Park View Estates

Allegation investigated: Lack of supervision resulted in resident sustaining an unwitnessed fall

On 07/28/2026, Licensing Program Analyst (LPA) Mikkelson contacted the licensee via email to deliver final findings regarding a complaint that was received on 10/24/2023. **Continued on 9099-C page Unsubstantiated Lack of supervision resulted in resident sustaining an unwitnessed fall Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Based on interviews conducted and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.the state’s words, verbatim · CDSS document, Jul 28, 2026 · control 22-AS-20231024170525

Allegation investigated: Staff do not ensure residents medications are being properly managed.

On June 4,2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a subsequent complaint investigation visit into the above allegation. LPA announced self and stated the purpose of the visit to staff. LPA met with Executive Director (ED) Peggy Ulland and delivered findings. During the visit, LPA reviewed Resident/staff roster, staff contacts, staff schedule, staff schedule, Physician’s Report. The following documents were obtained for Resident R1: Face Sheet, Physician’s report, Pre-appraisal, Needs and Service Plan, Progress Notes, Admissions Agreement, Bathing Schedule logs, Medication Administration Records, and Pendant/Call Logs, Hospital Records, Home Health Records, Doctor’s orders, and Pharmacy Records. CONTINUE TO LIC9099-C.... Substantiated Regarding the allegation, Staff do not ensure residents medications are being properly managed, it was alleged that facility staff did not administer medication as prescribed. Based on record review, Yorba Linda Pharmacy received an order for R1 on September 17, 2025 from Dr. Muhammad. The order for Levofloxacin was filled and delivered to the facility on September 19, 2025. According to facility staff, when a medication is delivered to the facility and pending, it is physically placed with the Centrally Stored Medication. Prior to administration, a nurse reviews and approves the medication, and places it in the medication cart. When approved, the medication populates on the MARs and Med Techs are able to begin administering the medication to the resident. Facility progress notes indicate that on September 19, 2025 at 21:25, the medication was administered to R1 “at 9pm per Wellness Nurse”, however this is not reflected on the Medication Administration Records (MARs). On September 20, 2025 at 10:03, a progress note states the medication is not available. On September 21, September 23, and September 27, 2025, progress notes state the medication is not located in the med cart and staff will follow up with the pharmacy. Per the MAR, on September 21 and September 23, 2025, the medication was administered to R1 and signed by Med Techs. These errors were not reported to the Department as of June 4, 2026. Based on record review and observations made during the investigation, the preponderance of evidence standard has been met for allegation: Staff do not ensure residents medications are being properly managed is deemed SUBSTANTIATED. An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report, LIC9099D, LIC811, and appeal rights were provided at the end of the visit. LPA attempted to interview R1, however the resident no longer resides at the facility. Seven out of nine residents interviewed reported having no issues with receiving the services they are being charged for, with four of those residents adding they get all the shower assistance they need, as scheduled. A review of R1’s service plan dated September 10, 2025, indicates R1 needed assistance with showers, which were scheduled for three days per week. LPA reviewed the facility’s shower logs from that period which confirm R1 refused showers at least six days during the three months they resided at the facility. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above 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, the allegation is deemed Unsubstantiated. An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report provided at the end of the visit.the state’s words, verbatim · CDSS document, Jun 4, 2026 · control 22-AS-20250929104833

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(c)(2) · Plan of correction due date: Jun 11, 2026

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident ... provided all ... requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on observation, interviews, and record review, the facility did not administer medication to R1 as prescribed, which poses a potential Health, Safety, and Personal Rights risk to persons in care. Records reviewed indicate that the medication was administered to R1 on 9/21 & 9/23/2025, however progress notes state the medication was not available in the cart from 9/19-9/27/2025.the state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: The facility will retrain all medication staff on the section cited above and submit proof of attendees to CCLD via email by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Jun 11, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events... This requirement was not met as evidenced by: Based on observation, interviews, and record review, the facility did not administer medication to R1 as prescribed, which poses a potential Health, Safety, and Personal Rights risk to persons in care. Records reviewed corroborated that R1's medication errors were not reported within the required time frame.the state’s words, verbatim · CDSS document, Jun 4, 2026

Plan of correction: Administrator stated that they will submit an incident report regarding R1's medication errors to the Department by COB on 6/8/2026. The facility will retrain all staff on the section cited above and submit proof of attendees to CCLD via email by POC due date.

Allegation investigated: Staff allowed resident to be left in soiled clothing for extended periods of time Staff does not ensure call system is answered in a timely manner Staff do not ensure residents are spoken to in an appropriate manner Staff did not ensure a new care plan was provided to residents responsible party Staff relocated resident to higher level of care without authorization from residents responsible party

On 06/02/2026, Licensing Program Analyst (LPA) contacted the licensee via email to deliver final findings regarding a complaint that was received on 05/01/2024. **Continued report on 9099-C page Unsubstantiated Staff allowed resident to be left in soiled clothing for extended periods of time Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff does not ensure call system is answered in a timely manner Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff do not ensure residents are spoken to in an appropriate manner Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff did not ensure a new care plan was provided to residents responsible party Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff relocated resident to higher level of care without authorization from residents responsible party Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.the state’s words, verbatim · CDSS document, Jun 2, 2026 · control 22-AS-20240501091507

Allegation investigated: Staff did not observe resident for change in condition

On 06/02/2026, Licensing Program Analyst (LPA) contacted the licensee via email to deliver final findings regarding a complaint that was received on 12/23/2024. Staff did not observe resident for change in condition Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 2, 2026 · control 22-AS-20241223115217

Allegation investigated: Staff are verbally abusing residents 10.Licensee did not ensure staff trainings are up to date Uncleared staff providing care to residents Unqualified staff providing care to residents Unlawful evictions Staff did not ensure facility files are accurate Staff did not ensure resident's room was free of odor Staff are not providing adequate food service to residents Staff are not properly cleaning resident's rooms Staff are not providing activities for residents

On 06/02/2026, Licensing Program Analyst (LPA) contacted the licensee via email to deliver final findings regarding a complaint that was received on 04/11/2024. ***continued on 9099-C page Unsubstantiated Staff are verbally abusing residents Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Uncleared staff providing care to residents Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Unqualified staff providing care to residents Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Unlawful evictions Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff did not ensure facility files are accurate Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff did not ensure resident's room was free of odor Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff are not providing adequate food service to residents Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff are not properly cleaning resident's rooms Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff are not providing activities for residents Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. **Continued on 9099-C2 page Licensee did not ensure staff trainings are up to date Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.the state’s words, verbatim · CDSS document, Jun 2, 2026 · control 22-AS-20240411095716

Allegation investigated: Staff did not provide medical attention to resident in a timely manner.

On 06/02/2026, Licensing Program Analyst (LPA) contacted the licensee via email to deliver final findings regarding a complaint that was received on 08/07/2023. Staff did not provide medical attention to resident in a timely manner. Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 2, 2026 · control 22-AS-20230807095252

Allegation investigated: Resident sustained pressure injuries due to lack of staff supervision.

On 06/02/2026, Licensing Program Analyst (LPA) contacted the licensee via email to deliver final findings regarding a complaint that was received on 03/06/2023. Resident sustained pressure injuries due to lack of staff supervision. Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 2, 2026 · control 22-AS-20230306161347

Allegation investigated: Residents sustained injuries while in care Due to lack of supervision resident sustained multiple falls Staff left resident unattended Staff failed to provide appropriate transportation Staff failed to safeguard resident's personal belongings Staff failed to provide resident's authorized representative with an incident report

On 06/02/2026, Licensing Program Analyst (LPA) contacted the licensee via email to deliver final findings regarding a complaint that was received on 04/26/2022. ***Report continued on 9099-C page Unsubstantiated Residents sustained injuries while in care Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Due to lack of supervision resident sustained multiple falls Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff left resident unattended Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff failed to provide appropriate transportation Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated.. Staff failed to safeguard resident's personal belongings Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated. Staff failed to provide resident's authorized representative with an incident report Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated.. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.the state’s words, verbatim · CDSS document, Jun 2, 2026 · control 22-AS-20220426104412

Type of visit: POC

This unannounced POC inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of verifying correction of deficiencies issued during the complaint inspection conducted on October 13, 2026. LPA met with Administrator (AD) Peggy Ulland and discussed the purpose of the inspection. During the inspection, LPA and AD toured the facility and observed the following: Type A Violation cited under California Code of Regulations (CCR) Title 22, Section 87303(i)(1)(A) pertaining to memory care rooms not having a call system has been cleared. The citation was issued on December 30, 2025. On January 21, 2026, AD confirmed a call system had been installed in the memory care rooms and common areas and followed up with a photograph of one of the call buttons. During today’s inspection, LPA and AD inspected the memory care, confirmed the memory care rooms have a call system, and tested the system. There were no deficiencies observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, May 18, 2026

Type of visit: Case Management - Deficiencies

This unannounced Case Management – Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of issuing citations for deficiencies observed during the investigation unrelated to Complaint Control No. 22-AS-20250919161621. LPA met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection. During the course of the investigation, LPA inspected the facility, conducted interviews, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Home Health Plan of Care, Resident #2’s (R2) Medical Records, R2’s Hospice Order, and R2’s Facility Health Care Visit Reports. Per the facility’s wellness director, R1 had a suprapubic catheter placed while they resided in the facility and R1’s family moved them out of the facility for a higher level of care approximately three weeks later. R1 had multiple falls which were not related to the care of the suprapubic catheter, caregivers emptied R1’s catheter bag, and R1 voluntarily moved out. The facility did not have R1’s home health records, did not communicate with R1’s doctor or home health regarding R1’s catheter care needs, and had no information on what R1’s catheter care needs were and whether they were met. LPA obtained R1’s Home Health Plan of Care from the family which documents R1’s catheter care needs, but the facility was unable to show that these needs were met at the facility before R1 moved out. Per AD and the facility’s wellness director, R2, a current resident on hospice, also has a suprapubic catheter, but the facility does not have R2’s home health or hospice records. R2’s Medical Records and R2’s Hospice Order do not identify R2’s catheter care needs. R2’s Facility Health Care Visit Reports document that R2 received two and sometimes three visits a week from home health and later hospice, catheter care was provided during many of these visits, and no concerns were noted with the care R2 was receiving for their catheter. However, the facility was unable to provide information or documentation of what R2’s catheter care needs were or whether they were met. On October 13, 2025, LPA requested the facility’s plan of operation from AD, AD was unable to locate it at the facility, and AD did not provide the plan of operation to LPA until October 29, 2025, after obtaining it from an off-site location. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, May 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87609(a)(4) · Plan of correction due date: Jun 8, 2026

87609 … Home Health Agencies ... (b) … (4) The licensee and home health agency agree in writing on the responsibilities … in caring for the resident’s medical condition(s). This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not maintain home health agency agreements for R1 and R2 resulting in the facility not being able to confirm whether their suprapubic catheter needs were being met by home health, which poses a potential health risk to persons in care.the state’s words, verbatim · CDSS document, May 18, 2026

Plan of correction: Licensee stated they will submit a protocol to LPA by POC due date for ensuring they have all required home health documentation for residents on home health.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87613(a)(1) · Plan of correction due date: Jun 8, 2026

87613 …Restricted Health Condition (a) … the licensee shall: (1) Communicate with all other persons who provide care to that resident …. This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not communicate with R1’s doctor and home health regarding R1’s suprapubic catheter care needs resulting in R1 not receiving their full required catheter care for approximately three weeks, which poses a potential health risk to persons in care.the state’s words, verbatim · CDSS document, May 18, 2026

Plan of correction: Licensee stated they will submit a protocol to LPA by POC due date for ensuring the facility is aware of residents’ home health care needs and is following up to ensure they are being met.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(h)(4) · Plan of correction due date: Jun 8, 2026

87633 Hospice Care… (h) … the licensee shall maintain … (4) A copy of the resident’s current hospice care plan approved by the licensee, the hospice agency, and the resident… This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not maintain a copy of R2’s hospice care plan resulting in the facility not being able to confirm whether their suprapubic catheter needs were being met by hospice, which poses a potential health risk to persons in care.the state’s words, verbatim · CDSS document, May 18, 2026

Plan of correction: Proposed POC: Licensee stated they will submit a protocol to LPA by POC due date for ensuring they have all required hospice documentation for residents on hospice.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87208(a) · Plan of correction due date: Jun 8, 2026

87208 Plan of Operation (a) … The plan and related materials shall be on file in the facility … This requirement was not met as evidenced by: Based on interviews, the licensee was unable to locate the plan of operation at the facility and had to obtain it from an off-site location, which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, May 18, 2026

Plan of correction: Licensee showed LPA a printed copy of their plan of operation and confirmed a copy would be available at the facility moving forward. POC cleared.

