Palm Villas, Campbell

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Marcella Tarin and Coryse Ngangmenyi conducted an unannounced annual inspection and met with Administrator (ADM) Michelle White. LPAs stated the purpose of the visit. LPAs toured the interior and exterior of the facility with ADM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. The facility was observed to be clean, safe, sanitary and in good repair. LPAs toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPAs observed the refrigerator temperature at 36 F and Freezer at -8 F. LPAs observed the knives as locked an inaccessible to residents. LPAs observed the main kitchen door is locked. LPAs observed the medication storage area and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. The facility fire system was inspected by an outside agency on 5/29/2026, and passed inspection. Fire extinguishers were last serviced on 3/19/2026. LPAs reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed. The facility's last drill was conducted on 3/16/2026. Page 1 of 2 LPAs toured 10 random resident bedrooms with the ADM. All 10 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPAs toured 8 bathrooms. All 8 bathrooms had hand soap, hand towels and/or paper towels, functioning lights, and covered trash bins. LPAs measured water temperature with a range of 105 F to 110.1 F. During tour of exterior, LPAs observed the facility laundry room to not have a door. ADM states the door was removed to install new washers and dryers. LPAs observed the laundry room is located outside of a locked facility gate and is not accessible to residents in care. LPAs requested ADM to provide documentation of installed laundry door to CCLD once completed. LPAs reviewed 3 resident records. LPAs reviewed 3 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPAs reviewed 3 staff records. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Administrator (ADM) Michelle White and a signed copy of this report was provided. Page 2 of 2 END OF REPORTthe state’s words, verbatim · CDSS document, Jul 10, 2026

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Case Management-Incident visit regarding the elopement of a resident from the facility on 11/30/2025. LPA met with Community Director (CD) Michelle White. LPA stated the purpose of the visit. On 12/3/2025 the Department received an incident report regarding the elopement of Resident R1 on 11/30/2025. The incident report states on 11/30/2025, at approximately 8:30PM staff were unable to locate R1 at the facility. Staff immediately began a search of the surrounding neighborhood, both on foot and by vehicle. At approximately 8:55PM police contacted the facility regarding R1 being located at the Wing Stop (on the corner of Bascom Ave and Camden Ave). R1 was returned to the facility on the same evening and was not injured during the elopement. During today's visit, LPA interviewed staff and 1 resident. LPA requested pertinent documentation to include but not limited to physicians reports, service plans, preplacement appraisals, and staff schedules. LPA determined this case management requires further investigation. No deficiencies were cited during today's visit per California Code of Regulations, Title 22. An exit interview was conducted with CD and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 4, 2025

Allegation investigated: Facility neglected resident in care. Facility staff did not provide resident with activities. Facility staff did not safeguard residents personal belongings. Facility staff are not meeting residents dietary needs.

