are unobstructed throughout, including outdoors. See page 2 of this report Page 2 - Annual Inspection An annual Fire and Sprinkler System Inspection was conducted by Jorgensen Fire Co. on 5/22/25. Fire Extinguishers were serviced 7/7/25. LPA reviewed Fire and Emergency Drill logs. Required postings were observed in the entry and lobby area. Emergency Disaster and Infection Control Plans were reviewed. Due to time constraints, LPA will return to conduct record review of resident and employee files and complete the inspection. There were no citations issued today. An Exit interview was conducted with AD and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 5, 2025

Allegation investigated: Resident sustained unexplained injuries while in care Staff are not safeguarding resident's personal possessions while in care Staff are not preventing a dog/dogs that is/are present in the facility from harming resident in care

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a subsequent complaint visit. LPA explained the reason for the visit and discussed the allegations with Administrator (AD) Deanne Edwards. Investigation findings were delivered to the facility during this visit. This Department investigated the allegations above. Resident R1 is under the care of Compassionate Care Hospice. Record Review of R1's facility file, Chart notes, Hospice notes and current Hospice Care Plan dated 2/6/25 was conducted. R1’s conditions, including changes in skin care needs wound care and treatments are properly documented. Facility Chart notes also record the ongoing communication between the facility staff, R1's Responsible Party and the Hospice Agency. See LIC9099C for continuation of this report Unfounded Continuation - Staff are not safeguarding resident's personal possessions while in care Staff are not preventing a dog/dogs that is/are present in the facility from harming resident in care After further review of the statement submitted by the Reporting Party (RP) which generated this complaint, it is determined that the two (2) allegations above were not made in reference to incidents that occurred at the facility. This Agency has investigated the allegations listed. We have found that the allegations are UNFOUNDED, therefore we have dismissed the allegations. There were no citations issued An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2025 · control 24-AS-20250408125753

Allegation investigated: Staff dispensed medication(s) not prescribed to residents Staff did not report incident involving residents as required

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the initial complaint visit. LPA explained the reason for the visit and discussed the allegations with Administrator (AD) Deanne Edwards. Investigation findings were delivered to the facility during this visit. This Department investigated the allegations above. Interviews were conducted and confirm that on 7/21/25, Residents R1 and R2 were given and took the wrong medications. Based on interview and record review of Med Tech chart Notes the incident was not reported to the resident's representatives as required. Additionally, an incident Report was not submitted to CCLD. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 9099-D. An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Aug 25, 2025 · control 24-AS-20250820163504

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 26, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed…. (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Licensee did not ensure residents were assisted with self-administration of medications as needed. Staff MT gave R1 and R2 the wrong medications on 7/21/25. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 25, 2025

Plan of correction: Licensee's contracted consultat provided in person medication re-training for all medication related staff. Proof of training provided during the visit. DEFICIENCY CLEARED DURING VISIT

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Sep 1, 2025

87211 Reporting Requirements (a) Each licensee... (1) A written report shall be submitted to the licensing agency and to the person responsible...( D) Any incident which threatens the welfare, safety or health of any resident… This requirement was not met as evidenced by: Licensee did not ensure a written report was submitted to CCLD for the medication errors which occured 7/21/25. Additionally, the facility did not report the incident to R1 and R2's Responsible Persons or Physicians. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 25, 2025

Plan of correction: AD has agreed to notify R1 and R2's Responsible Persons and Physicians of the medication errors. Additionally, a written statement which includes the facility Incident Report procedure and that all reporting has been completed will be submitted. to CCLD by poc date.