Type of visit: Case Management - Other

This unannounced Case Management – Other inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering amended findings for Complaint Control Numbers 22-AS-20250829102755 and 22-AS-20250919161621. LPA met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection. During the inspection, LPA and AD reviewed and discussed the previously delivered findings and the amended findings and LPA delivered the amended reports to AD. An exit interview was conducted and copies of this report and the amended reports were discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, May 18, 2026

Type of visit: Required - 1 Year

On April 13, 2026, Licensing Program Analysts (LPA) Eboni Bentley arrived at the facility unannounced for the purpose of conducting the Required 1 Year Annual evaluation. LPA was greeted and granted entry by staff after stating the purpose of the visit. The Executive Director Peggy Ulland was out on vacation. Health Services Director Hanofi Edogiawerie was present and assisted with the inspection. The facility has a resident census of 148 residents in care. The facility is a two-story building, with a memory care wing on the first floor. In the middle of the building is a courtyard, for Assisted Living, with shaded patio seating and a fountain. Memory Care unit has a garden courtyard of its own in the back of the building, that is secured. The delayed egress doors around memory care were tested and found to be operational. A sample of fifteen resident records were reviewed during the visit. Background clearance and association to the facility was verified for staff members on the roster. Interviews were conducted with residents and staff. LPA toured the physical plant with Maintenance Director Matt Yem and inspected a total of seventeen resident apartments. All rooms contained the required furnishings, and bathrooms were found to be operational, with grab bars secured in place. The hot water temperature measured between 116.8 and 118.6 degrees Fahrenheit in fifteen bathrooms used by residents in care. All common areas were inspected including the kitchen, dining, and courtyards. There were ample supply of clean towels and linens. Toxins, disinfectants, sharps, and medications were secured and inaccessible. The interior and exterior portion of the facility were observed clean. The outdoor passageways were free of obstruction with sufficient seating and shading. CONTINUE LIC809-C.... First aid kit is maintained and contains all the necessary elements. The smoke/carbon monoxide detectors were tested last on April 10, 2026 per Maintenance Director and proof of service will be submitted to LPA by April 24, 2026. Evacuation chairs were observed at each stairwell. The facility has several fire extinguishers that were charged throughout the facility, all last serviced on or around May 5, 2025. LPA observed insufficient amount of emergency food and water for 148 residents and additional for staff on duty. Due to insufficient time, a deficiency will be cited during the continuation annual visit. Background clearance and association to the facility was verified for staff members on the roster. Interviews were conducted with residents and staff. Based on the observations made during today's visit, no deficiencies are being cited, however a continuation visit is needed and additional records will be requested. An exit interview was conducted and a copy of this report was provided to Health Services Director, Hanofi Edogiaweriethe state’s words, verbatim · CDSS document, Apr 13, 2026

Allegation investigated: Staff did not isolate resident with COVID Resident experienced several falls due to neglect Resident has scabies Resident has ringworm Staff are mismanaging residents’ medications

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to investigate the above-mentioned allegations. Upon arrival, LPA Haddadin was greeted and granted entry by Executive Director (ED) Peggy Ulland. The purpose of the visit was explained. The investigation included staff and resident interviews, record reviews, and direct observations of the physical plant. The allegations investigated were: “Staff did not isolate resident with COVID,” , “Resident experienced several falls due to neglect,”, “Resident has scabies,” “Resident has ringworm,” and “Staff are mismanaging residents’ medications,” During the investigation, the LPA was able to obtain and review physician report and progress notes for Resident 1 (R1). Regarding the allegation that staff did not properly isolate a resident with COVID-19, LPA reviewed R1’s progress notes dated January 11, 2022 which documented that R1 was placed in isolation after testing positive for COVID-19. Unsubstantiated The documentation further showed that staff provided meals to R1 during the quarantine period; however, R1 at times refused food and became verbally aggressive despite repeated staff efforts to provide assistance. In addition, LPA conducted five staff interviews and five resident interviews, and all individuals interviewed denied the allegation. LPA also confirmed through staff interviews and LPA observations that the facility maintains a supply of personal protective equipment (PPE) for use as needed. During record review, LPA verified that staff had received training on infection control procedures and protocols to follow in the event of an outbreak. Regarding the allegation that the resident experienced several falls due to neglect, facility records reflected that on August 10, 2021, R1 was found by staff lying on their back in the hallway and complaining of back pain. The fall was unwitnessed. Out of precaution, the facility arranged for R1 to be transported to a local hospital for evaluation. According to the facility’s documentation, R1 did not sustain any fractures and was later discharged from the hospital. Per records reviewed there were no other falls documented for R1. LPA was unable to interview R1 due to R1 moving out of the facility. Regarding the allegations that the resident had scabies and ringworm, LPA reviewed R1’s records and found no documentation confirming either diagnosis. Progress notes dated July 2, 2021, indicated that R1 developed a rash on the left ankle, which was treated as directed by the resident’s physician. All treatments were recorded by the facility’s Medication Technician. Five staff were interviewed and reported direct knowledge of R1 and reported R1 did not have any diagnosis of scabies or ringworm. Five residents were interviewed who reported they had no knowledge of residents in care having scabies or ringwork. Regarding the allegation that staff mismanaged residents’ medications, LPA interviewed five staff members who handle resident medications who reported having no knowledge of R1’s medications being mismanaged. LPA interviewed five residents who denied having issues with medications not being received timely and/or receiving incorrect medications. LPA observed facility medication administration process during visits. incorrect medications. LPA observed facility medication administration process during visits. During the process LPA observed Medication Technicians matched each medication with the resident’s name, dosage, and photograph before dispensing. Based on the investigation, there was insufficient evidence to prove that the alleged violations occurred. Therefore, the allegations: “Staff did not isolate resident with COVID,”, “Resident experienced several falls due to neglect,”, “Resident has scabies,” “Resident has ringworm,” and “Staff are mismanaging residents’ medications,” are deemed Unsubstantiated An exit interview was conducted with Executive Director (ED) Peggy Ulland and a copy of this report was provided to the facility representative.the state’s words, verbatim · CDSS document, Mar 26, 2026 · control 22-AS-20220421153926

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced case management visit to the facility to amend Complaint Report No. 22-AS-20220421153926. Upon arrival, LPA Haddadin was greeted and granted entry by Executive Director (ED) Peggy Ulland. LPA explained the purpose of the visit. An exit interview was conducted with the Executive Director, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 26, 2026

Allegation investigated: Staff did not prevent inappropriate behaviors between residents Staff are not providing adequate food service for residents Staff are not meeting resident's toileting needs Facility walls are dirty Facility floors are dirty

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to investigate the above-mentioned allegations. Upon arrival, LPA Haddadin was greeted and granted entry by Executive Director (ED) Peggy Ulland. The purpose of the visit was explained. The investigation included staff and resident interviews, record reviews, and direct observations of the physical plant. The allegations investigated were: “Staff did not prevent inappropriate behaviors between residents,” “Staff are not providing adequate food service for residents,” “Staff are not meeting residents’ toileting needs,” “Facility walls are dirty,” and “Facility floors are dirty.” Regarding the allegation that staff are not providing adequate food service to residents, LPA interviewed five staff members who reported residents receive three meals a day with additional meals available upon request. {***CONTINUE9099C***} {***THIS IS AN AMENDED REPORT***}1 Unsubstantiated LPA interviewed five residents who confirmed they get three meals a day and they have access to additional food in fridges located in lounge & memory care unit. LPA toured the facility and observed two refrigerators: one on the first floor near the lounge area containing food items such as sandwiches, pudding, apple juice, and orange juice, and another refrigerator in memory care unit offering the same. The facility menu was observed and found to reflect residents’ dietary plans. A review of the facility’s quarterly dietitian report, completed by the Dining Manager, showed that the facility received a passing score of 47.5 out of a possible 52 point Regarding the allegation that staff are not meeting residents’ toileting needs, the investigation determined as follows: LPA interviewed five staff members who reported they conduct resident checks approximately every two hours and more if required. Staff members further reported residents have the ability to call for assistance if needed. Two of the five staff interviewed reported direct knowledge of R1. Progress notes dated July 2, 2021, documented that staff attempted to assist R1 with hygiene and a shower, but R1 refused care and repeatedly asked staff to leave the room. LPA interviewed five residents who reported if they required help, they would receive it from facility staff. Residents reported staff check on residents throughout the day. Facility records confirmed that staff maintain a log for memory care resident two-hour checks. Facility does not maintain a log for facility Assisted Living resident checks. LPA tested facility pull cords in residents rooms and observed staff responding timely during visits. Regarding the allegation that staff failed to prevent inappropriate behaviors between residents, interviews were conducted with five staff members of which two reported knowledge of a verbal altercation between R1 and resident 2 (R2). Staff reported when the incident occurred residents were separated and no further incidents occurred. Staff denied that any physical interaction occurred between the two residents. LPA also interviewed five residents, all of whom stated they had no knowledge of any physical or verbal altercations between residents. A review of the facility’s Progress Notes revealed no evidence to support the allegation. Additionally, Progress Notes for Resident 1 (R1) showed no further incidents of aggression toward peers or staff. {***CONTINUE 9099C***} {***THIS IS AN AMENDED REPORT***} Regarding the allegations that facility walls and floors are dirty, LPA interviewed five staff members who reported the facility has housekeeping and maintenance. Housekeeping cleans resident rooms, common areas and bathrooms daily and clean additionally as needed. LPA interviewed five residents, who reported their rooms are cleaned regularly and have no observed dirty walls or floors. Resident rooms are cleaned on a schedule. LPA toured the facility and observed that the walls and floors were clean meaning free of graffiti and no chipped paints. LPA observed the facility to be free of odors. Review of housekeeping and maintenance logs indicated the facility follows a scheduled cleaning routine performed by designated maintenance staff. Based on the investigation, there was insufficient evidence to prove that the alleged violations occurred. Therefore, the allegations: Staff did not prevent inappropriate behaviors between residents,” “Staff are not providing adequate food service for residents,” “Staff are not meeting residents’ toileting needs,” “Facility walls are dirty,” and “Facility floors are dirty” are deemed Unsubstantiated. An exit interview was conducted with Executive Director (ED) Peggy Ulland and a copy of this report was provided to the facility representative. {***THIS IS AN AMENDED REPORT***}the state’s words, verbatim · CDSS document, Mar 20, 2026 · control 22-AS-20220421153926

Allegation investigated: Facility is in disrepair.

On March 12, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for the purpose of conducting the 10-day complaint investigation into the above allegation. LPA was greeted and granted entry by Maintenance Director Matt Yem, after explaining the purpose of the visit. Executive Director (ED) Peggy Ulland arrived shortly to assist with the investigation. During the visit, LPA conducted a tour of the facility kitchen with staff and observed the refridgerator, freezer, dry storage room, cooking area, and dishwashing area. LPA reviewed facility documents including: Resident Roster, Staff Roster, Staff Contacts, Staff Schedules, Direct Supply Tels work order, and Ecolab Service Request/Inspection report. Interviews were conducted with staff and witnesses. CONTINUE TO LICE9099-C.... Substantiated The following was determined during the investigation: Regarding the allegation, Facility is in disrepair, it was reported that there was a dishwasher leaking in the kitchen, resulting in excessive puddles of water on the kitchen floor. During the visit, LPA observed a dishwasher in working order. Four out of five staff interviewed confirmed the allegation, stating the dishwasher was not working for at least one week prior to being repaired. One staff stated the leak began on February 25, 2026 and repairs were requested on multiple occasions. A record review confirmed the machine was leaking and repairs had not been completed until March 4, 2026, per Ecolab Service Request/Inspection Report dated March 4, 2026 at 3:18pm. The facility also provided the Direct Supply Tels work order dated March 2, 2026 and two out of four five staff stated the initial request for repair was made to Industrial Electric on that date. The facility decided not to go with the vendor and requested service from Ecolab on March 3, 2026. The investigation revealed the facility failed to repair the dishwasher in a timely manner, causing staff to wash dishes by hand and use a squeegee to remove excess water on the dishwashing area floor for several days. During the tour of the kitchen, LPA also observed a freezer, reported to be in disrepair. The freezer was taped off and labeled "Do Not Touch or move (Electrical Wire Exposed)." Five out of five staff confirmed the freezer was not working at the time of the visit and was not working since March 11, 2026. One staff stated the freezer was scheduled for service later that day. Therefore, based on LPA's observations, interviews which were conducted, and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Facility is in disrepair is deemed SUBSTANTIATED as per Title 22, Division 6, Chapter 8 of the California Code of Regulations. A deficiency is being cited on the attached LIC 9099D. An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report, LIC9099D, and the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Mar 12, 2026 · control 22-AS-20260304153800

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 19, 2026

87303(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 is not met as evidenced by: Based on observation, interviews, and record review, the facility failed to comply with the section cited above in two out of two kitchen appliances, which poses a potential risk to persons in care. Interviews and record review revaled the dishwasher was leaking for at least one week and LPA observed a freezer in disrepair during the visit.the state’s words, verbatim · CDSS document, Mar 12, 2026

Plan of correction: The administer stated the freezer will be repaired and will provide proof to CCLD by POC due date.

Allegation investigated: Staff neglect resulting in death of resident. Facility did not ensure resident was provided prescribed medication. Facility falsifying medication chart. Facility not responding to resident's call light in a timely manner. Unqualified staff administering insulin to residents.