Licensing Program (LPA) Marcella Tarin arrived unannounced to conduct an initial complaint investigation visit. LPA met with Community Director (CM) Michelle White. On 10/16/2025 the Department received a complaint with the above allegations. On 10/20/2025 LPA Tarin interviewed Reporting Party (RP). RP alleges the facility ‘seems to not care” for R1 and all facility staff were ‘fake.’ RP did not provide additional information regarding the above allegations. On 10/20/2025 LPA Tarin interviewed 3 Staff (S1 to S3) and 5 Residents (R1 to R5). 3 Out of 3 staff R1 is receiving care based on his/her care plan. Page 1 of 3 Unfounded 3 out of 3 staff state R1 is receiving palliative care and receives palliative care five 5 days a week. LPA interviewed 5 residents (R1 to R5). 4 Out of 5 residents did not provide information due to neurocognitive disorder. R5 states the staff are taking great care of him/her and has no issues with the care he/she is receiving. LPA reviewed R1’s physician’s report dated 6/1/2025, which states R1 has neurocognitive disorder and is receiving palliative care. LPA reviewed R1's care plan dated 8/7/2025, which states R1 is Max assist with bathing, dressing, grooming, dental, transfer and mobility, and cognitive. LPA reviewed R1's comprehensive palliative care plan dated 10/9/2025, which states R1 is receiving treatment from skilled nurses, palliative aides, and palliative volunteers since 10/11/2025. Facility staff did not provide resident with activities. On 10/20/2025 LPA Tarin interviewed 3 Staff (S1 to S3) and 5 Residents (R1 to R5). 3 Out of 3 staff R1 is being provided activities in his/her room due to ambulatory status. S3 states palliative care volunteers visit with R1 twice a month and provide R1 with activities such as music therapy and pet therapy. LPA interviewed 5 residents (R1 to R5). 4 Out of 5 residents did not provide information due to neurocognitive disorder. R5 states he/she participates in the facility activities, but did not recall the specific activities. LPA reviewed the facility's October 2025 activities calendar to included art activities such as art appreciation and physical movement activities. Facility staff did not safeguard residents personal belongings. On 10/20/2025 LPA Tarin interviewed 3 Staff (S1 to S3) and 5 Residents (R1 to R5). 3 Out of 3 staff R1 has not had of his/her personal belongings go missing. Page 2 of 3. LPA interviewed 5 residents (R1 to R5). 4 Out of 5 residents did not provide information due to neurocognitive disorder. R5 states he/she has not had any of his/her personal belongings go missing. LPA reviewed R1's safeguard for personal property and valuables, which was declined (no items listed) by R1 upon move-in on 9/8/2020. LPA reviewed incident reports for R1 and did not observe reports for missing personal belongings. Facility staff are not meeting residents dietary needs. On 10/20/2025 LPA Tarin interviewed 3 Staff (S1 to S3) and 5 Residents (R1 to R5). 3 Out of 3 staff R1 has a thin/liquids diet, which is provided to R1 by facility staff. S3 states R1 is on a thin/liquids diet as part of R1's care plan. LPA interviewed 5 residents (R1 to R5). 4 Out of 5 residents did not provide information due to neurocognitive disorder. R5 states he/she is provided 'healthy' meals by the facility and enjoys the food. LPA reviewed R1’s physician’s report dated 6/1/2025, which states R1 has a modified diet consisting of thin liquids, which is being provided by facility staff. LPA reviewed R1's service plan dated 8/7/2025, which states for 'Meals and Nutrition' R1 needs 'Max assistance' with a soft/thin liquids diet provided by facility staff daily. This agency has investigated the complaint alleging the facility neglected resident in care, facility staff did not provide resident with activities, facility staff did not safeguard residents personal belongings, facility staff are not meeting residents dietary needs. We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. An exit interview was conducted, and a copy of this report was provided. Page 3 of 3 END OF REPORT.the state’s words, verbatim · CDSS document, Oct 20, 2025 · control 26-AS-20251016085414

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with Designated Administrator (DA) Michelle White. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with DA to include but not limited to the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA observed video surveillance of the courtyard/entrance to the facility. LPA observed cameras in the hallways of the facility. DA states the cameras are non-operational. DA states the courtyard/entrance is the only area with video surveillance in the facility. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed refrigerator temperature at 36F and Freezer at -5F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. The smoke detectors were last inspected by a third party vendor on 3/14/2025 and passed inspection. Fire extinguishers were last serviced on 3/10/2025. Page 1 of 2 LPA reviewed the facility first aid kit, and it was observed to be complete. The facility emergency drill log was reviewed and drills are being conducted monthly. The facility's last drill was on 5/21/2025. LPA toured 10 random resident bedrooms. 10 Out of 10 resident rooms have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPA measured water temperature in 7 resident bathrooms with a range of 113.3 F to 119.6 F. LPA reviewed 4 resident records. Resident records included emergency contact information, physician’s report, needs and service plans, and personal rights. LPA reviewed 4 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 4 staff records. Staff records included fingerprint background clearance, medical assessment with TB result, personnel record, and staff training. No deficiencies were cited during today's visit per California Code of Regulations Title 22. An exit interview was conducted with Designated Administrator Michelle White and a signed copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 18, 2025