Allegation investigated: Resident injured while in care

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a subsequent complaint visit. LPA explained the reason for the visit and discussed the allegations with Administrator (AD) Deanne Edwards. Investigation findings were delivered to the facility during this visit. This Department investigated the allegation: Resident injured while in care. R1’s Service Plan dated 5/31/23 notes R1 is independent in ambulation and does not address falls or fall risk. Record review of Incident Reports, facility Narrative Charting and interviews conducted confirm R1 experienced multiple falls between 12/12/23 - 12/12/24, many requiring hospitalization. R1’s, Service plan was outdated and Physician Report 6/10/24 incomplete. The facility did not have a safety plan or interventions in place for R1. On 12/12/2024, R1 sustained a fall at thet facility resulting in a fracture. See LIC 9099C for continuation of this report Substantiated Continued - Unsubstantiated This Department investigated the allegation: Resident sustained a bed sore while in care. R1 was hospitalized on 12/12 and again on 12/13/25 – on both dates, records indicate assessments conducted with no skin issues. An RN took a photo on 12/14/24 that appears to be a wound or sore. On 1215/24 a wound specialist described R1’s wound as a “full thickness wound”. The cause is unknown, and the specialist did not determine a stage or specific diagnosis provided. It is unable to be determined when the skin issue originated or the cause of the injury. This Department investigated the allegation: R1 moved into the facility with a known diagnosis of Diabetes per Physician Report dated 10/11/22. The facility did not have Physician Orders to monitor or test R1’s blood sugar. Though the facility did not have orders to test blood sugar, there also were no interventions in place per the current Service Plan dated 5/31/23 to monitor or identify possible changes in condition to Diabetic related conditions or emergencies. This Department investigated the allegation: Staff do not safeguard a resident's personal belongings. Interviews with Care Staff and Memory Care Director (MCD) confirmed the missing belongings. Interviews confirm searches for these items were conducted, but they were not found. Employee and Family members state that a log of personal belongings was not maintained. Record review reveals that upon admission, LIC621 Client/Resident Personal Property and Valuables was not completed. A blank copy with a line through it was located in R1’s file. Based on interview and record review the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. There were no citations issued. An exit interview was conducted and a copy of this report was provided. Continuation of substantiated report The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D. An Immediate Civil Penalty is being assessed for $500 on the attached on the attached LIC421IM. An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights werethe state’s words, verbatim · CDSS document, Aug 25, 2025 · control 24-AS-20250108144027

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(5) · Plan of correction due date: Aug 26, 2025

87464 (f) Basic services shall at a minimum include: (5) Regular observation of the resident's physical and mental condition, as specified in Section 87466, Observation of the Resident. This requirement was not met as evidenced by: Licensee did not ensure Resident (R1)'s basic services of regular observation of physical and mental change of condition were met. R1 experienced multiple falls. The facility did not update Service plan or put interventions in place to prevent falls or injury. 12/12/24, R1 fell and sustained a fracture. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 25, 2025

Plan of correction: AD has agreed to submit a written stattement which will include the facility procedure for fall risk identification and care planning to CCLD by poc date of 8/27/25 10:00am.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a Case Management - Health & Safety inspection in conjunction with an initial complaint investigation (Control Number 24-AS-20250408125753). LPA met with and explained the reason for the visit with Administrator (AD) Deanne Edwards. During the visit, LPA toured Memory Care with AD and Memory Care Director (MCD) Traci Horn. LPA observed residents in common areas participating in activities. LPA randomly selected resident apartments to observe. Apartments were found to be clean, containing required furniture, linens and paper products.Bathrooms were clean and there were no accessible hazardous items. Staff members were present and available to assist residents. There were no health & safety concerns observed. LPA and AD toured the Assisted Living. Residents were observed participating in activities or walking throughout the facility comfortably. Common areas were clean, free of obstruction and available for resident or visitor use. LPA randomly selected resident apartments to observe. Apartments were found to be clean, containing required furniture, linens and paper products. Staff members were present and available to assist residents. There were no health & safety concerns observed. There were no citations issued. An exit interview was conducted and a copy of this report was signed and left with ADthe state’s words, verbatim · CDSS document, Apr 9, 2025

Allegation investigated: Staff are mismanagaing resident's medication Staff are not providing resident's authorized representatives with resident's records

Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to deliver complaint investigation findings. LPA met with Administrator (AD) Deanne Edwards and explained the reason for the visit. This Department investigated the allegation: Staff are mismanagaing resident's medication. Based on record review of Narrative Charting Notes, for Resident (R1) February - October 2024, there were multiple instances where the facility ran of of medications Xanax and Memantine resulting in R1 missing medication doses. R1's controlled Drug Medication Administration Record (count) is missing Med Tech documentation that the medication was given as ordered on multiple occasions between 6/1 - 8/17/24. On 7/30/24 and 8/2/24 the count documents medication was given 4 times in a day instead of the ordered 3 per day. The count and MAR show that Xanax was not given from 7/10-7/17/24 due to "miscommunication" as stated on a fax to Physician on 8/12/24. Additionally, Interviews revealed that a medication error occurred due to a staff member giving R1 the wrong medication. See LIC9099C for continuation of this report Substantiated This Department investigated the allegation: Staff are not providing resident's authorized representatives with resident's records. Record review of email correspondence confirm that the facility Administrator (AD) declined to provide R1's Durable Power Of Attorney/Responsible Party (DPOA) with copies of R1's MAR as requested. Per DPOA, the MAR has been provided for review in the past with no issues. The current AD informed DPOA "it is our company policy not to release MAR documents at any time". During interview with AD, AD stated that the MAR reports are used as an internal document and not considered part of the resident file/record. Based on interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited in accordance with California Code of Regulations Sections Incidental Medical and Dental Care and Resident Records on the attached LIC 9099-D. An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Feb 10, 2025 · control 24-AS-20241101112523