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to deliver findings for the above allegations from April 10, 2023. LPA was greeted and granted entry into the facility by the concierge and met with Hanofi Edogiawerie, Health Services Director and stated the purpose of the visit. During the investigation LPA interviewed staff, residents and any witnesses regarding the events from 2023 and requested the following: resident rosters from October 23, 2025, and November 20, 2025, Care staff schedule from October 23, 2025, and employee lists with phone numbers; which include terminated or former employees. LPA reviewed six of six resident files including for Resident #1 (R1) and Resident #6 (R6); and five former employee files. Unusual Incident Reports for six residents were requested for 2021-2023. (Continued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) LPA investigated the allegation that staff neglect resulted in the death of resident. Resident #6 moved into the facility on February 12, 2021, and passed away on March 28, 2023. Per Park View Estates Move In Record dated February 12, 2021, and Medication Administration Records, R6 had diagnoses of Type 2 Diabetes Mellitus without complications, Vascular Dementia, unspecified severity and Essential Hypertension. R6 resided in Memory Care (MC). It was alleged that the oxygen concentrator was not working at time of R6’s time of death and that staff failed to check if it was working. Per initial interview with the hospice agency, R6 was receiving hospice services at the time of death and R6 passed away due to natural causes. The hospice agency provided the oxygen concentrator and if there were issues, a vendor would be called for repair. LPA interviewed a second witness who provided the death certificate. The cause of death for R6 was Heart Disease unspecified. Per interview with Witness #2 (W2) the resident passed away naturally and hospice was present. Thus the allegation that staff neglect resulted in the death of the resident is Unsubstantiated. The Department investigated the allegations that the resident was not provided prescribed medication and that the facility was falsifying medication charts. It was alleged that Resident #5 (R5) went into seizures due to staff not ordering the medication. It was reported that staff would mark the Medication Administration Record (MAR) that the medication was given when it was not. R5 was not able to be interviewed since they no longer resided at the facility at time of visit. LPA reviewed Unusual Incident Reports and noted a seizure incident that occurred on August 23, 2022. It was noted on the Unusual Incident Report, submitted to the Department on August 24, 2022, that the resident took the anticonvulsant medication daily. LPA reviewed the MAR and noted that the anticonvulsant medication was given daily and initialed by various medication technicians (med techs). LPA interviewed one of one staff and one of one witness who had knowledge of the incident. One of one staff denied the allegation. One of one witness stated the name of a former med tech who would falsify records and initial given medications. LPA confirmed the med tech named by the witness was the med tech initials on the Medication Administration Record for the incident on August 23, 2022. LPA was unable to interview the MedTech in question. When LPA asked the witness about the particular incident, the witness could not remember this happening. LPA interviewed one of one staff member present who could not recall the specifics of the incident. Thus the allegations that: Facility did not ensure resident was provided prescribed medication and Facility falsifying medication chart are Unsubstantiated.(Cont'ed on LIC 9099-C1) (Continued from LIC 9099-C) It was also reported that the facility was not responding to a resident’s call light in a timely manner and took longer than thirty minutes due to insufficient staffing. LPA interviewed staff and witnesses regarding staffing in Memory Care. Three of three staff could not confirm, nor deny the allegation that call lights were not answered properly. One witness recalled being short staffed in 2023 but did not confirm that call lights were not answered in a timely manner. The facility conducted an in-service training on May 21, 2025, regarding call pendant procedures. Thus the allegations that facility is not responding to resident’s call light timely is deemed Unsubstantiated. It was alleged that Unqualified staff were administering insulin to residents. LPA interviewed three of three staff members who denied this allegation. LPA obtained the facility policy regarding injection administration. Only a nurse, such as the licensed vocational nurse (LVN) can administer medications. The facility employs a LVN; as well as the Health Services Director (HSD) who both have a valid LVN license. The allegation stated that med techs were administering insulin to residents. LPA reviewed four of four resident Medication Administration records who received insulin at the time of complaint received. Only one of the four residents still resided at the facility. LPA interviewed Resident #1 (R1) who stated they self-injected their insulin and that, for four to five months, staff did assist with injections. R1 could not confirm if the staff member was a nurse or a med tech, but that R1 prefers to self-inject themself. LPA attempted to interview three of five med techs from 2023. Three were no longer employed by the facility and did not have working phone numbers or emails. Two of the five med techs interviewed denied the allegation. LPA also reviewed five of five staff electronic files which include training and in-services. Staff members’ training records document five of five staff completed medication administration training. Thus the allegation that unqualified staff were administering insulin to residents was Unsubstantiated. Although the above allegations may have happened there is not a preponderance of evidence to prove the alleged violations occurred; therefore, the allegations that: Staff neglect resulting in death of resident, Facility did not ensure resident was provided prescribed medication, Facility falsifying medication chart, Facility not responding to resident's call light in a timely manner and Unqualified staff administering insulin to residents are Unsubstantiated. An exit interview was conducted with Hanofi Edogiawerie, Health Services Director and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 17, 2026 · control 22-AS-20230410115728

Type of visit: Case Management - Other

This unannounced Case Management – Other inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering amended findings for Complaint Control Number 22-AS-20250919161621. LPA met with Staff #1 (S1) Hanofi Edogiawerie and explained the reason for today’s inspection. During the inspection, LPA and S1 reviewed and discussed the previously delivered findings and the amended findings and LPA delivered the amended report to S1 who signed the amended report on behalf of Administrator (AD) Peggy Ulland. An exit interview was conducted and copies of this report and the amended report were discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Dec 30, 2025

Type of visit: Case Management - Other

On December 5, 2025, Licensing Program Analyst (LPA) Eboni Bentley and Licensing Program Manager (LPM) Lourdes Montoya arrived unannounced for a Case Management – Other visit for the purpose of obtaining access to resident records stored electronically. LPA and LPM introduced self and stated the purpose of the visit to Executive Director (ED) Peggy Ulland. During today's visit, LPA and LPM were provided full access to R1’s paper and electronic records. No deficiencies were cited during this visit. An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report was provided at exit.the state’s words, verbatim · CDSS document, Dec 5, 2025

Type of visit: Case Management - Other

THIS REPORT HAS BEEN AMENDED TO REMOVE LIC809-D PAGE. On November 12, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for a Case Management – Other visit for the purpose of obtaining all resident records stored electronically, that were not obtained during the case management visit on November 4, 2025. LPA introduced self and stated the purpose of the visit to Executive Director (ED) Peggy Ulland. During today's visit, LPA obtained hard copies of all residents’ progress notes, In-service training on Catheter, hospice record for one resident, staff roster and resident roster. An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this amended report was provided.the state’s words, verbatim · CDSS document, Nov 12, 2025

Type of visit: Case Management - Other

On November 4, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for a Case Management – Other visit for the purpose of conducting an additional investigation for Complaint Control No 22-AS-20250929104833. LPA announced self and stated the purpose of the visit to Executive Director (ED) Peggy Ulland. During the visit, LPA requested full viewing access to facility records in Point Click Care (PCC) and was provided with a new password. ED stated LPA had limited access to records as LPA was not performing or supervising care tasks. Due to insufficient time and information, this case management requires further investigation and a subsequent visit will follow. An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Nov 4, 2025

Allegation investigated: Staff do not ensure call assistance buttons are responded to in a timely manner.

On October 29, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a subsequent complaint investigation visit into the above allegation. LPA announced self and stated the purpose of the visit to staff. Executive Director (ED) Peggy Ulland shortly arrived on site to assist with the investigation. On October 6, 2025, LPA initiated the complaint investigation and toured the facility accompanied by ED Ulland and obtained documentation. During the follow-up to the investigation, LPA was provided with Resident/staff roster, staff contacts, and staff schedule. The following documents were obtained for Resident 1 (R1): Admissions Agreement, staff schedule, Physician’s Report, Progress Notes, Bathing logs, Medication Administration Records, and Pendant/Call Logs. LPA requested additional hospital records, Home Health, Doctor’s orders, and any clinical records obtained for Resident be sent to the Department by 5pm on 10/29/2025. CONTINUE TO LIC9099-D.... Substantiated The following was determined based on observations and record review: Regarding the allegation that Staff do not ensure call assistance buttons are responded to in a timely manner, the following has been concluded: Based on record review of pendant button calls and responding time over a period of 90-days, it was established that there were approximately three occurrences of pendant button calls that were responded to between thirty-five minutes to one hour and eight minutes, calling the initial call. While some pendant button calls were addressed timely, these occurrences demonstrate that a timely response is not guaranteed. During an interview, Witness 1 (W1), reported waiting for 48 minutes to get a response when pendant button was used. W1 stated no one came so they went to get assistance from a caregiver in the hallway, outside of Resident 1 (R1’s) room. Based on record review and observations made during the investigation, the preponderance of evidence standard has been met for allegation: Staff do not ensure call assistance buttons are responded to in a timely manner is deemed SUBSTANTIATED. A deficiency is being cited as per the California Code of Regulations, Title 22, Division 6, Chapter 8. Civil Penalty Assessed. An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report, LIC9099D, LIC421FC and appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, Oct 29, 2025 · control 22-AS-20250929104833

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Nov 5, 2025

87464 Basic Services … (f) Basic services shall at a minimum include: (1) Care and supervision…This requirement was not met as evidenced by: Based on documents and interviews, the licensee did not provide the service of responding to R1's pendant call for assistance in a timely manner, three times within a 90 day period, which poses a potential personal rights risk to persons in care. Civil Penalty Assessed.the state’s words, verbatim · CDSS document, Oct 29, 2025

Plan of correction: The licensee stated they will retrain staff regarding timely call button and pendant esponses and submit proof to LPA by POC due date.

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

This unannounced Case Management – Other inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting additional investigation for Complaint Control Nos. 22-AS-20250829102755 and 22-AS-20250919161621. LPA met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection. During the inspection, LPA interviewed AD, staff, and obtained and reviewed resident records. Facility representative was advised that at this time further investigation is required. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Oct 29, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced Case Management visit to the facility. Upon arrival, LPA was greeted and granted entry. LPA met with Executive Director Peggy Ulland and explained the purpose of the visit. The purpose of this visit was to amend a previously issued complaint report under complaint number #22-AS-20220131170149. The amended report was reviewed and signed by the Executive Director along with this Case Management report. A copy of both reports was provided to the Executive Director for facility records.the state’s words, verbatim · CDSS document, Oct 27, 2025

Allegation investigated: Unlawful eviction

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in our Regional Office. LPA was greeted and granted entry by Concierge. LPA met with Executive Director (ED) Peggy Ulland and explained the purpose of the visit. It was alleged that Resident #1 (R1) received an unlawful eviction. LPA reviewed Admissions Agreement and R1 was admitted on 1/18/2022. An email from the accountant documented R1 moved out on 4/06/2022. Per interview with the Health Services Director (HSD), when Power of Attorney (POA) took R1 to the hospital for assessment, they did not provide any updates. HSD stated the facility reached out to the hospital but was not given any information due to the Health Insurance Portability and Accountability Act (HIPAA). On 4/15/22 HSD received a call from a case manager regarding R1 returning to the facility. HSD stated to case manager that R1 could return as long as it was safe and R1 was not a danger to themself or others. Case Manager understood. (Continued on LIC 9099-C) Unfounded (Continued from LIC 9099) HSD stated that at no time did the facility tell the resident or family that R1 would be evicted. There is no eviction notice that was served to R1 or responsible party. The facility requested a personal companion while awaiting R1 to get a psychiatric evaluation for safety reasons only. Based on LPA's record review, observations and interviews, the allegation that Resident #1 was given an unlawful eviction is Unfounded. The allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with Peggy Ulland, Executive Director and a copy of this report and LIC 811 were provided to the facility.the state’s words, verbatim · CDSS document, Oct 17, 2025 · control 22-AS-20220411112556

Allegation investigated: Resident sustained injuries while in care Staff did not properly assess resident's change in condition Staff refused to seek medical attention for resident Resident's shower bench is in disrepair Staff did not shower resident Staff did not meet resident's laundry needs Resident's bathroom is dirty Resident's rugs are dirty

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in our Regional Office. LPA was greeted and granted entry by Concierge. LPA met with Executive Director (ED) Peggy Ulland and explained the purpose of the visit. LPA requested the lease agreement for Resident #1 (R1) and obtained copies of the current resident roster, and current staff roster. R1 resided in Memory Care from 1/18/2022 to 4/06/2022. LPA reviewed R1's Physician's Report dated 9/9/2021 with a diagnosis of Alzheimer's Disease. Per Physician's Report, R1 did not have wandering or inappropriate/ aggressive behavior and R1 had the capacity for self care which included: bathing, dressing/ grooming, feeding self and being able to care for toileting needs. The Department interviewed two of two residents, two of two witnesses and eight of eight staff members regarding the above allegations. LPA also conducted a tour of the Memory Care Unit. (Continued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) It was alleged that the: Resident sustained injuries while in care, Staff did not properly assess resident's change in condition and Staff refused to seek medical attention for resident. LPA reviewed Unusual Incident Reports for R1 from 3/07/2022, 3/30/2022 and 04/05/2022. On 3/7/2022 R1 shoved Resident #2 (R2) in the hallway near the theater. R2 also had a diagnosis of dementia, It was documented and Power of Attorney (POA) was notified. In the report it stated POA would notify physician regarding aggressive behavior. On 3/30/2022 R1 had another incident with R2 in the dining room; hitting R2 with a book. 9-1-1 was notified and R1 and R2 were transported to the Emergency Room for further assessment. POA for R1 was notified and the facility Health Services Director (HSD) faxed physician of R1's continued behavior. On 4/05/2022 a third incident occurred where R1 pushed R2 to the ground. 9-1-1 was called and fire department and paramedics arrived. Police officers also responded and gathered witness statements. R1's POA was notified. In the incident report it is documented that R2 never provoked R1, and that a family conference was requested. On 4/06/22 R1's POA picked up resident and brought R1 to the hospital for a psychiatric evaluation. R1 did not return to the facility. After the first incident on 3/7/2025, the resident returned with new medications. The Executive Director spoke directly to the POA regarding a personal companion and requested an evaluation with a neurologist regarding behaviors to conduct a re-appraisal of R1's change of condition. HSD stated the POA never took R1 for assessment and that a statement made by POA made HSD realize R1 had a history of physical aggression that was not disclosed per Physician's Report. Medical Technicians (MedTechs) continued to communicate with the Primary Care Physician (PCP), per incident report and HSD interview, regarding R1's behavior. Per HSD interview, R1 did not sustain injuries and that is was R2 who sustained injuries due to R1's behaviors. The allegations that: Resident sustained injuries while in care, Staff did not properly assess resident's change in condition and Staff refused to seek medical attention for resident are Unsubstantiated. (Continued on LIC 9099-C1) (Continued from LIC 9099-C) It was alleged that: Resident's shower bench is in disrepair, Staff did not meet resident's laundry needs, Resident's bathroom is dirty and Resident's rugs are dirty. LPA reviewed housekeeping schedules. There are six housekeepers with two assigned to Memory Care. Housekeeping and laundry are scheduled seven days per week. Each housekeeper has a daily housekeeping inspection form; which include checking off if vinyl/carpet and shower/tub/ fixtures are in working order. Comments are written on the daily inspection list for follow-up such as: laundry to be done. LPA interviewed five of five staff members and the current Maintenance Director regarding housekeeping and laundry. Four of the five staff members were working during the time period of the incident. Per interviews, staff members stated resident bathrooms were cleaned and maintained since the Memory Care residents were encouraged to be in the common areas for socialization and activities, as well as dining. Housekeepers stated that in 2022 there were not a lot of memory care residents so it was easier to maintain resident rooms. LPA asked if any of the staff recalled the condition of R1's bathroom or laundry. Staff recalled the resident but stated if there was a broken shower chair, dirty rugs, an unclean bathroom or laundry that needed to be done, that it would have been noted and cleaned. None of the staff members interviewed remembered if R1's laundry was not cleaned since it was almost three years ago. LPAs Fred Arias and Rose Ruppert toured the Memory Care unit on December 30, 2024 and entered three random resident bathrooms while residents were at lunch. All bathrooms were clean and in working order. An interview with the Maintenance Director stated that Memory Care is usually clean and repairs are handled promptly. On 2/11/2025 LPA toured the laundry room and interviewed housekeeping and care staff regarding laundering procedures Housekeeping staff clean bedsheet linens and towels once a week per schedule; or as needed. Care staff cleaned residents' personal belongings once a week, or as needed. Thus the allegations that the: Resident's shower bench is in disrepair, Staff did not meet resident's laundry needs, Resident's bathroom is dirty and Resident's rugs are dirty are Unsubstantiated. (Continued on LIC 9099-C2) (Continued from LIC 9099-C1) It was alleged that Staff did not shower resident Per Physician's Report dated 09/09/2021, R1 had the capacity for self care which included: bathing, dressing/ grooming, feeding self and being able to care for toileting needs. Interview with the HSD stated staff did not shower R1 but would remind R1 to take a shower. Staff could not force R1 to shower if resident refused. This allegation is Unsubstantiated. Based on LPA record review, observations and interviews, 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 allegations that the: Resident sustained injuries while in care, Staff did not properly assess resident's change in condition, Staff refused to seek medical attention for resident, Resident's shower bench is in disrepair, Staff did not meet resident's laundry needs, Resident's bathroom is dirty, Resident's rugs are dirty, and Staff did not shower resident are Unsubstantiated. An exit interview was conducted with Peggy Ulland, Executive Director and a copy of this report and LIC 811 was provided to the facility.the state’s words, verbatim · CDSS document, Oct 17, 2025 · control 22-AS-20220411112556