Allegation investigated: Facility neglected resident in care causing resident to sustain injuries

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced initial complaint investigation visit and met Staff Jimena Pulido. LPA stated the purpose of the visit. On 6/13/2025 the Department received a complaint alleging that the facility neglected a resident in care causing resident to sustain injuries. It is alleged the Resident R1 sustained injuries on 6/11/2025. On 6/19/2025 LPA Tarin reviewed an Incident Report (IR) submitted to the Department for R1 who had an unwitnessed fall on 6/3/2025. The IR states the facility called emergency services and R1 was transported to the hospital. The IR states R1 would be transferred to a Skilled Nursing Facility (SNF). Page 1 of 2 Unfounded LPA interviewed Staff S1. S1 states R1 was taken to the hospital on 6/3/2025 and is still at a SNF. Based on interview and documentation review, R1's injuries did not occur at the facility as R1 was taken to the hospital on 6/3/2025 and was then transferred to a SNF. As of 6/19/2025, R1 has not returned to the facility. This agency has investigated the complaint alleging that facility neglected resident in care causing resident to sustain injuries. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with Staff Jimena Pulido, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 19, 2025 · control 26-AS-20250613095152

Allegation investigated: Staff did not intervene in resident on resident altercation resulting in resident being pushed to ground by another resident

On 11/19/2024, the Department received a complaint allegation that facility staff did not intervene in resident-to-resident altercation resulting in resident being pushed to ground by another resident on 11/15/2024. On 11/22/2024 Licensing Program Analysts (LPAs) Marcella Tarin and Manuel Monter investigated the alleged complaint that occurred on 11/15/2025 wherein staff did not intervene when Resident (referred to as R1) R1 was pushed to the ground by another resident (referred to as R2). On November 22, 2024 and April 25, 2025, LPAs interviewed 15 staff, S1-S15 regarding the incident on 11/15/2024. 13 Out of 15 staff stated they did not observe the incident. Staff S1 and S11 stated they were in the dining area when the incident between R1 and R2 occurred. Page 1 of 3 Unsubstantiated S1 states he/she and a Private Caregiver (referred to as PC) were in the dining area. S1 was serving lunch to a resident. S1 states he/she observed R1 touch R2 on the arm and stomach. S1 states he/she then heard R2 tell R1 to not touch him/her. S1 stated when he/she saw/heard this, he/she walked towards both residents. S1 stated while he/she was walking towards R1 and R2, that is when R1 touched R2 again, and R2 pushed R1 causing R1 to fall to the ground. S1 stated this all happened in less than 10 seconds. During interviews both individuals were busy with clients when then heard R1 and R2 arguing. Staff S11 stated he/she had just clocked in the day of the incident. S11 stated he/she was in the staff lounge area walking towards the dining room. S11 stated as he/she entered the dining room, S11 stated he/she saw R2 make contact with his/her arm toward R1, and saw R1 fall. S11 described the hand motion as a swiping motion, in R1's direction. S11 stated he/she saw S1 walking in the direction of both R1 and R2. S11 stated S1 was in the middle of the dining area, when the incident occurred. Residents were in the dining area at approximately 2PM, S1 heard R1 and R2 talking and heard R2 state “Don’t touch me” to R1. According to staff, they heard R1 and R2 briefly exchange conversation. LPAs interviewed PC on 4/1/2025 and states he/she was in the middle of the dining room on 11/15/2024. PC states that he/she was taking care of his/her resident when he/she observed R1 push R2. PC states that S1 went over to assist R1 when R2 pushed R1 down to the ground. LPAs interviewed 6 residents, R1-R5. 3 Out of 6 residents stated they did not observe the incident between R1 and R2. 3 Out 6 residents did not respond to questions due to neurocognitive disorder. LPAs reviewed physician’s reports for R1 and R2. R1’s physician’s report dated 12/3/2024 with a primary diagnosis of neurocognitive disorder, associated with “confusion, and sundowning behavior.” On the other hand, R2’s physician’s report dated 3/15/2023 with a primary diagnosis of neurocognitive disorder, associated with a mental condition of ‘confusion, inappropriate behavior and aggressive behavior.’ Page 2 of 3 ’LPAs reviewed R1 and R2’s appraisal needs and care plans dated 12/11/2023 and 12/27/2023. R1 and R2 have similar behaviors of aggression due to his/her neurocognitive disorder wherein both residents require supervision by staff. LPAs obtained and reviewed staff daily notes for R1 from 11/19/2024-12/11/2024. R2 had a previous incident documented on 8/16/2024, where R2 had aggressive behavior involving foul language and being physically too close to another resident. The Department has completed the investigation of the above allegation. Based on interviews conducted and record reviews, the Department has found that the above allegation is UNSUBSTANTIATED. Although the allegation that resident R1 pushed R2 is true, there is not a preponderance of evidence to prove that the allegations did or did not occur. An exit interview was conducted with Activities Director Michelle White and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 25, 2025 · control 26-AS-20241119153013

