Park Terrace

Allegation investigated: Staff threatened resident.

Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of initiating the complaint investigation into the above allegation. LPA met with Executive Director (ED) Geno Koehler and explained the reason for the visit. During the course of the investigation, LPA interviewed one resident and two staff. LPA obtained the following documentation for review: Resident/Staff Rosters, Face Sheet, Physician's Reports, Care Plan, Emergency Medical Treatment, Podiatry Agreement, hospital records, and Home Health Documentation. The investigation is as follows: Regarding the allegation, Staff threatened resident, it is alleged Staff #1 (S1) threatened to evict Resident #1 (R1) due to not following rules. R1 is independent with the Activities of Daily Living (ADL) and only receives services via outside agency specialists in which R1 is marked at 10 points per care plan dated June 12, 2026. However, there are no charges to the care. R1 is able to self-administer and store own medications also verified per the doctor's order and Physician's Report (LIC602) dated May 16, 2025. Unsubstantiated R1 indicated that they are able to independently care for self and does not need staff to assist them. S1 indicated that R1 does not provide status updates after medical appointments, so S1 had a conversation with R1 two weeks ago explaining the responsibilities of a licensed facility and process of an eviction. S1 denied threatening to evict R1. Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Staff threatened resident is deemed UNSUBSTANTIATED. An exit interview was conducted with Executive Director Geno Koehler, and a copy of this report was provided at the end of the visit. LPA observed a first aid supply which consisted of bandages, pads, wound cleanser spray, and other supplies in the resident's room. Per medical progress notes dated June 5, 2026, R1 has had multiple off and on ulceration to the legs for the last 12 years. R1 confirmed being able to independently care for their own wound prior to moving into the facility and does not require assistance from facility staff. R1 confirmed seeing a medical provider weekly at an outpatient wound care clinic. Per current care plan, R1 does not receive any care. Two of two staff interviewed did not corroborate with the allegation of lack of care as R1 independently cares for self and chooses not to provide facility updates for their medical appointments. This agency has investigated the complaint and based on the observations made, interviews which were conducted and the records that were reviewed, the following allegation: Resident sustained ulcers due to lack of care and supervision is deemed UNFOUNDED. 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. We have therefore dismissed the complaint. An exit interview was conducted with Executive Director Geno Koehler, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 8, 2026 · control 22-AS-20260629102353

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Jessica Cho made an unannounced Case Management visit for the purpose of conducting a health and safety inspection after receiving an incident report pertaining to Resident #1 (R1). LPA met with Executive Director (ED) Geno Koehler and explained the reason for the visit. During the visit, LPA conducted a health and safety check. LPA observed the facility to be clean, sanitary, and in good repair. Facility maintains ample supply of perishables and non-perishable food as required per regulation including emergency food and water. The fire extinguishers were serviced on June 17, 2026. The elevator is in working condition. There are no health and safety concerns at this time. LPA obtained the resident/staff rosters, R1's medical records, and care tracking log for the past year. No deficiency is being cited. An exit interview was conducted with Executive Director Geno Koehler, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 8, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1 Year Inspection using the Care Inspection Tool. LPA was greeted and granted entry and met with Executive Director (ED) Geno Koehler. The Executive Director has a valid administrator's certificate expiring July 22, 2026. The facility is comprised of five buildings. The main building is a two story property housing Assisted Living (AL) residents. Buildings A-D are single story housing Memory Care (MC) residents. There are 172 residents in care of which 4 residents are receiving hospice care. Facility is operating within the conditions and limitations specified on the license. LPA toured the physical plant accompanied by ED Koehler, and the following was observed: LPA observed the facility to be clean, sanitary, and in good repair. Hallways were free of clutter. LPA inspected 4 units on the first floor of the main building, 4 units on the second floor of the main building, and 2 units in the memory care building, a total of 10 units and their bathrooms. The residents' units were appropriately furnished, beds and bedding supplies were in good condition, adequate lighting was provided, and sufficient storage space for each residents' personal belongings were observed. The units and bathrooms appeared clean and sanitary with the exception of large carpet stains observed in one of ten units which will be replaced per ED. Slip resistant mats were observed to be available in the bathrooms. The hot water temperature in the resident bathrooms were within range measuring between 106.3 to 117.6. All shared bathrooms had sufficient supply of soap, toilet paper, and paper towels. The hot water temperature in the shared bathroom of the main building located by the kitchen measured at 139.1 exceeding the required range. LPA tested the carbon monoxide detector panel in each level which were operable. LPA observed ample two-day supply of perishables and seven-day supply of non-perishable food. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction, and there is sufficient seating and shading. The exit gates and swimming pool are secured for the safety of the residents. LPA reviewed the Emergency Disaster Plan (LIC610E). Facility maintains a working generator, food supply, and 3 large containers that holds 1700 gallon of water. The fire extinguishers are mounted, charged, and serviced on June 24, 2025. LPA observed facility receives quarterly smoke detector testing which was held on October 27, 2025. Facility staff are receiving quarterly disaster training which was last held on May 21, 2026. LPA observed medications are centrally stored in the medication carts which are stored in the medication room. Toxins, chemicals, cleaning solutions are stored in a locked closet. There are no health and safety hazards observed at the time of inspection. The Complaint Poster (PUB 475) did not meet the required size of 20"x26." LPA conducted a review of ten residents' and five staff files. No discrepancies were noted. The ED was reminded of the importance of ensuring that the hot water temperature is within range as required per the Title 22 regulation and to post the Complaint Poster which meets the 20"x26" size requirement. Based on the observations made, no deficiencies are being cited. Advisory Notes (LIC9102s) are being issued during the visit. An exit interview was conducted with Executive Director Geno Koehler, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jun 16, 2026

