Ranchview Senior Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced, required Annual Inspection. The facility file and personnel report was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Administrator Maria Flores. The facility's license shows a maximum capacity of forty-two (42) non-ambulatory residents, eight (8) of which may be bedridden. Additionally, the facility is approved for delayed egress and a secured perimeter, along with a hospice waiver for twenty (20). During today’s inspection there were twenty (20) residents in care, with two (2) currently receiving hospice services, and no bedridden. LPA, Administrator Flores, and Administrative Assistant Valeria Vera Baylon toured the interior and exterior of the facility and inspected all common areas and a sampling of occupied and unoccupied resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to clients were mostly compliant: Common bathroom sink on one wing was 113.4F and a hallway sink in the other wing read at 111.6F. LPA tested an additional common bathroom sink (near room #20) and it read at 79.5F. A Technical Violation (TV) was issued for the tap being under the required range of 105-120F. [Continued on LIC 809-C] [Continued from LIC 809] The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least two (2) days of perishable food, and at least seven (7) days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. LPA observed that knives and toxic chemicals stored in the kitchen were double locked. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or large bodies of water exist on the premises. LPA observed two (2) small decorative water fountains in the main courtyard, and both had a mesh covering to prevent access to the accumulated water. Per Administrator Flores, no firearms or ammunition are kept at the facility. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months, dated for service in May 2026. Last staff fire drill is logged forJuly 2026. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed one (1) staff and one (1) client, and interviews did not reveal any licensing or regulatory concerns. LPA reviewed facility records and confidential records were stored in locked areas. While reviewing the staff roster, LPA noted that one staff member (identified as S1) was not associated to the facility. Review of the Guardian background check database revealed S1 did have an eligible background clearance, just that they were not associated to the facility. Per review of S1's staff file, they began work at the facility in December 2023. One type A Deficiency is being cited per California Code of Regulations, Title 22, Division 6 on the attached LIC 809-D for S1 working at facility without having their clearance associated to the facility. In addition, a Civil Penalty is being assessed for the total amount of $500.00. Details are noted on the attached LIC 421BG form. The facility was able to submit an LIC 9182 request to the Regional Office to associate S1 during the visit. One Deficiency was cited during the inspection along with one (1) Technical Violation (TV). An exit interview was conducted with Administrator Flores to whom a copy of this report, the LIC 9102 (TV form) and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.the state’s words, verbatim · CDSS document, Sep 22, 2026

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Nacole Patterson and Jose De La Cruz conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by and discussed the purpose of the visit to Marketing Manager Maria Flores. The facility's license shows a maximum capacity of 42 non-ambulatory residents, ages 60 and over of which 8 may be bedridden. Delay egress and secured perimeter approved and hospice waiver for 20 residents. During today’s inspection there were 21 residents in care. LPAs and Maria Flores toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Maria, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs interviewed staff and clients, and reviewed facility records. The files reviewed by LPAs contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Marketing Manager Maria Flores to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jul 31, 2025

Allegation investigated: Staff did not administer resident's medication resulting in seizure. Staff left resident in soiled diaper for extended period of time. Neglect/lack of supervision resulted in sexual activity between residents. Licensee did not answer communications from resident's representative promptly. Staff did not have proper training to administer medications.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations made on 03/06/2025. LPA introduced themselves and disclosed the purpose of the visit to Marketing Manager Maria Flores. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, outside sources, and records review. It was alleged that staff did not administer medication to Resident 1 (R1), resulting in a seizure. Staff interviews revealed that the correct medication and dosage was administered to R1 at the correct time. Staff informed that the color of medications changed at times due to pharmacy preparation or generic versions of the same prescription. An independent investigation was conducted by an outside source protective agency. The outside source informed that their investigation did not produce evidence that a medication error occurred. Review of the Medication Administration Record (MAR) for the date in question revealed that R1 received the correct dosage at the correct time. (Continued on LIC9099 p.1) Unsubstantiated Continued from LIC9099 p.1) The prescription was administered at 8:00am and 8:00pm per the prescription