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Manuel Monter and Marcella Tarin arrived unannounced to deliver the results of a complaint investigation. During the complaint investigation, a case management deficiencies visit was conducted due to violations discovered during the investigation process. LPA met with Community Director(CD), Michelle White While investigating the complaint 26-AS-20241119153013, LPAs obtained and reviewed staff daily notes for R2 had a previous incident documented on 8/16/2024, where R2 had aggressive behavior involving foul language and being physically too close to another resident CD stated its tough with R2. CD stated in instances where this happens, R2 is the resident who reacts. CD stated the facility tries to keep R2 with residents who wont bother him/her, which include residents who are more touchy. CD stated the facility also seats R1 when eating with residents who won't disturb him/her. CD stated he/she didn't add this information he/she told LPA during todays visit to R2's care plan. LPA reviewed R2’s Appraisal/Needs & Services (ANS) December 27, 2023. Based on a review, this ANS, it does not address R1's aggressive behaviors or how the facility will address this behavior that R2 exhibited. Based on a review of R2's Physicians December 27, 2023 with a primary diagnosis of neurocognitive disorder, associated with a mental condition of ‘confusion, inappropriate behavior and aggressive behavior. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Community Director, Michelle White and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Apr 25, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: May 2, 2025

87463 Reappraisals (a) The pre-admission appraisal,... shall be updated in writing as frequently as necessary ... to note significant changes in condition,... to keep the appraisal accurate. ... This requirement was not met as evidenced by; Based on records reviewed and interviews,CD stated the changes implemented to address R2’s agressive behaviors are not reflected on R2’s Needs and Services Plan. ADM acknowledged she did not update the care plan. 1 of 2.the state’s words, verbatim · CDSS document, Apr 25, 2025