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Ruth Martinez to follow up on an incident reported to Community Care Licensing. LPA met with Geno Koehler, Executive Director and Autumn Conquest, Assistant Executive Director and explained the purpose of today’s visit. Incident was self-reported on April 09, 2026, regarding resident (R1’s) incidents on April 07, 2026. Staff indicated that R1 is an independent resident at the facility. On April 07, 2026, at 4:21pm R1 was observed to be having a difficult time walking in the hallway by staff. R1 complained of pain and unable to continue walking. R1 was assisted to a chair and staff immediately called paramedics. R1 was sent out to the hospital for evaluation and staff learned at a later time that R1 had injury to their left hip and under went surgery. R1 was sent to a skilled nursing for recovery once they were discharged from the hospital. R1 is currently at a skilled nursing facility until further notice. Staff upon review of the common space cameras in the hallway noted that R1 was seen walking in the hallways and turned the corner where there is a blind spot from the camera and it looks as though R1 tripped and fell to the ground. Staff was unable to determine the cause of the fall and R1 had very little information to give of the cause. R1 does not require any assisted devices for ambulating in the facility. R1 was last assessed for any changes on October 29, 2025 and does not reflect to be a fall risk or needing assisted devices for ambulating. Care plan dated October 29, 2025 does not reflect R1 to need ambulation assistance or additional services. R1's physicians report reflects that R1 is independent and does not require any assisted devices or have a motor impairment. R1's assessments Continued on LIC809-C do not reflect that R1 is a fall risk. Facility will reassess R1 upon return the facility for any changes in condition and to determine if R1 requires additional care services. LPA found that facility acted appropriately and in a timely manner to address the incident. LPA did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative, and a copy of the report was furnished to the facility.the state’s words, verbatim · CDSS document, Apr 21, 2026

Allegation investigated: Staff do not answer residents calls for assistance timely.

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegations. Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted, and copies of pertinent records. It is alleged that staff do not answer residents’ calls for assistance timely, specifically to for resident (R1) and resident (R2) for dates if September 10, 2025, and October 23, 2025. LPA Martinez conducted a tour of the physical plant of the facility on December 11, 2025, and tested various pull cord throughout the facility. The response time from care staff was 2 minutes at all pull cord testing. Interview with staff stated that with Continued on LIC809-C Unsubstantiated the two dates in question for September 10, 2025, and R1 the pull cord was pulled on and off several times and when staff went to check on resident staff was informed the cord was pulled and then turned off by person pulling the alarm. Since the alert showed multiple times, staff went in to check on residents regardless of if the alarm was cleared. For October 23, 2025, the staff received an alert and R2 waited minutes and when staff arrived at the apartment 911 had already been called by a family member. Review of records device activity report for R1 & R2 apartment reflect that on September 10, 2025, the cord was pulled four times as follows: 4:14.58 AM pulled cleared 4:15:20Am duration of 22 seconds and 4:31:22 AM pulled cleared 4:31:36 AM. October 23, 2025, the cord was pulled at 7:08:06PM cleared 7:19:19PM duration of 11 minutes and 13 seconds. Interview with 5 of 5 residents stated that when they press their pendent or pull the cord the staff always respond within a reasonable time, and they don’t wait to long for assistance. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with the facility representative and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Mar 10, 2026 · control 22-AS-20251203102018