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Feb 11, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility.... (4) The licensee shall assist residents with self-administered medications as needed. This requirement ws not met as evidenced by: Licensee did not ensure R1 received assistance with self-administered medications Facility ran out of medications on multiple occasions. A MT gave R1 medications out of the discontinue med storage to avoid having to speak to RP, Xanex was not given due to "miscommunication" 7/10-7/17/24. This poses an immediate health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 10, 2025

Plan of correction: AD has agreed to submit a written statement to include the immediate actions taken by the facility once the errors were identified. This statement will be submitted via email to CCL by poc date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(c)(1) · Plan of correction due date: Feb 17, 2025

87506 Resident Records (c) All information and records... (1) The licensee shall… The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement was not met as evidenced by: Licensee did not ensure that confidential information was provided to R1's designated representative when requested. R1's MAR documentation was not provided to R1's DPOA/designated representative upon written request. This poses a potential health & safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 10, 2025

Plan of correction: AD has agreed to contact R1's Designated Representative to offer to provide the MAR documentation requested. AD will submit a written statement which notes the outcome of the conversation and action taken by the facility to comply with the request. Statement will be submitted by poc date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct a Case Management - Health & Safety Inspection. LPA met with and explained the reason for the visit with Resident Care Director (RCD) Melinda Ocaranza. Angel Navaro was authorized to sign this report. LPA and RCD toured the facility which including firstf resident apartments in Assisted Living (AL) as well as Memory Care (MC). In AL, LPA selected multiple apartments to observe including all residents receiving Hospice Care. Apartments were clean with unobstructed walkways. Linens and paper products were observed with extra supply available. LPA observed Med Techs, Care Staff, Housekeeping, Maintenance and Concierge staff. The kitchen was clean, staff were preparing lunch. Cleaning supplies and knives were properly stored. Required food supply was observed and properly stored. During the tour of AL, LPA observed residents sitting in common areas such as open sitting rooms, the dining room, and Bistro area. These common areas were clean, odor free with clear walkways. There are daily and monthly activity calendars posted. The Activity Director was present and preparing for the day. Medication and Housekeeping carts were found to be locked appropriately as were Med Rooms. There were multiple patios and sitting areas available outdoors. The grounds were well kept with unobstructed walkways. MC area was toured. Delayed egress doors were in working order. LPA observed 20 residents in common areas participating in a program or sitting at dining room tables. Apartments were accessible and clean. Cleaning/disinfecting products were properly secured. Linens and paper products were observed with extra supply available. Common areas and walkways were clear throughout. During this visit, LPA interviewed RCD and Memory Care Director (MCD). LPA was provided copies of staff schedules, as well as staff and resident rosters There were no health and safety issues observed during this inspection. No citations issued. An exit interview was conducted and a copy of this report was left with Angel Navaro.the state’s words, verbatim · CDSS document, Oct 16, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Administrator (AD) Jennifer Vasquez. During this visit, LPA toured the facility inside & out. Resident apartments were clean and contained required furnishings and lighting. LPA observed required items in bathrooms with hot water measuring between 105 – 107 degrees in multiple rooms. LPA observed hygiene items, towels, extra bedding, and linens which were stored and available for use. The kitchen was observed to be clean, in good repair with necessary items and appliances. LPA observed required food supply and paper products. Common dining rooms were observed during meals. Residents enjoyed restaurant style dining service. Knives, cleaning/disinfecting supplies and chemicals were locked are stored separate from food. Medications are centrally stored and locked. A First aid kit contained required items. Facility has multiple visitation and common areas available. LPA walked the outdoor areas to find the grounds to be well kept with walkways, sitting areas and gardens. Doors and passageways are unobstructed throughout the facility including outdoors. An annual Fire system inspection was conducted by Jorgensen Fire Co. on 4/26/24. Fire Extinguishers were serviced and found to be charged. Carbon Monoxide detectors are placed in each apartment. LPA reviewed fire and Emergency Drill logs. LPA conducted resident and staff file reviews. Required postings were observed throughout the facility. Emergency Disaster and Infection Control Plans were reviewed during the inspection. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D in the areas of: Personnel Requirements, Storage Space and Incidental Medical and Dental Care Services. See LIC809C for continuation of this report. An exit interview was conducted and Plan of Correction (POC) developed. A signed copy of this report and Appeal Rights were provided. LPA requested the following updated forms faxed to CCLD by 9/26/24: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Emergency Disaster Plan LIC610E, Infection Control Plan (LIC9282 (6/23)) Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage.the state’s words, verbatim · CDSS document, Aug 26, 2024