Plan of correction: ADM stated she will send a letter of understanding regarding the regulation. ADM stated she will send an updated care plan for resident R2. ADM stated she will send the Plan of correction to LPA by POC date, May 2, 2025. (Continue) 2 Out of 2. This poses a potential health, safety or personal rights risk to persons in care.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Marcella Tarin and David Marrufo conducted an unannounced required 1 year visit and met with Administrator Garry Sneper. During visit LPAs toured the facility inside and out. LPAs toured the facility kitchen area. LPAs observed a perishable food supply of at least 2 days and a nonperishable food supply of 7 days. LPAs observed storage area with cleaning supplies and tools. The storage area was locked and inaccessible to residents. LPAs toured 1 hallway bathroom and measured the water temperature to be 114 degrees Fahrenheit. The bathroom had functioning lights and available soap and paper towels. LPAs toured 7 resident rooms. Each room had working lights, and available bedding and clothing storage areas. LPAs toured the bathrooms in each bedroom and found them to have working lights, available soap and paper towels. Water temperatures in the toured resident bathrooms ranged from 114 degrees Fahrenheit to 119 degrees Fahrenheit. LPAs tested the smoke detectors in each room, and observed the smoke detectors to be functioning properly. The smoke detectors also function as carbon monoxide detectors. LPAs tested 1 hallway carbon monoxide detector and it functioned properly. LPAs observed 2 resident exits to be clear of obstruction, and 1 out 1 tested alarmed exit tested properly when tested. LPAs reviewed 7 resident Centrally Stored Medication and Destruction Record (CSMDR). Each reviewed CSMDR was complete during visit. LPA's reviewed 7 resident records, R1-R7. Resident R2 and Resident R4 did not have Appraisal Needs and Service Plan. Resident R5 is missing the first page of the Safeguard for Property and Valuables form. LPAs reviewed 7 out of 7 staff records to be complete. The last conducted Fire Drill is recorded at 5/20/2024. Advisory notes were issued. See LIC 9102 pages for more information. No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Garry Sneper. A copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 20, 2024

Type of visit: Collateral

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Collateral visit and Met with the facility Medication Manger Jimena Pulido (MM). The purpose of the visit was to interview resident R1 and to collect R1's medical records as part of a complaint investigation of another licensed facility.. During the visit, LPA interviewed MM, resident R1, and 3 staff (S1 - S3). LPA toured the bedroom of R1 with MM. LPA requested R1's medical records and medical notes. No deficiencies cited today. The report was provided to MM for signature. A copy of the report was provided to MM.the state’s words, verbatim · CDSS document, Jun 14, 2024

Allegation investigated: Facility is restricting visitation.

On 2/8/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegation. LPA met with Administrator Garry Sneper & Office Manager Myra Belza. LPA explained the purpose of the visit. Regarding the allegation of facility is restricting visitation, reporting party (RP) mentioned that since the facility has been in a COVID outbreak, they have restricted visitation. RP also stated that they have been unable to visit resident for many days. During the investigation, LPA Heberle interviewed six responsible parties or family members. Five out of six mentioned that they were able to visit their loved once with no issue. One family member (F1) mentioned that visitation was not allowed but that message was a couple weeks or more ago. Administrator Garry Sneper also stated ever since the complaint on 01/11/2023, the facility has not restricted visitation in any capacity. He also stated that they had to take the exterior visitation tent down due to extreme winds, but that they still allowed all visitation indoors, including allowing family members of positive residents into the COVID positive wing of the facility. LPA Donato obtained visitation logs around this time, and it showed that family members are able to visit the facility provided they get their temperature checked and with the suggestion of wearing a mask. Based on interviews and record reviews, the department has determined that the allegation is UNFOUNDED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The report was reviewed, and a copy is provided. Unfoundedthe state’s words, verbatim · CDSS document, Feb 8, 2024 · control 26-AS-20230227092413

Allegation investigated: Facility A/C is in disrepair Staff are not providing a comfortable environment for residents Staff are restricting residents visitors from certain areas in the facility Staff are not providing activities for residents