Type of visit: Case Management - Incident

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit to follow up on an incident reported to Community Care Licensing. LPA met with Autumn Conquest, Assistant Executive Director and explained the purpose of today’s visit. Incident was self-reported on November 18, 2025, regarding resident (R1’s) incidents on November 16, 2025. R1 resides in the memory care unit. On November 16, 2025, at 5:20am staff heard crying coming from R1's bedroom. Staff went in to check on R1 and R1 was found on the floor of their bedroom. Staff noted that R1 had a bump and laceration on their forehead. R1 was complaining of pain to their left arm. Staff immediately called 911 and R1 was sent out to the hospital for further evaluation. Staff notified R1’s primary care physician and R1’s responsible party. Since R1 is in the memory care unit they do not have a pendant, the memory care unit is set up of four cottages with 10 private bedrooms with 10 residents per cottage. Each cottage has one staff for NOC shift and does continuous rounds to check in on residents. The cottages are small premises where staff can hear any resident clearly. Records reflect that R1 walks on their own when in the cottage but require assistance when going on walks in the courtyard or on a community outing. R1 is not a fall risk and the last fall incident was back in February of 2025. R1 returned the same day back to the facility with instruction to follow up with an orthopedic specialist. R1's responsible party is handling follow up appointments. LPA found that facility acted appropriately and in a timely manner to address the incident. LPA did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative, and a copy of the report was furnished to the facility.the state’s words, verbatim · CDSS document, Nov 24, 2025

Allegation investigated: -Facility staff is refusing to give medication to resident.; -Facility staff is not following doctors orders.

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to initiate an investigation into the above identified complaint allegations. LPA arrived at the facility and was greeted by the receptionist and granted entry. LPA spoke with Gene Koehler, Executive Director, and explained the purpose of the visit. During the course of the investigation, interviews were conducted, a tour of the physical plant of the facility was conducted, a review of resident records was completed and obtained copies of pertinent documents obtained. It is alleged facility staff is refusing to give medication to a resident, specifically to Seroquel and Ativan. Interview with 3 of 3 staff stated that resident (R1) had a change in medication earlier this month to their Cotinued on LIC9099-C Unsubstantiated medication of ABHR, and Seroquel, but R1 never received a physician’s order for Ativan. Record review revealed that prescription for ABHR gel went from a PRN medication to a routine medication. Prescription for Seroquel went from bedtime to twice a day. Comfort hospice records show that updated physicians’ orders were received on July 4, 7th and 23, 2025 for ABHR and Seroquel only and there was no Ativan registered to the order. MAR sheets for July for R1 reflect that all medication prescribed to R1 has been administered and no discrepancies were observed in the logs. It is alleged that facility staff are not allowing doctors orders. Interviews with 2 of 2 staff stated that R1 had been having more episodes of agitation than usual. Staff reached out to hospice to have prescription of agitation to be changed from PRN to routine medication while primary doctor was on vacation. Staff stated that it was the only medication that was requested to be modified. Record review revealed that hospice documentation from Comfort Hospice visiting professional dated July 7, 2025, reflects that they received a request for ABHR to be made to a routine medication. The physicians order received from Comfort Hospice Inc. on July 7, 2025, stated ABHR gel to be applied four times daily routine and was no longer a PRN medication. Physicians’ orders for July 4th and 23rd, 2025 reflect update to medication dosage and MAR sheets for July reflect the changes to medication and given as prescribed. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.the state’s words, verbatim · CDSS document, Jul 29, 2025 · control 22-AS-20250725150055