Allegation investigated: Facility staff do not ensure the care needs of residents are being met Staff doe not ensure residents have access to clean water for consumption Staff does not ensure cleaning supplies are safely secured from residents Staff does not ensure discontinued medications are properly discarded Staff does not dispense medications as prescribed Staff do not ensure residents records are properly maintained Staff do not ensure residents are provided personal privacy Staff does not ensure reporting requirements are followed Licensee does not ensure facility records are safely secured Staff do not ensure updated food menus are made available to residents

Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegations. LPA arrived at the facility and was greeted and granted entry. LPA spoke with Peggy Ulland, Executive Director, and explained the purpose of the visit. Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted, and pertinent documents collected. It is alleged facility staff do not ensure the care needs of the resident’s are being met. Records review revealed that all logs reflect residents are on a schedule for services at the facility and logs reflect as services performed. Interview with staff stated that residents get the care they need and there is no issue Continued on LIC9099-C Unsubstantiated with doing so. Interview with 10 of 10 residents stated that they get the care they need, get the assistance they ask for, and they don’t have a problem with getting care. It is alleged that staff does not ensure residents have access to clean water for consumption. LPA Martinez conducted a tour of the facility on April 30, 2024, and on October 8, 2025, and did not observe the water containers used for water are clean and clear of any mold, or dirt. LPA did not observe any issues with the water that is used for consumption or available to residents. Interview with executive chef stated We have a water container in the memory care unit where we clean it out twice a day. Generally, it has slices of fruit in the water for flavor. That is available for residents all the time and the water containers are changed out often for fresh water. Interview with 10 of 10 residents stated that they have not noticed the water to be dirty and they can ask for a cup of water at any time and get it. It is alleged that staff does not ensure cleaning supplies are safely secured from residents. LPA Martinez conducted a tour of the physical plant of the facility on the following dates: April 30, 2024, and October 8, 2025, and did not observe any toxins, cleaning supplies or chemicals in any common spaces or the kitchen of the facility. LPA inspected that facility has a centralized storage unit for toxins located in the back hallway of the facility which residents do not have access to, the toxins are kept in the storage unit as well as in the maintenance director’s office. Entry door to the hallway is by the entry of the dining room and only access by a key card. Interview with staff stated that when the housekeepers or any other staff need cleaning supplies or toxins that they retrieve from the storage unit and then return to the same unit. Each housekeeper has a cart that they load toxins and unload at their end of shift in the storage unit. Interview with 10 of 10 residents stated that they don’t have access to the kitchen and they have not seen any toxic chemicals just laying around in the facility. It is alleged that staff does not ensure discontinued medication are properly discarded. LPA conducted a facility visit and toured the medication room for the facility on April 30, 2024, and October 8, 2025, and observed that in the medication room there is a container that is used to discard medication. The container is in a room that requires a key card to enter. Interview with lead med tech stated that there is a container to discard discontinued medication in the medication room. Container is a one way entry and you cannot retrieve Continued on LIC9099-C the medication once it is dispensed in the container. Once medication is disposed there isn’t a way to retrieve the medication or remove it from the container. Once the container is full there is a shipping label adhered to the box with a phone number that is called for pick up by a vendor. It is alleged that staff does not dispense medication as prescribed. Record obtained for MAR (medication administrator records) for March and April of 2024 revealed that all medication was given accordingly and there are no missed dosages. Interview with staff stated that medication is given then logged out in the computer system to indicate that it was given. Interview with 10 of 10 residents stated that they get their meds and they haven’t not had issue with not getting the medication. Staff comes to them and gives them medication at the time that it is due. It is alleged that staff do not ensure residents records are properly maintained. A review of 13 resident records revealed that all resident files contained required documentation including updated physician reports and care plans and are complete. Interview with staff stated that all records are kept electronically and they also have a physical file on hand in the event it is needed for review. At the time of visit records requested were made available to LPA. It is alleged that staff do not ensure residents are provided with personal privacy. LPA toured the facility and observed that resident bedrooms are apartment style units with a main door for entry. Interview with 10 of 10 residents stated that they feel like they have privacy at the facility and in their bedroom. They stated that they have privacy at the facility in their bedroom, common spaces and with their relationships with other residents. It is alleged that staff does not ensure reporting requirements are followed. Record review revealed that CCLD has on records as receiving LIC624 unusual report about the staff and residents at the facility. CCLD has received reports such as falls, staff, and elopements to name a few incident types received. Interview with staff stated that they report out any incident no matter if it is with residents or staff. Staff stated there was an incident with staff last month (March of 2024) that as reported to CCLD and LPA Rosie came out and did a visit for it. stated stated they knew that they need to report incidents to the department. It is alleged that licensee does not ensure facility records are safely secured. LPA Martinez conducted a facility visit April 30, 2024, and requested to view records. LPA toured the facility and observed that records Continued on LIC9099-C for staff are kept locked in the Executive Director’s office and resident records are located locked in the first floor medication room and/or on each floor where resident resides. Facility also has electronic records that are kept in their system with a passcode locked. Interview with staff stated that records can be accessed by staff with a key if they have access to them. Employee records are only accessed by the business office director, resident records only have access by med techs, but financial documents are separated, and they don’t have access to that section of records, and caregivers have access to the PCC system that is used for electronic files. It is alleged that staff do not ensure update food menus are made available to residents. LPA conducted a tour of the facility on various dates and observed that there is a monitor mounted on the wall of the entry of the dining room displaying menus digitally, menus for specials physically displayed outside the dining, printed menus on tables, and menus in the reception area of the lobby. Interview with kitchen staff sated there is an always available/regular menu on the tables in the dining room, 24 hours specials that are on the dining room TV that run 7 days of specials lunch and dinner and snack menu that are given at 10:00am/2pm/7pm for 7 days a week, staff print out menus to cover all residents each Monday morning. Based on the information mentioned above, the Department is unable to ascertain if the allegations 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 allegations 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, Oct 14, 2025 · control 22-AS-20240423101324

Allegation investigated: Facility did not allow resident access to dining room.

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection. The investigation into the allegation that facility did not allow resident access to dining room revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed AD, residents, witnesses, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Medical Records dated October 30, 2024, R1’s Physician’s Report dated September 13, 2024, R1’s Admission Agreement, R1’s Service Plan dated September 3, 2025, and R1’s Progress Notes. It was alleged that R1, who lives in the memory care section and has always eaten in the assisted living dining room per agreement with the facility, is no longer allowed to eat in the assisted living dining room. Per R1’s Medical Records dated October 30, 2024, R1 has mild dementia and R1’s Physician’s Report dated September 13, 2024, indicates R1 has mild cognitive impairment and is non-ambulatory. Substantiated Per R1’s family, R1 is eligible for assisted living based on their cognitive status but was placed in memory care because facility staff advised that R1’s physical needs could be better met in memory care and because there was an available room in memory care. R1’s family stated they agreed to this arrangement as long as R1 had access to all of the assisted living amenities, including the dining room. When interviewed, R1 also stated that eating in the assisted living dining room was a condition of their admission to the facility. R1’s Admission Agreement does not indicate whether R1 lives in assisted living or memory care and does not mention any agreement that R1 be allowed to eat in a particular dining room. However, R1’s Service Plan dated September 3, 2025, states that caregivers will escort R1 to the assisted living dining room for all meals and that this has been part of R1’s care plan since R1 was admitted, which shows that there was an agreement that R1 would live in memory care but eat in assisted living. No information was obtained regarding whether or not this was to be a temporary agreement, but the facility complied with the agreement for approximately one year. When interviewed, AD stated that when R1 moved in, R1 was allowed to eat in the assisted living dining room to help them acclimate to the facility, but the agreed upon plan was always to transition R1 to eat in the memory care dining room. Per AD, in early September 2025, R1 began to transition to eating in the memory care dining room starting with once a week and increasing in frequency until they ate only in the memory care dining room, R1 and their family agreed to this, and R1 has been enjoying eating in the memory care dining room and is making friends there, although sometimes R1 forgets that the transition is going on and believes they should be eating in the assisted living dining room. Per R1’s Progress Notes, on September 3, 2025, it was noted that R1 will transition to having meals in the memory care dining room starting September 8, 2025, and R1’s family was present during this conversation with R1. Per R1’s family, on August 26, 2025, a meeting was held where facility staff advised R1’s family that they believed R1 needed to live fully in memory care, which R1’s family disputed. However, it was agreed that R1 would eat in the memory care dining room one day per week. AD stated that R1 and their family agreed to start having R1 eat in the memory care dining room once per week but that the number of days per week would gradually increase until R1 ate only in the memory care dining room. However, R1’s family denied ever agreeing to have R1 eat in the memory care dining room more than once per week. R1’s Progress Notes indicate that on September 16, 2025, R1 was upset when told to have dinner in the memory care dining room, refused to go and returned to their room, and did not eat much of dinner and per R1’s family, R1 contacts them complaining about not being allowed to eat in assisted living. However, per AD and R1’s Progress Notes, R1 has communicated that they enjoy eating in the memory care dining room multiple times and any instances of R1 complaining about eating in the memory care dining room are the result of R1 being coached to say these things. Per an email from R1’s family dated September 23, 2025, R1’s family confirmed to the facility that the agreement was only that R1 would eat in the memory care dining room once per week and would have all other meals in the assisted living dining room. When interviewed, R1 denied agreeing to eat in the memory care dining room, stated they want to eat in the assisted living dining room, and specifically described what aspects of the memory care dining room they do not like. Based on the information obtained, R1 and their family did not agree to have R1 eat in the memory care dining room more than once per week. However, per R1’s Progress Notes, as of September 15, 2025, R1 was eating in the memory care dining room twice a week and per AD, as of October 6, 2025, R1 is eating in the memory care dining room four times a week. AD stated that the facility offered R1’s family to reassess R1 for suitability in assisted living so R1 could move to assisted living, but R1’s family refused. However, the facility also did not conduct a reassessment showing a change of condition requiring R1 to fully live in the memory care unit without access to assisted living amenities as previously agreed and documented in R1’s care plan, although AD stated they brought this up to R1’s family multiple times. Based on the information obtained, there was an agreement to have R1 eat in the assisted living dining room at least six days a week, this service was documented in R1’s care plan, and the facility stopped providing this service without agreement from R1 and their family or properly reassessing R1 to document why R1 should fully live in memory care without access to assisted living amenities. While R1 may have enjoyed eating in memory care in some instances, R1 also communicated their preference to eat in assisted living in other instances. The information obtained corroborated the allegation. During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. Civil penalties for repeat violations are being assessed. See LIC421FC. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative. It was alleged that the facility’s memory care call system does not meet Title 22 requirements and is ineffective because it uses motion detectors that cannot be activated by residents to call for help and the facility’s pendants are voluntary and most memory care residents do not have them. When interviewed, AD confirmed that the only aspect of the facility’s call system inside memory care rooms is a motion detector system. LPA inspected the facility and observed that, while assisted living rooms have call buttons, memory care rooms have only motion detectors, although there are call buttons on the outside of the memory care rooms near the front doors. LPA interviewed the facility’s maintenance director who stated the motion detectors in the memory care bedrooms and bathrooms register movement and trigger an alert if there is a certain level of continuous movement which directs care staff to check on residents in their rooms in addition to their regular checks. Per the facility’s maintenance director, the motion detector system also registers residents’ open doors. However, neither of these functions meet the purpose of a call system, which is to allow a resident to call for assistance when needed or for help during an emergency. Per AD, seven out of the 42 residents in memory care have pendants, which allows these residents to call for help, which means 35 residents in memory care have no access to a call system. LPA interviewed five memory care residents, three of whom did not have pendants and confirmed that the only way to request assistance is to leave their rooms and go find staff physically. In addition, when LPA tested the motion detectors in five memory care rooms by triggering them repeatedly to test whether they would trigger any alert, the motion detector system malfunctioned and became non-functional for multiple hours, while the pendant system still operated properly. LPA also noted that the detector near the beds would not register someone in bed waving their arms around and, even if it did, it is unclear if the detector would activate any alert or simply log the motion. The information obtained corroborated the allegation, as not only did the motion detector system malfunction when tested, it cannot meet the requirements of a call system for memory care residents even when operating as designed. During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative. This is an amended reportthe state’s words, verbatim · CDSS document, Oct 13, 2025 · control 22-AS-20250919161621