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 7/12/2024 Licensing Program Analyst (LPA) Katie Brown arrived unannounced for a case management - other inspection regarding immediate exclusion of Staff 1 (S1). LPA was greeted by Facility Designee, Resident Care Director (RCD) Melinda Ocaranza. LPA introduced self, stated the purpose of the visit. LPA requested to meet with Administrator Jennifer Vasquez who was out of the facility and unable to attend the visit. LPA discussed Staff (S1) with RCD. LPA informed Administrator that S1 is excluded and cannot work or be on the premises of the facility and should be disassociated. During the visit, LPA confirmed that S1 never worked at the facility and was disassociated 7/3/2024. No deficiency was observed. An exit interview was conducted and a copy of this report was provided to RCD, whose signature confirms receipt of this report via email - mocaranza@paintbrushassistedliving.comthe state’s words, verbatim · CDSS document, Jul 12, 2024

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA) Katie Brown and Lissett Padgett arrived unannounced to conduct the required Annual inspection. LPA met with Administrator Jennifer Vasquez Administrator (AD) and explained the purpose of the visit. Facility was toured with Memory Care Director Traci Horn (MCD). During this visit, LPAs toured the facility inside & out. Resident rooms contained required furnishings and lighting. LPAs observed required items in bathrooms with hot water measuring between 110.1 to114.4 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were properly stored. LPAs observed required food supply and paper products. Medications are centrally stored and locked. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility including outdoors, delayed egress gate was found to be in working order. First aid kits are located throughout the building and found to contain required items. Fire Extinguishers are located throughout the facility and were serviced in 2023. Smoke and Carbon Monoxide detectors are tested annually with Jorgensen fire safety company. LPAs conducted resident and staff file reviews and interviews. Administrator’s re-certification was confirmed to be in pending status and was received by the Department as required. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D. See LIC 809C for continuation of this report. An exit interview was conducted and a Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with Resident Care Director, Melinda Ocaranza, whose signature on this form confirms receipt of these documents. LPA requested the following updated forms faxed to CCLD by 10/19/2023: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Emergency Disaster Plan LIC610E, Infection Control Plan review page, Personnel Report (LIC 500), Client Roster (LIC 9020) and Proof of current Liability Coveragethe state’s words, verbatim · CDSS document, Oct 12, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(1)(C) · Plan of correction due date: Oct 13, 2023

87465 Incidental Medical and Dental Care (h)The following requirements shall apply.....: (1) Medications shall be centrally stored under the following circumstances: (C) ...Because of potential dangers related to the medication itself, ...the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others. This requirement was not met as evidenced by: Licensee did not ensure medications were properly stored and/or inaccessible to residents in care. Per R4's physician report, all medications including PRN should be inaccessible. LPA's observed multiple medications in the residence. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 12, 2023

Plan of correction: AD has agreed to remove all medications from R4's room. A written statement will be submitted by POC date that states the plan to inservice staff and ensure medications are inaccessible to R4. Additionally an audit of residents rooms will be conducted.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87705(c)(5) · Plan of correction due date: Oct 23, 2023

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by: Licensee did not ensure R1 and R3 Physician's Report were updated as required. This poses an potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 12, 2023

Plan of correction: AD has agreed to submit a copy of updated Physician Report via email to CCLD by POC Date. Additionally, AD has agreed to conduct an audit of resident files to ensure compliance.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Oct 13, 2023

87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Licensee did not ensure the facility was clean, safe and sanitary. LPA observed mold in the ice machine.the state’s words, verbatim · CDSS document, Oct 12, 2023

Plan of correction: AD has agreed to perform a deep clean of the ice machine and send picture via email to CCLD by POC date. Additionally, a ice machine cleaning procedure will be implimented to include routine cleaning.