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by receptionist. LPA met with Autumn Conquest, Assistant Executive Director and Ito Chong, Assisted Living Director and explained the nature of the visit. Facility is licensed for 230 non-ambulatory residents, approved for secured perimeters, and delayed egress. Facility has an approved hospice waiver for 20 residents. The facilities current census is 172 residents. There are 10 residents on hospice during today's visit. This facility consists of two main areas. The assisted living and the memory care unit which are protected by delayed egress exits. LPA Martinez along with staff toured the physical plant of both the assisted living and the memory care unit. LPA observed a bistro adjacent to the main dining room where residents can obtain different snacks and beverages selections than in the main dining area. The bistro offers snacks all day so residents may dine when convenient. LPA observed menus for both areas and the food offered is varied and healthful. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Maintenance records were observed in the main kitchen. Facility has two food vendors that deliver food supplies. One of the vendors delivers once a week, where as the other vendor delivers twice a week. During the tour LPA observed residents involved in an activity as well as a posted activity schedule including games, exercise, and outings at the facility. LPA inspected that medication is centrally stored in a safe locked location; facility has a medication room and use medication carts to distribute medication to residents. LPA observed and inspected medication carts that are used to dispense meds to residents and observed Continued on LIC809-C medication was labeled and stored inaccessible to residents in care. Ten resident bedrooms were inspected in combination of assisted living and memory care unit and observed to have the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Resident bathrooms were inspected tested for water temperature and water temperature measured between 115.9 to 117.5 degrees F in tested bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Call buttons were observed in each resident apartments and when pulled a signal is sent to caregivers pagers and front receptionist as backup and accuracy for answering the call. LPA tested the pull cord system and observed it to be working properly. LPA observed several residents who appeared clean, and happy. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in a locked storage closet. LPA toured the memory care unit and observed a kitchen/ dining room as well as posted activity schedule for memory care residents. LPA observed residents in the memory care unit with care staff present. LPA observed the delayed egress exits and observed for proper functioning. LPA observed smoke/carbon monoxide detectors and sprinkler system. Fire extinguishers are fully charged and were observed to be mounted on the wall throughout the facility. Smoke detectors, sprinkler system, and fire extinguishers are tested yearly by an outside agency, and LPA verified last testing was done January 10, 2025 for the sprinkles and February 7, 2025 for the smoke/carbon monoxide detectors. Emergency drills are being conducted quarterly, LPA verified facility has a fire drill log. Outside grounds have ample shaded seating for residents in both assisted living and memory care unit. LPA observed a swimming pool in the outside perimeters of the assisted living side with a fence around it. LPA observed the pool gate that has a self-latching entry door which opens away from the pool. The fence has a key lock at the gate door for inaccessibility. LPA measured the pool fence which measured 5ft 10in from base of the floor to the top of the fence and it was observed to enclose the entire pool area. LPA reviewed 10 resident files and five staff files. All resident files contained required documentation including updated physician reports and care plans. Staff files contained required documentation including health screens, first aid, and fingerprint clearance. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the facility representatives and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 16, 2025

Allegation investigated: Staff gave resident another resident's medication Staff did not involve resident in the care plan

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to deliver findings related to the investigation of the complaint allegations identified above. Upon arrival, LPA was greeted by facility staff and granted entry. LPA met with Autumn Conquest, Assistant Executive Director and explained the purpose of the visit. The findings are based on an investigation that included a review of the resident’s file, a physical plant tour of the facility, and interviews with relevant staff and residents. The complaint alleged that staff gave resident another resident’s medication. Interview with staff 1 (S1) stated that Resident 1 (R1) had been given resident 2 (R2) medication on April 05, 2025, and notified the Continued on LIC9099-C Substantiated department on April 06, 2025, of the medication error. Record review reflects that R1 was given R2’s medication the night of April 5, 2025, and R1 had no adverse reaction to the medication. The complaint alleged that staff did not involve resident in the care plan. Review of resident’s records revealed that R1 move in the facility on September 22, 2024. A care plan dated September 24, 2024, reflect on page 3 document to be signed only by the community, residents and/or family/responsible party/POA is missing. Care plan dated October 28, 2024, reflect on page 3 no signature from any parties. Records for care plan reflect a care plan with no effective date but signature page reflects September 21, 2024, with an electronic signature for both community and resident. Interview with R1 stated that they did not attend any of the care plan meetings and have not signed any documents because of this. Based on the information gathered the preponderance of evidence standard has been met, therefore, the allegations, facility gave resident wrong medication and resident was not involved with care plan are found to be SUBSTANTIATED. Based on this inspection, deficiencies were observed at this time in the areas evaluated per Title 22 Division 6 Chapter 8 of the California Code of Regulations. See LIC9099-D for deficiencies. This report was reviewed with facility representative and a copy of this LIC9099, LIC9099-D report was provided and left at facility. Appeal rights reviewed, and a copy provided. states able to leave community unassisted is marked no and furthermore stated patient cannot leave unassisted due to MCI. Physician’s report dated October 9, 2024, page 3 number 14m states able to leave community unassisted is marked no. Interview with 2 of 2 staff stated that R1 did not have a change of condition upon admissions to the facility R1’s physician’s report stated R1 could not leave the facility unassisted and R1 did not agree with the information that was provided. Staff stated they have not observed any incidents that would indicate that R1 has had a change of condition. Based on the information gathered during the investigation, interviews and review of all documents obtained, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. This report was reviewed with facility representative and a copy was furnished to the facility.the state’s words, verbatim · CDSS document, May 19, 2025 · control 22-AS-20250410123109