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Oct 27, 2025

87464 Basic Services … (f) Basic services shall at a minimum include: (1) Care and supervision…This requirement was not met as evidenced by: Based on documents and interviews, the licensee did not provide the service of having R1 eat in the assisted living dining room, which they prefer, six times a week as agreed and documented in R1’s care plan, which poses a potential personal rights risk to persons in care. Civil Penalty Assessed.the state’s words, verbatim · CDSS document, Oct 13, 2025

Plan of correction: The licensee stated they will go back to the agreed upon schedule of R1 eating in the memory care dining room one day a week and submit proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(i)(1)(A) · Plan of correction due date: Oct 20, 2025

87303 Maintenance and Operation … (i) Facilities shall have signal systems which shall meet the following criteria: (1) … (A) Operate from each resident's living unit... This requirement was not met as evidenced by: Based on observation, the licensee did not ensure memory care residents without pendants had access to a call system they could activate to request assistance or call for help in an emergency from their rooms, which poses an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 13, 2025

Plan of correction: The licensee stated they will submit a plan to ensure all memory care residents have access to the call system from inside their rooms by POC due date. This is an amended report

Allegation investigated: Facility added care services without consent. Unlawful eviction

This is an amended report . This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection. The investigation into the allegations that facility added unnecessary care services and unlawful eviction revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, witnesses, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Admission Agreement, R1’s Medical Records, R1’s Home Health Records, and Eviction Notice dated September 17, 2025. Unsubstantiated Regarding the allegation that facility added unnecessary care services: it was alleged that the facility added additional unnecessary and non-medical care for R1, which was duplicative of the care provided by the facility’s staff. The investigation revealed that R1 was admitted to the facility with a foley catheter and subsequently had surgery to replace insertion of the foley catheter with a suprapubic catheter. R1’s Medical Records document that R1 needed daily cleaning and bandage changes for their suprapubic catheter, which must be performed by a skilled professional. However, R1’s Home Health Records and interviews revealed that this skilled care was provided approximately only twice a week. The facility advised R1 that their needs were not being met and they needed a higher level of care. Based on the facility’s policy and R1’s Admission Agreement, temporary one-on-one supervision would be instituted at the resident’s expense when it has been determined that a resident needs a higher level of care. The facility retained an external agency to provide a temporary one-on-one caregiver for R1 to ensure continuous supervision and mitigate the risk of interference with the catheter site; however, the services were not initiated, as R1’s family declined and instead secured their own private caregiver. Regarding the allegation of unlawful eviction: it was alleged that the Eviction Notice dated September 17, 2025, issued to R1 was unlawful. The notice indicated that the facility was seeking termination of residency on the basis that it was unable to meet R1’s care needs, including the need for 24-hour nursing care. The investigation revealed that R1 experienced a change in condition following surgical replacement of a Foley catheter with a suprapubic catheter, resulting in a higher level of care needs, including daily site cleaning, dressing changes, and frequent showers. Records indicate that R1 was not receiving adequate home health services, and the catheter site was consistently noted to be red and irritated. Additionally, catheter care must be performed only by appropriately skilled professionals. Based on the information gathered during the investigation, the facility determined it was unable to meet R1’s increased care needs. Accordingly, the Eviction Notice dated September 17, 2025, was found not to be unlawful, as it was issued based on the facility’s documented inability to meet R1’s required level of care. Based on LPA’s observation, interviews conducted, and records reviewed, there was not sufficient evidence to support the above allegations. 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 allegations are deemed UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was discussed with and provided to facility representative. This is an amended report. This is an amended report. This is an amended report. This is an amended report. This is an amended report. This is an amended report. This is an amended report.the state’s words, verbatim · CDSS document, Oct 6, 2025 · control 22-AS-20250919161621

Allegation investigated: Staff retaliated against resident in care

This is an amended report. This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection. The investigation into the allegation that staff retaliated against resident in care revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, witnesses, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Admission Agreement, and R1’s Medical Records. Unsubstantiated It was alleged that the facility retaliated against R1 by adding additional unnecessary and non-medical care for R1, which was duplicative of the care provided by the facility’s staff and charged R1’s responsible party without their approval. The investigation revealed that R1 was admitted to the facility with a foley catheter and subsequently had surgery to replace insertion of the foley catheter with a suprapubic catheter. R1’s Medical Records document that R1 needed daily cleaning and bandage changes for their suprapubic catheter, which must be performed by a skilled professional. However, R1’s Home Health Records and interviews revealed that this skilled care was provided approximately twice a week. The facility advised R1 that their needs were not being met, they needed a higher level of care, and that one-on-one supervision would be required. R1’s family believes the requirement of one-on-one supervision was retaliation due to issues they had raised with the facility. However, the facility’s policy and R1’s Admission Agreement indicate temporary one-on-one supervision would be instituted at the resident’s expense when it has been determined that a resident needs a higher level of care. The facility retained an outside agency to provide one-on-one supervision to R1, but the service was never provided as R1’s family refused and obtained their own private caregiver. Based on gathered information, R1 requires a higher level of care, due to their suprapubic catheter which required daily cleaning, bandage changes and frequent showers. In addition, R1 required additional supervision to prevent R1 from picking at their catheter site, which was observed to be red and irritated. There is no evidence to support that these care requirements were imposed in retaliation. Based on LPA’s observation, interviews conducted, and records reviewed, there was not sufficient evidence to support the above allegations. 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 allegations are deemed UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was discussed with and provided to facility representative. This is an amended report. This is an amended report. It was alleged that on August 8, 2025, R1 was observed to have a blood-stained catheter bandage, but that staff did not notice the stain or report it to R1’s doctor or responsible party, R1 was taken to the hospital, the hospital determined no additional treatment and R1 was able to return to the facility with no special care or changes in medication required. Per R1’s family, on August 4, 2025, R1 had surgery to replace a foley catheter with a suprapubic catheter. R1’s family stated that on August 8, 2025, R1 was observed with a blood-stained catheter bandage, which was not noticed or reported by staff. When interviewed, AD stated that the blood observed was only a small amount and was to be expected after surgery, paramedics arrived and agreed with AD’s assessment, but R1’s family insisted on taking R1 to the ER and R1 returned a few hours later. However, R1’s family stated it was actually AD who thought the blood was a major issue and wanted to send R1 to the hospital, R1’s family did not have concerns about the blood stain, and R1 returned from the hospital with no concerns or changes of condition noted by the doctor. R1’s Medical Records dated August 8, 2025, corroborate that R1 was seen at the ER, no treatment was needed, and there was no change in condition. No information was obtained corroborating that R1 had a change of condition or that the blood stain noted on R1’s bandages was unexpected after R1’s surgery. The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Oct 6, 2025 · control 22-AS-20250829102755

Allegation investigated: Staff retaliated against resident in care

This is an amended report. This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection. The investigation into the allegation that staff retaliated against resident in care revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, witnesses, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Admission Agreement, and R1’s Medical Records. Unsubstantiated It was alleged that the facility retaliated against R1 by adding additional unnecessary and non-medical care for R1, which was duplicative of the care provided by the facility’s staff and charged R1’s responsible party without their approval. The investigation revealed that R1 was admitted to the facility with a foley catheter and subsequently had surgery to replace insertion of the foley catheter with a suprapubic catheter. R1’s Medical Records document that R1 needed daily cleaning and bandage changes for their suprapubic catheter, which must be performed by a skilled professional. However, R1’s Home Health Records and interviews revealed that this skilled care was provided approximately twice a week. The facility advised R1 that their needs were not being met, they needed a higher level of care, and that one-on-one supervision would be required. R1’s family believes the requirement of one-on-one supervision was retaliation due to issues they had raised with the facility. However, the facility’s policy and R1’s Admission Agreement indicate temporary one-on-one supervision would be instituted at the resident’s expense when it has been determined that a resident needs a higher level of care. The facility retained an outside agency to provide one-on-one supervision to R1, but the service was never provided as R1’s family refused and obtained their own private caregiver. Based on gathered information, R1 requires a higher level of care, due to their suprapubic catheter which required daily cleaning, bandage changes and frequent showers. In addition, R1 required additional supervision to prevent R1 from picking at their catheter site, which was observed to be red and irritated. There is no evidence to support that these care requirements were imposed in retaliation. Based on LPA’s observation, interviews conducted, and records reviewed, there was not sufficient evidence to support the above allegations. 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 allegations are deemed UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was discussed with and provided to facility representative. This is an amended report. This is an amended report. It was alleged that on August 8, 2025, R1 was observed to have a blood-stained catheter bandage, but that staff did not notice the stain or report it to R1’s doctor or responsible party, R1 was taken to the hospital, the hospital determined no additional treatment and R1 was able to return to the facility with no special care or changes in medication required. Per R1’s family, on August 4, 2025, R1 had surgery to replace a foley catheter with a suprapubic catheter. R1’s family stated that on August 8, 2025, R1 was observed with a blood-stained catheter bandage, which was not noticed or reported by staff. When interviewed, AD stated that the blood observed was only a small amount and was to be expected after surgery, paramedics arrived and agreed with AD’s assessment, but R1’s family insisted on taking R1 to the ER and R1 returned a few hours later. However, R1’s family stated it was actually AD who thought the blood was a major issue and wanted to send R1 to the hospital, R1’s family did not have concerns about the blood stain, and R1 returned from the hospital with no concerns or changes of condition noted by the doctor. R1’s Medical Records dated August 8, 2025, corroborate that R1 was seen at the ER, no treatment was needed, and there was no change in condition. No information was obtained corroborating that R1 had a change of condition or that the blood stain noted on R1’s bandages was unexpected after R1’s surgery. The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Oct 6, 2025 · control 22-AS-20250829102755

Allegation investigated: Resident received an unlawful eviction

Licensing Program Analyst (LPA) Jerome Haley made unannounced visit to begin the investigation into the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit upon entering the facility. Prior to beginning the complaint investigation, LPA was led on a tour of the facility by the Health and Services Director Hanofi Edogiawerie. After the tour, interviews were conducted and documents were requested, received, and reviewed. Regarding the complaint allegation above, the department reviewed the notice and interviewed staff and family. 4 of 5 individuals confirmed an eviction notice was served to Resident 1 (R1) due to a change in condition and needing a higher level of care. Staff 1 (S1) and Witness 1 (W1) both confirmed an eviction notice dated August 14, 2025, was served to R1. Continued on LIC9099C Substantiated Document review revealed an incomplete eviction notice was served to R1’s family on August 14, 2025. The eviction notice failed to include the following regulation requirements of Section 87224 of Title 22: • Resources available to assist in identifying alternative housing and care options which include, but are not limited to the following: 1) Referral services that will aid in finding alternative housing. 2) Case management organizations which help manage individual care and service needs. • A statement informing residents of their right to file a complaint with the licensing agency, as specified in Section 87468, subsection (a)(4), including the name, address, and telephone number of the nearest office of community care licensing and the State Long Term Care Ombudsman office. • If you object to this move, you have a right to file a complaint with the licensing agency, as specified in CCR 87468.1(a)(4) • As specified in Health and Safety Code Section 15696.683(a)(4): "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with summons and complaint. You have the right to contest the eviction in writing and through a hearing." Based on the evidence gathered through interviews and document review, the preponderance of evidence standard has been met, therefore, the above allegation is SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22. An exit interview was conducted, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 21, 2025 · control 22-AS-20250814135335

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Aug 22, 2025

Eviction Procedures - The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by: Based on interviews and records review, the facility issued an eviction notice without complying with Title 22 regulations, including the requirement to provide information about available resources for the resident and the right to file a complaint with the Licensing Agency. This poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 21, 2025

Plan of correction: Facility representative states, the eviction notice will be rescinded and notification will be emailed to R1's family, LPA Bentley, and LPA Haley. The plan of correction is due by 2:00pm on the POC due date.