On 2/8/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegations. LPA met with Administrator Garry Sneper & Office Manager Myra Belza. LPA explained the purpose of the visit. Regarding the allegation that facility A/C is in disrepair, reporting party (RP) reported that while visiting the facility on 4/27/2023 around lunch time, there was no air conditioning on. LPA interviewed a staff member (S1), and mentioned that the airconditioner did break down that day and a technician was called in to repair it. This was also confirmed by another staff S2, and stated that the technician came right away but that a part was needed to be ordered so the technician came back on Monday (05/01/2023) to finish the repair.There were fans provided for the residents to help with ventilation and alleviate the heat. The A/C that broke down is just on the dining area. Unfounded Regarding the allegation of staff are not providing a comfortable environment for residents, RP stated that there were residents eating lunch outside in the heat and there was no staff around. According to S2, residents don't have lunch outside unless there are activities. Residents can freely roam around the facility, whether just sit outside the patio or go around inside the facility. Facility has also enough staffing to be able to cater to the residents. Regarding the allegation of staff are restricting residents visitors from certain areas in the facility, RP stated that visitors are not allowed to go in the dining room or the living room. LPA confirmed with Administrator Garry Sneper that there hasn't been any restrictions since the facility was cited in January of 2023 for another complaint. The facility has been compliant with visitations. Facility only has suggestions and recommendations for family members when visiting the facility. For the allegation of staff are not providing activities for residents, RP stated that there were no activities happening. RP stated that the residents were sitting around doing nothing. RP stated that there was no TV or anything else happening. According to S2, the activity coordinator emails the staff for the activities to be done each month. The facility staff can't force the residents to join the activities if they are not up to it but they do certainly try to encourage residents. LPA also obtained the activities calendar during this month and it shows a full set of activities per day. LPA was able to interview a resident (R1) and stated that they like and enjoy the activities done in the facility. R1 also mentioned that sometimes they watch movies in the TV. LPA attempted to interview other residents but wasn't able to get answers due to cognitive issues. Based on interviews and record reviews, the department has determined that the allegations are UNFOUNDED, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The report was reviewed, and a copy is provided.the state’s words, verbatim · CDSS document, Feb 8, 2024 · control 26-AS-20230427151001

Type of visit: Case Management - Other

On 2/8/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced case management visit. LPA met with Administrator Garry Sneper & Office Manager Myra Belza. LPA explained the purpose of the visit. LPA is delivering 2 amended reports for the following complaints: 26-AS-20220225121016 26-AS-20220412110249 No deficiencies cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Feb 8, 2024

Allegation investigated: Resident not administered medication as prescribed.

This is an amended Report On 1/08/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegation. LPA met with Office Manager Myra Belza & Resident Services Director Blyth Obien. LPA explained the purpose of the visit. Regarding the allegation of resident not administered medication as prescribed, reporting party (RP) stated he/she believes the resident (R1) was overdosed on medication since 2021. R1 is prescribed multiple medications. RP is alleging that these medications are used to calm R1 down and restraint due to behavioral issues. cont.. 9099-C Unfounded Based on interviews by LPA Heberle, two staff members mentioned that there never was an issue of residents having mismanagement of medications. On staff member (S1) stated that the facility does not have any involvement in which medications residents are taking. The family can make request that the facility administer certain medications, but staff always makes sure the doctor okays and prescribes it first. The facility communicates with doctors if they believe the medication needs to be changed. LPA Heberle & LPA Donato was also able to interview residents and two out of five mentioned that they don’t have any issues with medications, and they are able to get it on time. Three residents were not able to respond to questions due to cognitive diagnosis.. LPA Donato was able to review records for R1, and according to the centrally stored medication, facility gave the medication according to doctors’ orders. Therefore, based on the interviews conducted, files reviewed, and information collected, the allegations mentioned are UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. The report was reviewed, and a copy is provided.the state’s words, verbatim · CDSS document, Jan 8, 2024 · control 26-AS-20220225121016

Allegation investigated: Staff yelled at client

This is an amended report. On 1/08/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegation. LPA met with Office Manager Myra Belza & Resident Services Director Blyth Obien. LPA explained the purpose of the visit. Regarding the allegation of staff yelled at client, reporting party (RP) observed a staff member who was helping resident drink water and take medication, the staff member yelled at the resident and making repeated accusations. LPA interviewed five out of five residents and everyone mentioned that they feel well taken care of here. A staff member (S1) who has been here since 2018 was also interviewed and stated that they don’t remember any incident of a staff yelling at a resident. Current staff have started working at the facility since 2023. Based on observation and interviews, the department has determined that the allegation is UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. The report was reviewed, and a copy is provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 8, 2024 · control 26-AS-20220412110249

Allegation investigated: Staff did not monitor residents interaction with each other.