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 2, 2025

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(4) The licensee shall assist resident with self-administered medications as needed. This requirement was not met as evidenced by: Based on interview and documents, the licensee did not ensure R1 received assistance with self-administered medications due to a medication error, which posed a potential health risk to persons in care.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Executive Director will provide additional training to all Medication Technicians and submit proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87467(a) · Plan of correction due date: Jun 2, 2025

(a) Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility. This requirement was not met as evidenced by: Based on interview and documents, the licensee does not have a signed care plan by resident.the state’s words, verbatim · CDSS document, May 19, 2025

Plan of correction: Executive Director will complete the residents care plan with resident and/or resident's responsible party's input and approval, completed and signed. Executive Director will send a signed copy of the care plan and written plan to LPA in the event residents refuse to sign by POC date.

Allegation investigated: Facility physically abused resident.

Licensing Program Analysts (LPAs) Ruth Martinez and Hanna Gough conducted an unannounced visit to the facility to deliver findings related to the investigation of the complaint allegation identified above. Upon arrival, LPAs were greeted by facility staff and granted entry. LPAs met with Geno Koehler, Executive Director, and explained the purpose of the visit. The findings are based on an investigation that included a review of the resident’s file, a physical plant tour of the facility, and interviews with relevant staff and residents. The complaint alleged that Resident 1 (R1) had unexplained bruising and had experienced a fall. Resident file review revealed the following: Care plans dated February 16, 2024, and March 18, 2024, indicate that R1 Continued on LIC9099-C Unsubstantiated uses a walker for mobility and a wheelchair for longer distances. Transfers are generally minimal and staff may assist as needed. R1 requires staff supervision and occasional assistance during mobility, and there is no known or reported history of falls. Staff are instructed to observe and report any changes in gait or balance. A care plan dated September 20, 2024, notes that R1 requires mobility escort to and from meals and common areas, minimal assistance for transfers, and supervision to ensure safety. Safety checks are conducted four times per night during the NOC shift. Again, no history of falls was reported at that time. A resident assessment dated February 7, 2024, indicates that R1 uses a pendant call system, requires wheelchair escorts, and uses a walker. It also notes that R1 had a fall approximately 1.5 years ago while attempting to dispose of recycling. Staff interviews (3 of 3) revealed that staff became aware of the recent fall after observing bruising on R1. R1 reportedly stated they had fallen but could not recall specific details. Resident interview confirmed that R1 fell while attempting to get up from a recliner and lost balance. R1 also stated they did not report the fall to staff at the time. Based on the information gathered during the investigation, interviews and review of all documents obtained, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. This report was reviewed with Executive Director and a copy was furnished to the facility.the state’s words, verbatim · CDSS document, Apr 30, 2025 · control 22-AS-20250114115805