Allegation investigated: Staff represented themselves as the resident to authorize the bank to issue a check to the facility

Licensing Program Analyst (LPA) Celine Rodriguez conducted an unannounced 10-day visit to the facility for the complaint and to deliver the findings. LPA Rodriguez explained the purpose of today's visit, and was greeted by Health and Wellness Director (HWD) Hanofi Edogiawerie. During the investigation, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed. It was alleged that staff represented themselves as the resident to authorize the bank to issue a check to the facility. LPA interviewed resident 1 (R1) who confirmed that the facility staff does not, nor has not touched any of R1’s finances, and provided confirmation that R1’s son is the power of attorney (POA) who handles R1’s finances. Continued on LIC9099-C... Unsubstantiated Interviews with staff, witnesses, and R1 revealed that R1 was scheduled to go to the bank with the Long Term Care Ombudsman (LCTO), to assist with withdrawing money to make a payment towards R1’s rent bill, however the visit to the bank never occurred due to R1 not showing up. Per documentation review, of R1’s financial ledger, R1 was admitted to the facility in November 2024, and is currently residing at the facility. In addition to the record review of R1's ledger, there were only a total of 2 checks issued to the facility from the day of R1's admission date to present day, however, the additional checks issued to the facility were never processed due to insufficient funds, or due to the payment being stopped or cancelled by the individual who wrote the check, therefore totaling R1’s current due balance to $42,774.41. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA 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 HWD Edogiawerie. A copy of this report was explained and provided.the state’s words, verbatim · CDSS document, Aug 19, 2025 · control 22-AS-20250814085623

Type of visit: Case Management - Other

On July 3, 2025 at 8:00am, Licensing Program Analysts (LPAs) Eboni Bentley and Rose Marie Ruppert made an unannounced case management visit to monitor compliance assurance following Non-Compliance Conference on 5/28/2025. Upon arrival, LPAs stated the purpose of the visit to Life Enrichment Director Tina Tanus and Concierge Paige Pheng, who contacted the administrator. Executive Director Peggy Ulland arrived a short time later. During the visit, LPAs obtained resident and staff rosters, staff schedule, and confirmed census of 150 residents in care. LPA Bentley inspected the facility, conducted health and safety checks on residents, and observed no health and safety issues. Staff training and audits are in order, there was enough staff to supervise all the residents during the time of the visit, and all records reviewed are within the conditions agreed to with CCL. All other areas from NCC plan agreement were reviewed and the facility was in compliance at the time of LPA's visit. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report was provided at the end of the visit.the state’s words, verbatim · CDSS document, Jul 3, 2025

Allegation investigated: Staff did not provide authorized representatives with a 30 day eviction notice

LIcensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to deliver findings for a complaint received in our Regional Office. LPA met with Peggy Ullland, Executive Director (ED) and explained the purpose of the visit. LPA reviewed Resident #2 (R2)s: ID and Emergency Information Form, Admissions Agreement, Physician's Report, Appraisal Needs and Services Plan, Durable Power of Attorney documentation and Eviction notice documentation. LPA also reviewed Unusual Incident Reports submitted for eviction in 2025 by the facility. LPA interviewed R2 who acknowledged receipt of eviction notice. The eviction notice was served on March 28, 2025 for non-payment of funds and for R2 to vacate on April 28, 2025. Power of Attorney (POA) stated they did not receive mailed eviction notice on May 9, 2025. ED Ulland emailed the POA, on May 9, 2025, and notified LPA Eboni Bentley regarding this. (Continued on LIC 9099-C) Unfounded (Continued from LIC 9099) The eviction date was moved to June 10, 2025. Based on LPA's conversation with R2, R2 understood that the notice was for non-payment and that R2 had until June 10, 2025 to pay or to vacate. LPA interviewed four of four witnesses and two of two staff during the complaint investigation who were aware of R2's situation. LPA obtained a witness statement regarding R2's eviction. This agency has investigated the complaint that: Staff did not provide authorized representatives with a 30 day eviction notice. We have found that the complaint was unfounded, meaning the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with Peggy Ulland, Executive Director, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, May 28, 2025 · control 22-AS-20250513092805

Allegation investigated: Resident sustained fractures due to staff neglect Resident fell multiple times due to staff neglect Unlawful eviction Staff did not provide resident's authorized representative with itemization of fee increase Facility internet is in disrepair

On 05/23/2025, Licensing Program Analyst (LPA) Cassandra Mikkelson contacted the licensee via phone and email to deliver final findings regarding a complaint that was received on 09/05/2024. During the course of the investigation the current and former executive directors, staff, and residents were interviewed and multiple documents were reviewed. **Report continued on 9099-C page** Unsubstantiated Resident sustained fractures due to staff neglect It was alleged that due to neglect/lack of care and supervision resulted in Resident 1 (R1) falling on 01/12/2022 and sustaining two femur fractures. During the course of the investigation LPA interviewed R1, witnesses, and prior Facility Director Heather Myers regarding R1's fall and injury on 1/12/2022 which occurred in their room and was unwitnessed. Witness statement indicated that R1 used their pendant to call for assistance to go to the bathroom. R1 got up on their own when staff did not respond in a timely manner, and R1 fell to the floor breaking both femurs. R1 stated they got out of bed on their own and went to the bathroom using their walker. When R1 was finished on the toilet, they stood up to get their walker and fell to the ground, breaking both of their femurs. R1 stated they could not recall using their pendant to call for staff assistance when they had finished using the toilet, nor when they were on the ground after the fall. R1 stated they screamed for help and staff arrived quickly. LPA reviewed the Unusual Incident/Injury Report related to this incident which states R1 told the Med Tech Staff 1 (S1) that R1 rolled out of their bed injuring their legs. LPA spoke with Heather Myers who was the Facility Director on 1/12/2022. Heather stated that R1 was brought a daybed and R1 would place their ankles under the foot rail. On the evening of 1/12/2022, it is believed R1 broke their legs when rolling out of bed with their ankles caught in the bedrail of the daybed. Heather stated when staff found R1 in their room, they were lying next to their bed still wrapped in their blankets. R1 was assessed by facility staff who immediately called 911 and notified a family member. R1 was transported to the hospital for further evaluation and diagnosed with femur fractures in both legs. S1 does not work at the facility any longer and LPA’s attempts to contact them were unsuccessful. Based on interviews and document review, there was no evidence to corroborate the allegation of neglect by staff resulting in R1's fall and injury. Therefore, the allegation of Neglect/Lack of Care and Supervision of Resident R1 falling on 1/12/2022 and sustaining two femur fractures will be unsubstantiated. **Continued on 9099-C2 page** Resident fell multiple times due to staff neglect Neglect/Lack of Care and Supervision or Resident 1 (R1), falling on 8/6/2023, and sustaining a sprained ankle. On 8/6/2023, Resident 1 (R1) suffered an unwitnessed fall in their bathroom. Witnesses stated that R1 used their pendant to get assistance from bed to go to the bathroom and a staff member responded promptly and transferred R1 from their bed to the toilet. When R1 was done using the toilet, they used their pendant for assistance to get off the toilet and be taken back to bed. R1 waited a long time and when no one responded, R1 got up on their own and fell injuring their ankle. R1 stated they transferred themself from their bed to their wheelchair and got to the bathroom on their own. When R1 was done using the toilet, they used their pendant and emergency pull chain in the bathroom to call for assistance with getting up from the toilet and back to bed. R1's legs started to hurt, so they attempted to get from the toilet to their wheelchair and fell. R1 estimates they were on the bathroom floor for approximately 30 minutes before a staff member found them and assisted them back to bed. R1 stated they were not experiencing any immediate pain and there was no visible injury. R1 said they began to experience pain later in the day, did not notify staff of their pain. R1 stated staff wanted them to be sent to the hospital for evaluation, but R1 refused and wanted to wait and see if it got better on its own. R1 was taken to the hospital a few days later, and R1 was diagnosed with an ankle sprain. LPA requested pendent call logs for this incident to determine the length of time it took staff to respond and was advised that the system is only able to retrieve the previous week of calls. By the time LPA requested them, the logs were no longer available. LPA did review currently accessible call logs dated 9/1/2023 through 9/7/2023 and the majority of the requests were responded to in ten minutes or less. There was no evidence to corroborate the allegation of neglect by staff resulting in R1's fall and injury on 08/06/2023 or 01/12/2022. This allegation is unsubstantiated. **Continued on 9099-C3 page** Unlawful eviction LPA reviewed a letter from the facility to R1’s POA dated September 01, 2023, which states the facility is serving a 30-day eviction notice to R1 based on a recent appraisal which determined that the facility could no longer meet the needs of R1. LPA reviewed an eviction notice dated August 24, 2023, and a Negotiated Risk Assessment for dated August 17, 2023, which states the POA for R1 has been advised that R1 is a high fall risk and the facility feels that R1 needs a higher level of care to avoid any future incidents of falls. R1 will need additional support to try to reduce the risk of falls. R1 may remain in the community until the facility reaches the point where it cannot provide care at all. Alternatives offered and/or attempted to decrease risk, including, but not limited to: Suggested higher level of care to support high fall risk. Attempted: Discussed this and was declined by POA. This allegation is unsubstantiated. Staff did not provide resident's authorized representative with itemization of fee increase LPA reviewed a letter from the facility addressed to R1 which states “Beginning 07/01/2023 your monthly total will be $5050.00 for rent and services. This will include all regular monthly items currently on your account. This notification lists R1’s current monthly charges of $4,410.00 with care charge of $420.00 for a total charge of $4,830.00 per month. Notification also included the proposed new charges of $4,630.00 and care charges of $420.00 for a total of $5,050.00 per month beginning on 07/01/2023. This letter serves as your 60-day written notice, as stated in your Rental Agreement. LPA also reviewed a Resident Statement dated 08/01/2023 for Resident 1 (R1). The statement lists R1’s monthly charge of $4,630.00 and a care charge of $420.00. This allegation is unsubstantiated. **Continued on 9099-C4 page** Facility internet is in disrepair On 09/05/2023 LPA toured the facility and conducted interviews. On that day LPA determined that the internet was working in the facility. This allegation is unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED. Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.the state’s words, verbatim · CDSS document, May 23, 2025 · control 22-AS-20230905093407

Allegation investigated: Facility staff does not respond to the call system in a timely manner

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Concierge and explained the purpose of the visit. LPA toured Resident #1 (R1's) apartment in Memory Care with the Maintenance Director (MD) to check that R1s pendant call system was working. LPA observed pendant and motion sensors to be operational. LPA interviewed resident, who was in the dining room, and asked resident to press pendant to make sure it is working properly. Pendant immediately showed R1's apartment number and location on the mobile app and staff immediately came to clear the pendant by deactivating it with a magnetic sensor. LPA asked three of three residents in the dining room if there were issues with pendants and how long it took staff to respond to calls for assistance. Three of three residents stated most response times are within fifteen to forty-five minutes. R1 stated it has taken as long as two hours to get staff to respond to a (Continued on LIC 9099-C) Substantiated (Continued from LIC 9099) pendant call. LPA obtained copies of R1's: ID and Emergency Information form, Physician's Report, Appraisal/Needs and Services Plan and a copy of the pendant log from February to May 20, 2025. LPA also obtained current resident and staff rosters. LPA reviewed the pendant log and found several dates and times where the response time was longer than two hours. Staff interviews stated caregivers know to clear pendants and will continue to work on this with staff. Family have been working with the facility regarding this matter and pendant logs show there has been improvement in the recent month and that most pendant calls are answered within a twenty minute period. Based on LPA observations, record review and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation that: Facility staff does not respond to the call system in a timely manner, is found to be Substantiated. A deficiency has been cited per California Code of Regulations. An exit interview was conducted with Cauleen Ritchie, Clinical Specialist and a copy of this report, LIC 858, LIC 9099-D and Appeal Rights were provided to the facility.the state’s words, verbatim · CDSS document, May 20, 2025 · control 22-AS-20250516105349

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: May 21, 2025

878464 Basic Services: (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on LPA record review and interviews with residents and staff, pendant call times were not responded to in a timely manner. This poses and immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 20, 2025

Plan of correction: Facility will conduct an in-service training with staff regarding call pendant procedures. Executive Director (ED) Ulland will send proof of documentation to LPA by POC date via email with training provided and procedures implemented to address this issue.

Allegation investigated: Resident call system was not operational

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Concierge and explained the purpose of the visit. LPA toured Resident #1 (R1's) apartment in Memory Care with the Maintenance Director (MD). Motion detectors sense movement in the bathroom and living areas in the apartment and staff are alerted using the application on mobile devices and tablets. MD also showed LPA a button outside the apartment entry where staff or residents can also press. MD demonstrated how this worked and concierge could be heard on the walkie calling out the apartment number for care staff to check within two minutes. If staff do not acknowledge within five minutes, the concierge calls it out again and will reach to the manager to respond to the call. (Continued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) LPA interviewed resident, who was in the dining room, and asked resident to press pendant to make sure it is working properly. Pendant immediately showed R1's apartment number and location on the mobile app and staff immediately came to clear the pendant by deactivating it with a magnetic sensor. LPA asked three of three residents in the dining room if there were issues with pendants and all had working pendants. LPA obtained copies of R1's: ID and Emergency Information form, Physician's Report, Appraisal/Needs and Services Plan and a copy of the pendant log from February to May 20, 2025. LPA also obtained current resident and staff rosters. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation that the resident call system was not operational is Unsubstantiated. An exit interview was conducted with Cauleen Ritchie, Clinical Specialist and Peggy Ulland, ED and a copy of the report was provided to the facility.the state’s words, verbatim · CDSS document, May 20, 2025 · control 22-AS-20250516105349

Allegation investigated: Staff do not meet a resident's catheter needs while in care