On 12/5/23, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegation. LPA met with Office Manager Myra Belza. LPA explained the purpose of the visit. Regarding the allegation of Staff did not monitor residents’ interaction with each other, RP stated that On 10/20/2021 at 10 pm, RP saw three staff watching football game on TV while one resident was in the dining room (no staff supervising), and another resident down a hall. RP wondered if staff were too busy to ensure safety of residents. Based on interviews, both Resident Services Director (RSD) & Office Manager (OM) mentioned that around 10 pm is the change in shift between staff. The staff that were sitting and watching were already off and has turned over to the night shift. Therefore, based on the interviews conducted, files reviewed, and information collected, the allegations mentioned are UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Report is reviewed and a copy is provided. Unfoundedthe state’s words, verbatim · CDSS document, Dec 5, 2023 · control 26-AS-20211109171759

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Illegal Eviction Facility is restricting visitation Resident sustained unexplained injuries Staff did not report an incident to resident's representative

On 11/21/23, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegations. LPA met with Blyth Obien, Resident Services Director Myra Belza, Office Manager. LPA explained the purpose of the visit. Regarding the allegation of illegal eviction, the reporting party (RP) stated that Administrator (S1) gave the resident (R1) a 30-day notice. Based on interview with S1 and co-Administrator (S2), while there was a 30-day notice provided by the facility, R1 wasn’t evicted. Responsible parties, S1 & S2 reached an agreement that the resident will just be transferred since the facility is not able to cater to R1s higher level of care. Based on record reviews, it was stated in the 30-day notice the different incidents that have occurred and violated the facility’s house rules. Additionally, it was also noted that there is a need that wasn’t previously identified in the pre-appraisal that was conducted. It was indicated in the LIC 603 (Pre-Appraisal Form) that R1 doesn’t have any aggressive behaviors as reported by POA. Unfounded Regarding the allegation of facility restricting visitation, RP stated that visits were only 30 mins. Based on interviews, S1 stated that RP is allowed to visit every day. No visitor has been denied visitation in the facility. They have scheduled visitation during this time. Even if visitors don’t have a schedule around this time, the facility still lets them in. Family visits are always accommodated. Depending also on the residents, the facility requests that they delay visitation for up to a week to allow for assimilation. It is never mandatory; it is only a recommendation. LPA reviewed visitation logs and it showed that RP was able to sign in and temperature was checked upon entering the facility as well as other visitors visiting other residents. Based on records review, the facility was also following some COVID-19 protocols during this time. Visitation is allowed but Screening protocol is followed, scheduled visitation, well-fitting face mask are always required upon entry and within the facility. Limit the number of visitors on the facility premises at any one time to avoid having large groups congregate. Facility encourages short indoor visits and longer outdoor visits. Regarding the allegations resident’s sustained unexplained injuries and staff not reporting an incident to resident's representative. RP said the staff never reported a skin laceration to RP, RP stated that On 10/1/2021 staff reported to RP that R1 had a lemon size bruise on the outer arm. Based on record reviews, this incident happened around 9/27/21 where staff found a skin discoloration on R1’s right arm. This skin discoloration was observed by staff during routine checks done in the facility. There were no prior incidents that happened before this, so it is hard to determine how R1 sustained this skin discoloration. On the progress reports for R1, its was stated there that incidents were all reported to physician and responsible parties. These incidents were also reported to Licensing. Therefore, based on the interviews conducted, files reviewed, and information collected, the allegations mentioned are UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Report is reviewed and a copy is provided.the state’s words, verbatim · CDSS document, Nov 21, 2023 · control 26-AS-20211109171759