Type of visit: Case Management - Incident

This unannounced case management visit is being conducted by Licensing Program Analysts (LPAs) Ruth Martinez and Hanna Gough to follow up on an incident reported to Community Care Licensing. LPAs arrived at facility was greeted by receptionist and granted entry. LPAs met with facility representative and explained the purpose of today’s visit. Incidents were self-reported on January 27, 2025, regarding resident (R1’s) incidents on January 22, 2025. During today’s visit, LPA Martinez interviewed staff, completed resident file review, and obtained copies of pertinent documents. On January 22, 2025, R1 was in their apartment sweeping their kitchen when they lost their balance and fell. R1 was an independent resident and did not get any assistance while at the facility. Since R1 was an independent resident, they do not require to have a pendent unless they choose to have one. R1’s daughter was at the community and decided to take the resident to the hospital. Upon stay at the hospital it was determined that R1 now needed assistance and decided to move out R1 to a smaller board and care facility and notified facility that resident was moving out and not returning to the facility. LPAs found that facility acted appropriately and in a timely manner to address the incident and all other immediate attention to injuries in question. LPAs did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative, and a copy of the report was furnished to the facility.the state’s words, verbatim · CDSS document, Feb 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by receptionist. LPA met with Geno Kohler, Executive Director and explained the nature of the visit. Facility is licensed for 230 non-ambulatory residents, approved for secured perimeters, and delayed egress. Facility has an approved hospice waiver for 20 residents. The facilities current census is 168 residents. There are 15 residents on hospice during today's visit. This facility consists of two main areas. The assisted living and the memory care unit which are protected by delayed egress exits. LPA Martinez along with Executive Director toured the physical plant of both the assisted living and the memory care unit. LPA observed a bistro adjacent to the main dining room where residents can obtain different snacks and beverages selections than in the main dining area. The bistro offers snacks all day so residents may dine when convenient. LPA observed menus for both areas and the food offered is varied and healthful. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Maintenance records were observed in the main kitchen. During the tour LPA observed residents involved in an activity as well as a posted activity schedule including games, exercise, and outings at the facility. LPA inspected that medication is centrally stored in a safe locked location; facility has a medication room. LPA observed and inspected medication carts that are used to dispense meds to residents and observed medication was labeled and stored inaccessible to residents in care. Eight resident bedrooms were inspected and observed to have the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Resident bathrooms were inspected tested for water temperature and water temperature measured between 117.6 degrees F in tested bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Call buttons were observed in each resident apartments and when pulled a signal is sent to caregivers pagers and front receptionist as backup and accuracy for answering the call. LPA observed several residents who appeared clean, and happy. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in a locked storage closet. LPA toured the memory care unit and observed a kitchen/ dining room as well as posted activity schedule for memory care residents. LPA observed residents in the memory care unit with care staff present. LPA observed the delayed egress exits and observed for proper functioning. LPA observed smoke/carbon monoxide detectors and sprinkler system. Fire extinguishers are fully charged and had a service date of June 10, 2024. Smoke detectors, sprinkler system, and fire extinguishers are tested yearly by an outside agency, and LPA verified last testing was done June 10, 2024. Emergency drills are being conducted quarterly. Outside grounds have ample shaded seating for residents in both assisted living and memory care unit. LPA observed a swimming pool in the outside perimeters of the assisted living side with a fence around it. LPA observed the pool gate has a self-latching entry door which opens away from the pool. The fence has a key lock at the gate door for inaccessibility. LPA measured the pool fence which measured 5ft 10in from base of the floor to the top of the fence and it was observed to enclose the entire pool area. LPA reviewed 10 resident files and four staff files. All resident files contained required documentation including updated physician reports and care plans. Staff files contained required documentation including health screens, first aid, and fingerprint clearance. LPA as a reminder provided annual fee dues information. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Executive Director and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jun 12, 2024

Allegation investigated: -Residents need a higher level of care

Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegation. LPA arrived at the facility and was greeted by front office staff and granted entry. LPA spoke with Ito Chong, Assisted Living Director and explained the purpose of the visit. Based on the information obtained during this investigation the department has concluded the investigation into the above mentioned allegation. Findings are based upon this investigation which include interviews conducted, tour of physical plant of facility and copy of pertinent documents obtained. It is alleged residents need a higher level of care. Interviews with 2 of 2 staff revealed that there are no concerns for any resident in care that may need a higher level of care. The facility indicated that there have been residents that have been reassessed and there was no indication that those residents needed a higher level of care. Residents were reassessed due to caregivers indicating a concern that they may need a higher level of care. Interviews Continued on LIC9099-C Unsubstantiated conducted with 2 of 4 residents in care revealed that they felt that they get the care they need, they always have a two caregiver assistance, they get the physical therapy that is needed, and they get assistance when requested. Residents indicated that they had no concerns with their care and felt they were getting the care that they needed. Records review indicated that resident (R1) care plan 1 person assists with showers, 2 persons assist with transfers and is on level 4 care plan. Resident (R2) care plan indicates they need med assistance, escorting, 4 safety checks per shift and is on level 4 care plan. Resident (R3) care plan indicates that resident requires 1 person assist, escort resident as needed, 2 persons transfer assist and is on level 4 care plan. Resident (R4) log indicates that they get repositions every 2 hours, 2 persons assist transfer and is a care plan level 3. There were no indications that residents required a higher level of care or care that the facility could not provide. Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with facility representative and a copy of this LIC9099 report was left at the facility.the state’s words, verbatim · CDSS document, Dec 27, 2023 · control 22-AS-20210915083957