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegations listed above as well as to deliver findings to the licensee. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit to the facility's front desk. Executive Director Peggy Ulland was present and assisted with the visit. During the initial visit on March 15, 2025, LPA requested and obtained resident records, resident census and employee roster. LPA accompanied by staff conducted a tour of the facility's memory care unit. LPA additionally conducted two staff interviews and one resident interview. Documentation of an in-service training conducted on catheter care and perineal care was also provided by facility staff. Additional witness interviews conducted via telephone over the course of the investigation. CONTINUED ON FORM LIC9099-C Substantiated CONTINUED FROM FORM LIC9099 Regarding the allegation that Staff do not meet a resident's catheter needs while in care, the following has been concluded: Per a review of resident R1's transitional information gathered prior to R1's move-in on October 30, 2024 as well as a review of R1's physician report and pre-admission appraisal, it is indicated that R1 moved into the facility with a foley catheter already in place. The transitional information indicates that the resident's plan of care calls for the foley bag to be emptied once it reaches a third to a half of its full capacity. Based on photographs provided by witnesses dated January 14, 2025, there have been instances during which the foley bag was not emptied timely as foley bag appeared to be almost full at the time of the photograph being taken. Another instance of the catheter bag not being emptied overnight was found upon a review of R1's chart for May 2025. R1 had a documented history of urinary tract infections prior to their admission at the facility, therefore it is unsure whether the catheter management is related to any active infection occurring. Per statements made by facility staff during the initial investigation visit, an in-service regarding catheter care and perianal care was conducted after the incidents evidenced above. As a result, the allegation is found to be Substantiated, meaning that based on the evidence gathered during this investigation, the preponderance of evidence standard has been met. A corresponding deficiency is being cited on the attached form LIC9099-D. An exit interview was conducted with facility staff. A copy of the report along with appeal rights were provided. CONTINUED FROM FORM LIC9099-A Regarding the allegation that Staff do not meet a resident's incontinence need while in care, the following has been concluded: On February 25, 2025, R1 attended an appointment with their urologist for a scheduled replacement of their catheter bag. Upon arriving at their health care provider's office, the resident was found to be in soiled diapers. Per the caregiver's assessment on the day of the visit, peri care was provided on the morning of the appointment prior to the resident being brought out to the dining hall, where she was then directly picked up by family, it is therefore not possible to establish whether the diaper was soiled due to insufficient intervention from facility staff. Regarding the allegation that Staff are not meeting a resident's medical needs while in care, the following has been concluded: an interview with R1 along with a review of R1's resident records demonstrated regularly scheduled medical appointments. Incidents such as a fall occurring in December 2024 were also adequately reported to the resident's primary care physician. Additional charting notes and transmission records were provided for a hospitalization event that occurred in April 2025. There is therefore insufficient evidence to show that facility staff is failing to meet the resident's needs. As a result, both allegations listed above are found to be Unsubstantiated, meaning that while the alleged incidents may have occurred, or the concerns may be valid, there is not a preponderance of evidence to prove that the alleged violations took place. An exit interview was conducted and a copy of this report was provided to a facility representative.the state’s words, verbatim · CDSS document, May 13, 2025 · control 22-AS-20250303100218

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: May 30, 2025

Per CCR 87468.2(a)(4) on Additional Personal Rights of Residents in Privately Operated Facilities, residents are entitled: "To care, supervision, and services that meet their individual needs". This requirement is not met as evidenced by: Based on the reviewed plan of care, the investigation evidenced insufficient catheter care provided to R1 by facility staff. This constitutes a potential risk to the health, safety and personal rights of individuals in care.the state’s words, verbatim · CDSS document, May 13, 2025

Plan of correction: Adherence to R1's plan of care to be documented. Documentation to be provided to LPA before the plan of corrections due date.

Allegation investigated: Staff did not ensure that residents took their medication as prescribed

On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit. The Department received a complaint on 04/03/2025 and the initial 10 day visit was conducted on 4/11/2025. LPA Mendivil interviewed staff and residents as well as obtained copies of medication administration records (MAR) staff schedules and resident physicians report. Regarding the allegation that staff did not ensure that residents took their medication as prescribed, the investigation revealed the following: Interviews with 3 out of 4 residents stated they received their medications as prescribed, the 4th resident manages their own medications. 3 out of 4 residents stated staff finds them when it is time for their medications if they are not in their rooms. 4 out of 4 staff stated they ensure all residents are taking their medications as prescribed. Unsubstantiated 4 out of 4 staff stated they wait until the resident is done taking their medications to leave. All staff interviewed stated if a resident refuses a medication they will notate that in the MAR. 4 out of 4 staff stated none of the residents pocket or hide medications. Therefore based on the preponderance of evidence through records reviewed and interviews the allegation Staff did not ensure that residents took their medication as prescribed is determined to be UNSUBSTANTIATED, meaning 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. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 11, 2025 · control 22-AS-20250403142929

Allegation investigated: Facility lack appropriate staffing

Licensing Program Analyst (LPA) Rose Ruppert conducted a follow-up visit to deliver findings for a complaint received in our office on December 28, 2021. LPA was greeted and granted entry by the Concierge and met with Peggy Ulland, Executive Director (ED) regarding the purpose of the visit. It was reported that the facility was short-staffed, that staff members were required to work sick and were asked to work seven-days a week so that an outside staffing agency would not be used. On February 11 and 13, 2025, LPA obtained the current resident and staff rosters and requested to interview residents and staff who resided or worked at the facility in December 2021. During the investigation LPA interviewed four of four residents and seven of seven staff members. Four of four residents denied that there was a staffing issue and stated they did not observe staff working sick. All residents interviewed felt they received the care they needed and had no problems with the staff. (Coninued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) Seven of seven staff members were asked about the staffing shortage in December 2021 and if they were required to work seven days a week, or were asked to work while sick to avoid using a staffing agency. Seven of seven staff members denied the allegation and stated that, at that time the census was still low and and there were enough hired staff that an agency was not needed. Staff were not asked to work while sick and if a staff member wanted extra hours, they could choose to work, as needed. All seven staff members interviewed denied working seven days per week. LPA Ruppert requested staffing schedules from November 2021 through January 2022. Facility was unable to provide documentation since home office changed staffing software applications. A technical violation was given to the facility with Control Number 22-AS-20221207111938 since records missing did not pose an immediate or potential health risk to persons in care. Since ED Ulland’s arrival the facility has implemented uploading monthly and daily staff schedules into SharePoint to archive documents. Although the above allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred; therefore, the allegation that the facility lacked appropriate staffing is unsubstantiated. An exit interview was conducted with Peggy Ulland, Executive Director (ED) and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 24, 2025 · control 22-AS-20211228151621

Allegation investigated: Facility staff violated resident's rights Facility staff are restraining residents Facility is lacking PPE

Licensing Program Analyst (LPA) Rose Ruppert conducted a follow-up visit to deliver findings for a complaint received in our Regional Office on December 28, 2021. LPA was greeted and granted entry by the Concierge and explained the purpose of the visit with Peggy Ulland, Executive Director (ED). On January 4, 2022 the Department conducted a ten-day initial visit which needed further investigation. On February 11 and 13, 2025 LPA Ruppert visited the facility and requested to speak with residents who resided in the facility at the time of the incident. LPA interviewed two of two Memory Care Residents and two of two Assisted Living residents and asked if facility staff cursed or spoke inappropriately to them. Four of four residents denied the allegation. The four residents were asked if they were forced or restrained to take the COVID-19 vaccine. Four of four residents denied this allegation. Residents were asked if Personal Protective Equipment (PPE) was readily available to them. Four of four residents stated PPE was always available for their use. (Continued on LIC 9099-C) Unfounded (Continued from LIC 9099) LPA interviewed seven of seven staff members regarding the Maintenance Director (MD) in December 2021. Six of the seven staff members worked alongside the MD and denied the allegations that the MD cursed or spoke inappropriately to staff. One of the seven staff members interviewed was hired by MD and had no issues and denied the allegation that the MD cursed or spoke inappropriately to staff. Seven of seven staff members were asked if residents were coerced to take the COVID-19 vaccination and all staff denied this allegation. Seven of seven staff stated the COVID-19 shot was always a choice for residents and staff members. LPA inquired if there was plenty of PPE on-site. Seven of seven staff members stated they never had a shortage of PPE. LPA also observed the storage supply room had plenty of PPE for both residents and staff members. The Department has investigated the complaints alleging: that residents' rights were being violated by staff, that staff members restrained residents to take the COVID-19 vaccine and that the facility lacked PPE. The agency has found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with Peggy Ulland, Executive Director and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 24, 2025 · control 22-AS-20211228151621

Allegation investigated: Staff hits residents in care Staff pushes residents in care Staff does not treat residents with dignity and respect

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to deliver findings from a complaint received in our Regional Office on December 5, 2022. LPA was greeted and granted entry into the facility by the concierge and met with Peggy Ulland, Executive Director (ED) and stated the purpose of the visit. In December 2022 LPAs Rosie Quiroz and Alvaro Ramirez conducted six of six staff interviews, one outside vendor interview and interviewed the employee in question for a total of eight interviews. LPAs asked the eight people interviewed if: a staff member hits and pushes residents in care and does not treat residents with dignity and respect. Of the eight interviews, seven denied the allegations. One staff member confirmed the allegations and gave names of staff members to corroborate the report. LPA Ruppert interviewed two of two staff members who worked with the employee in question. Two of two staff members denied the allegations and had no problems with the employee in question. (Continued on LIC 9099-C) *****This is an amended report***** Unsubstantiated (Continued from LIC 9099) On February 13, 2025 LPA toured the Memory Care Unit and conducted four of four resident interviews. Two of the residents resided in Memory Care (MC) and two of the residents resided in Assisted Living (AL) and lived at the facility at the time of the incident. Four of four resident interviews denied the allegations. LPA reviewed the staff record of the employee in question and there were no disciplinary actions in their file. The employee no longer works at the facility and chose a different career opportunity in 2023. Based on LPA's record review and interviews conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Peggy Ulland, Executive Director and Cauleen Ritchie, Clincial Specialist and a copy of this report was provided to the facility. *****This is an amended report.*****the state’s words, verbatim · CDSS document, Feb 24, 2025 · control 22-AS-20221205140654

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:00 AM, LPA Tea was greeted and granted entry into the facility by the front desk staff and explained the reason for the visit. Facility is licensed for 150 non-ambulatory residents, of which 44 may be bed-ridden, and a hospice waiver for 15 residents. Currently there are 133 residents and 11 are on hospice during today's visit. The Executive Director (ED), Peggy Ulland arrived shortly after to assist during the visit. LPA Tea reviewed thirteen resident files and eight staff files. Resident files and staff files contained all required documentation. LPA Tea along with ED Ulland and Maintenance Director Matt Yem toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a two-story building, with a memory care wing on the first floor. In the middle of the building is a courtyard with shaded patio seating with fountains. Memory Care unit has a garden courtyard of its own in the back that is secured. LPA tested delayed egress around the memory care garden to be operational. Staff came immediately within seconds when the alert for delayed egress went off. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. The fire alarm system of the facility is monitored and maintained by a third-party company. Fire extinguishers are fully charged throughout the facility. Last disaster drill was conducted December 12, 2024. LPA observed evac chairs in every stairwell in the facility for emergencies. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Water temperature measured between 117.6 F degrees and 116.7 F degrees. LPA pulled emergency pendants in resident’s bathrooms; staff came in the room as promptly as they could. Common areas were clean and clear of hazards, doorways were free of obstructions. Facility kitchen and dining area was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed emergency food and water supplies stored in storage areas in the facilities. Annual inspection continued on LIC809-C LPA Tea observed residents playing bingo and partaking in activities in the activity room. LPA observed memory care residents partaking in bowling activities. The facility provides different activities for residents daily, which are posted throughout the facility. LPA reviewed medication storage and administration. Medications are stored in locked carts in each floor of the facility. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided. Based on the observation 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 An exit interview was conducted with ED Peggy Ulland and a copy of this report was given to the facility along with a copy of the LIC858, 858C; 859, 859C.the state’s words, verbatim · CDSS document, Jan 30, 2025

Allegation investigated: Facility staff did not provide adequate supervision to resident in care.

Licensing Program Analysts (LPAs) Rose Ruppert and Fred Arias made an unannounced complaint visit to deliver findings for the above allegation from May 25, 2022. LPA was greeted and granted entry into the facility by the concierge and met with Peggy Ulland, Executive Director and stated the purpose of the visit. During the investigation LPA Rosie Quiroz conducted a health and safety visit and interviewed Resident 1 (R1). The Department received a report that stated R1 spilled hot tea upon self and was sent to the hospital. LPAs Quiroz and Ruppert interviewed staff regarding the events from 2022 to determine if there was adequate supervision of the resident LPA Ruppert requested the resident’s file and the May 2022 staffing schedule. LPA Ruppert also subpoenaed resident records from Orange County Global Medical Center for the dates of May 20-22, 2022. Record review stated resident received third degree burns and was referred to the Burn Unit. (Continued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) LPA conducted three of three staff interviews, reviewed resident file and the Physician’s Report dated January 21, 2022. it was determined, by the medical assessment, that the resident was able to follow instructions and self-feed. At the time of the incident, three of three staff interviews stated staff were nearby to assist resident and contacted emergency personnel immediately. Although the above allegations may have happened there is not a preponderance of evidence to prove the alleged violation occurred; therefore, the allegation that facility staff did not provide adequate supervision to resident in care is Unsubstantiated. An exit interview was conducted with Peggy Ulland, Executive Director (ED) and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Dec 30, 2024 · control 22-AS-20220525095746

Allegation investigated: Staff failed to provide supervision resulting in not meeting residents needs

Licensing Program Analysts (LPAs) Rose Ruppert and Fred Arias made an unannounced complaint visit to deliver amended findings for the above allegation from December 7, 2022. LPAs were greeted and granted entry into the facility by the concierge and met with Peggy Ulland, Executive Director (ED) and stated the purpose of the visit. It was reported Staff 1 (S1) was not providing proper supervision to residents in care resulting in resident’s needs not being met. During the investigation LPAs Rosie Quiroz and Alvaro Ramirez interviewed six of six staff members and one witness regarding the events from 2022. Five of the six staff members denied the allegation that there was inadequate staff supervision in Memory Care and the witness only observed staffing issues on the PM shift in 2022. Six of six staff members and witness interviewed all did not report observing issues related to S1’s performance. In August 2024 LPA Ruppert interviewed five of five staff regarding current staffing and five of five stated there are no staffing issues at this time. One of five staff (Continued on LIC 9099) Unsubstantiated (Continued from LIC 9099) members interviewed reported they did not have any issues with S1 and that S1 was a leader and always helped the team. LPA Quiroz interviewed S1 who acknowledged the facility lacked staffing at times and that some residents can be more difficult to assist than others. S1 denied having any knowledge of abuse happening within the facility and was aware of requirements to report if observed. LPA Ruppert requested and reviewed the employee file mentioned in the complaint and there were no disciplinary actions for this employee. S1 resigned from the facility in 2023 due to obtaining another job. LPA Ruppert requested staffing schedules from November and December 2022. Facility was unable to provide documentation since home office changed staffing software applications. A technical violation was given since records missing did not pose an immediate or potential health risk to persons in care. Since ED Ulland’s arrival the facility has implemented uploading monthly and daily staff schedules into SharePoint to archive documents. Although the above allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred; therefore, the allegation that staff failed to provide supervision resulting in not meeting residents’ needs is unsubstantiated. An exit interview was conducted with Peggy Ulland, Executive Director (ED) and a copy of this report and LIC 9102-TV was provided to the facility.the state’s words, verbatim · CDSS document, Nov 18, 2024 · control 22-AS-20221207111938

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Rose Ruppert and Fred Arias made an unannounced case management visit and were greeted and granted entry into the facility by the concierge. The purpose of the visit was to deliver amended reports from August 15, 2024. LPAs met with Peggy Ulland, Executive Director (ED) at 2:30 PM. An exit interview and copy of this report, the amended LIC 9099s and LIC 9102-TV were provided to the facility.the state’s words, verbatim · CDSS document, Nov 18, 2024

Allegation investigated: Facility staff not trained to conduct proper response to emergency disaster. Facility failed to provide adequate staffing to meet resident's needs.

Licensing Program Analyst (LPA) Rose Ruppert made an unannounced complaint visit to deliver amended findings for the above allegations from September 13, 2022. LPA was greeted and granted entry into the facility by the concierge and met with Peggy Ulland, Executive Director and stated the purpose of the visit. During the investigation LPAs Rosie Quiroz and Rose Ruppert interviewed staff, residents and any witnesses regarding the events from 2022 and requested the staffing schedule, resident roster, staff disaster training records and fire drill reports as well as a copy of the Emergency Disaster Manual. Based on seven of seven staff interviews, all staff stated they are trained on how to properly respond to an emergency drill. LPA obtained and reviewed records by Fire Drill Service; the contracted company who conducted fire and disaster drill trainings from 2022-2024. Drills were conducted on almost a monthly basis. Staff stated memory care residents are not evacuated during these drills due to the manpower and amount of time it takes to evacuate the entire unit during drills. The facility has since worked with the (Continued on LIC 9099-C) Unsubstantiated (Continued from LIC 9099) Fountain Valley Fire Marshall to ensure the facility is able to demonstrate proper evacuation and disaster preparedness. Seven of seven staff interviews also stated that there are no staffing issues at the present time. At the time of the allegation in 2022, the corporate office stated that facilities experienced staffing shortages, due to the pandemic. LPA Quiroz obtained and reviewed facility staffing schedules to ensure there were staff scheduled to work. LPA Quiroz observed on September 21, 2022 that there were four staff members in Memory Care, five staff members for Assisted Living, two Medical Technicians (Med Techs), an Activity Director and a Resident Coordinator. LPA Quiroz observed three caregivers with fifteen Memory Care residents in the Activity Room participating in karaoke during the facility tour and residents were engaged in the activity. Although the above allegations may have happened there is not a preponderance of evidence to prove the alleged violations occurred; therefore, the allegations that: facility staff are not trained to conduct the proper response to an emergency disaster and that the facility failed to provide adequate staffing to meet resident’s needs are unsubstantiated. An exit interview was conducted with Peggy Ulland, Executive Director (ED) and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Nov 1, 2024 · control 22-AS-20220913154817

Type of visit: POC

Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose to clear the deficiency cited during the 10-day complaint investigation conducted on September 25, 2024 from 7:32am to 12:30pm. LPA was greeted and allowed entry by Concierge Paige Pheng and notified the lead management staff on duty. LPA met with Life Enrichment Director Tina Tanus and explained the purpose of the visit. 87303 Maintenance and Operation(a) The facility shall be... in good repair at all times. - The elevator was tested at 7:47am. Malfunctioning issue resolved on September 26, 2024. Facility has complied with the terms of the plan of correction. The deficiency is now cleared. An exit interview was conducted with Life Enrichment Director Tina Tanus and Executive Director Peggy Ulland by telephone, and a copy of this report including the Letter of Deficiency Citations Cleared were provided at the end of the visit.the state’s words, verbatim · CDSS document, Oct 10, 2024

Allegation investigated: Staff did not ensure the elevator is working properly.

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the 10-day complaint investigation into the above allegation. LPA was greeted and granted entry by Receptionist Paige Pheng and explained the purpose of the visit to Executive Director (ED) Peggy Ulland. During today's visit, LPA conducted a self-guided tour of the facility and observed a 'Do Not Enter Elevator Not Working' sign on one out of the two elevators on the property. Elevator was also tested during today's visit. LPA interviewed four staff and the representatives at the elevator company, and pertinent records were obtained which includes: Resident/Staff Roster, email receipt, and the elevator inspection report. The investigation revealed the following: It is alleged that staff did not ensure that the elevator is not working properly. LPA, ED, and Maintenance Director (MD) Matt Yem observed that the power to the Program Logic Control (PLC) Board which runs the elevator was not turning on approximately 11:35am. Per review of MD's video recording, the PLC board was working at 11:09am today. LPA, ED, and MD made a phone call to the elevator company's dispatch center, OTIS. Substantiated The dispatch operator reported that per her records, the initial repair was conducted on September 19, 2024 approximately 7:57pm and was completed successfully which was verified on the inspection report. A second service request was submitted to OTIS on September 20th, and the technician came to the facility the same day at 1:15pm per dispatch operator. However, the elevator issue was not resolved as the service technician indicated per MD Yem that the electrical issue was beyond his scope of work. Interviews conducted with four out of the four staff revealed that the elevator was successfully repaired on the 19th. Facility made attempts to reach out to the licensee's representative, seeking assistance on September 24th and 25th via email. Phone calls were made with two representatives from OTIS and Sunshine Retirement. Both representatives acknowledged that the facility is responsible for completing the repairs as it was not part of the contract, and facility was advised by OTIS to call an outside electrician. It was determined during the investigation that Elevator 2 is not working at this time. Facility was observed arranging a service with the electrician during the visit. It appears based on the investigation, that there was poor communication and/or misunderstanding of the contract which delayed the repair of the elevator since the 20th. Therefore, based on LPA's observations, interviews which were conducted, and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Staff did not ensure the elevator is working properly is deemed SUBSTANTIATED as per Title 22, Division 6, Chapter 8 of the California Code of Regulations. A deficiency is being cited on the attached LIC 9099D. An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report, LIC9099D, and the appeal rights were provided at exit.the state’s words, verbatim · CDSS document, Sep 25, 2024 · control 22-AS-20240923083308

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 4, 2024

87303 Maintenance and Operation(a) The facility shall be... safe,... 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: Based on LPA's observations, interviews, and record review, the elevator is currently malfunctioning which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 25, 2024

Plan of correction: Administrator stated that the elevator will be repaired and will notify LPA via email on or before the POC due date when the issue has been resolved.

Type of visit: Required - 1 Year

On today’s date, Licensing Program Analyst (LPA) Rosie Quiroz conducted a subsequent Annual Required visit after conducting a 10-day visit for complaint control #22-AS-20240501091507. LPA was greeted and met with Cauleen Ritchie, Regional Clinical Specialist (RCS), Peggy Ulland, Interim Director (ID), Jamie Pyles, Health and Wellness Director (HWD) and discussed purpose of today's visit. Dawn Blankenship, Regional Director of Operations (RDO) arrived during today's visit. Administrator (AD) Maria Arriaga has an Administrator certificate with expiration date of November 7, 2024. The facility is licensed to provide services to residents age range 60 and over. Approved for 150 (One hundred and fifty) Non-Ambulatory residents of which 44 (forty-four) may be bedridden. Approved Hospice Waiver for 15 (fifteen) residents. There are currently 12 (twelve) residents receiving hospice care services. Between 10:57am-1:55pm, LPA Quiroz along with (ID) Ulland and (HWD) Pyles toured the interior and exterior of facility premises consisting of memory care unit and Assisted Living area. During and after the inspection tour, LPA Quiroz conducted interviews with residents and staff. The required two (2) day perishable and seven (7) day non-perishable food supply was observed. Toxic substances were locked and inaccessible to residents in care. LPA observed cooking areas to be maintained with cleanliness. LPA observed facility refrigerator and freezer to be operational and met regulatory requirements. Resident's bathrooms were observed to have working sinks, faucets and flushing toilets. LPA tested hot water temperatures which ranged between 107.0 degrees- 114.0 degrees Fahrenheit. Grab bars and non-skid mats were also observed in resident bathrooms. Personal hygiene items for resident use were observed in each bathroom. LPA observed all resident rooms to have required linens, furnishings, and adequate lighting. All linens and furnishings were clean and in good repair. The medications were inaccessible to residents in care, centrally stored and maintained in compliance. All pathways, doorways, and emergency exits were observed to be free of obstruction. (CONTINUED ON LIC 809 C) CONTINUED...There were no bodies of water observed anywhere on the property. PPE stored in storage area on the second floor next to the medication room area. Between 2:05-3:30pm, LPA Quiroz reviewed ten (10) resident files and ten (10) personnel files. The residents and staff files were found to be in compliance. LPA observed staff answer facility telephone which verified a working telephone was maintained at the facility. Regulatory required postings were observed to be posted in the lobby area. Facility was operating within the allowed capacity. Fire extinguishers were charged, mounted throughout the facility and last serviced on April 30, 2024. Facility indicated Pest Control services facility monthly or as needed and last serviced on April 10, 2024. LPA verified that fire/disaster drills are conducted at least quarterly and on each shift by Maintenance/Safety Director. Last fire drill was conducted on May 2, 2024. The Emergency exit plans were posted and available for reference throughout the facility. Residents were accorded clean and comfortable accommodations. Based on the observations made during today’s visit, no citations were issued during today's visit. An exit interview was conducted with (ID) Peggy Ulland and (HWD) Pyles. A copy of today's report, LIC 858 and LIC 859 pages were provided at exit.the state’s words, verbatim · CDSS document, May 6, 2024

Type of visit: Case Management - Deficiencies

On today's date, Licensing Program Analysts (LPAs) LPA Rosie Quiroz and LPA Rose Ruppert conducted a subsequent unannounced visit after conducting 10 day visit for complaint control # 22-AS-20240411095716. LPAs met with Health and Wellness Director (HWD) Jamie Pyles and discussed purpose of the visit. On or about 3:10pm while conducting interviews with residents in Activity room, LPA Quiroz observed temperature in activity room to be 80 degrees fahrenheit and observed temperature gage to be locked. At 3:20pm, the temperature was observed to increase to 82 degrees Fahrenheit, this was verified with Activity Director who indicated "Temperature is controlled from Marketing not here." On or about 3:55pm, Maintenance Director Matt Yem arrived to activity room to decrease room temperature. At 4:17pm, the temperature was recorded to be 78 degrees fahrenheit. Ten of ten interviewees indicated "the activity room is always hot and not of comfortable temperature." During today's inspection visit, while conducting tour of the facility and conducting interviews for complaint control # 22-AS-20240411095716 the following deficiency was observed and is being cited via this case management deficiency. 87303(b):Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times. The facility is being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted with HWD Jamie Pyles, and a copy of this report, 809-D Page, Appeal Rights were provided at exit.the state’s words, verbatim · CDSS document, Apr 18, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(b) · Plan of correction due date: Apr 25, 2024

87303(b)-Maintenance and Operation : (b) A comfortable temperature for residents shall be maintained at all times. This requirement was not met as evidenced by: On or about 3:10pm while conducting interviews with residents in Activity room, LPA Quiroz observed temperature in activity room to be 80 degrees fahrenheit and observed temperature gage to be locked. At 3:20pm, Temperature was observed to increase to 82 degrees Fahrenheit, this was verified with Activity Director who indicated "Temperature is controlled from Marketing not here." On or about 3:55pm, Maintenance Director CONT...the state’s words, verbatim · CDSS document, Apr 18, 2024

Plan of correction: HWD agreed temperature in activity room is at a comfortable temperature prior to holding Activity and provide training on 87303 to all staff and submit proof of training by 4/25/2024. CONT... Matt Yem arrived to activity room to decrease room temperature. At 4:17pm, the temperature was recorded to be 78 degrees fahrenheit. Ten of ten interviewees indicated the activity room is always hot and not of comfortable temperature. This poses a potential risk to residents in care.

Type of visit: Case Management - Incident

This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Rosie Quiroz for the purpose of a health and safety check and to follow up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 03/05/24 regarding an incident involving Staff 1 #1 (S1). LPA was greeted by front desk receptionist and met with Jamie Pyles, Health Service Director (HSD) and Sacha Dunlap, Business Office Manager (BOM). LPA Quiroz called and spoke to Administrator (AD) Marissa Drinkhouse-Quintana and discussed the purpose of the inspection visit. During today’s inspection, LPA Quiroz along with (HSD) Jamie Pyles toured the interior and exterior of the facility premises and observed multiple staff and residents present throughout today's inspection tour. LPA conducted health and safety checks on the residents present and observed no imminent health and safety concerns. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations, the electricity and water were running, the facility had soap and paper towels, and the medications, sharps, and toxins were properly stored. LPA Quiroz interviewed (AD) Drinkhouse-Quintana via telephone who indicated Ombudsman and local police department were notified of incident. LPA Quiroz was provided with cross reporting case number to Fountain Valley Police Department. There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with (HSD) Pyles and a copy of this report was discussed and provided at exit.the state’s words, verbatim · CDSS document, Mar 5, 2024