order. LPA observed the medication packs in question, which contained R1's name and prescription. The tablets for the prescription were noted to be green in color. The investigation did not give evidence that a medication error occurred or that R1's seizure was related to medication. It was alleged that staff left Resident 1 (R1) in a soiled diaper for an extended period of time. Six (6) staff members were interviewed regarding the allegation. Staff members consistently informed that R1 was checked and assisted with incontinence care every 1-2 hours or more frequently due to R1's diet causing frequent bowel movements. Staff informed that R1's responsible party contacted the facility multiple times per day to make requests regarding R1's care, including for R1 to be changed. No staff had observed R1 not being changed timely or left in soiled briefs for an extended amount of time. An independent investigation was conducted by an outside source protective agency. The outside source informed that their investigation did not produce evidence that staff left R1 in a soiled brief for long periods of time. Review of facility records did not corroborate the allegation. R1's care schedule during the timeframe in question showed that R1 was checked for incontinence care in the morning, noon, evening, and night shift. Records also showed that the facility tracked the frequency and size of R1's bowel movements. A notice of care increase dated 08/27/2024 outlined the care tasks being provided to R1, which included incontinence care. R1's appraisals, Needs and Services Plan, and Physician's report all specified that R1 was incontinent and required assistance with toileting. Text messages between R1's responsible party and staff showed that staff were responsive to the responsible party's requests regarding R1's care. The information gathered evidenced that staff met and provided assistance with R1's incontinence care needs. No evidence was found that R1 was left in a soiled brief for an extended period of time. It was alleged that neglect/lack of supervision by staff resulted in sexual activity between Resident 1 (R1) and Resident 2 (R2). Interviews with staff who were present at the facility during the time of concern confirmed that R2, who had a baseline behavior of walking around the facility, did enter R1's room and lay on R1's bed. However, staff informed that R1 was not in the room during the time nor was R1 in their bed during this incident. (Continued on LIC9099 p. 3) (Continued from LIC9099 p.2) Staff informed that the person who made this claim manipulated the incident. Staff informed that R2 was known to walk the facility and sometimes lie in other residents' beds, but never when another resident was in the bed. Staff informed that R1 was in the living room when R2 was found in their bed, and no contact was made between the residents. An independent investigation was conducted by an outside source protective agency. The outside source (OS1) informed that their investigation did not produce evidence that any sexual activity occurred between R1 and R2. OS1 informed that a person known to R1 found R2 in R1's bed, but R1 was not in the bed. OS1 believed that the situation was manipulated for personal gain. No records were found to refute or confirm the allegation. During an unannounced facility visit LPA directly observed R2 walking around the facility. R2 could not be qualified as a valid historian due to impaired cognition. LPA did not observe R2 enter other resident rooms during the visit or have any altercations with another resident. It was alleged that Licensee did not answer communications from resident's representative promptly. Five (5) staff were interviewed regarding the allegation. Staff members unanimously informed that R1's representative called the facility numerous times per day, texted them on their personal phones, visited the facility, and made frequent requests and demands regarding R1's care, which were accommodated. Staff provided examples, such as the kitchen staff being asked to make a fresh fruit smoothie (no frozen fruit) for R1 each morning per request, specific staff being requested to administer coconut oil on R1's hair and braid it daily, ensuring R1 was placed in specific positions at certain time of day with pillows and stuffed animals strategically placed under a specific arm. Staff additionally informed that R1's representative also made unreasonable requests such as requesting a staff member's birthday be celebrated on a different day than R1, even though their birthdays were on the same day and the facility had a longstanding tradition of creating facility-wide events for all resident and staff birthdays. Staff informed that R1's representative called the facility approximately 3-4 times per day for status updates and to make requests for R1's care, and additionally called them on their personal cell phones when they were not on shift. Staff members consistently stated that inquiries from R1's representative were responded to promptly. (Continued on LIC9099 p. 4) (Continued from LIC9099 p.3) An independent investigation was conducted by an outside source protective agency. The outside source (OS1) informed that their investigation did not produce evidence that R1's representative was not responded to timely. OS1 informed that the representative was demanding and difficult to please. A second outside source familiar with R1 informed that the representative asked a lot from the facility and was very pushy, calling continuously. The outside source informed that it may have been a matter of misperception regarding the level of response from the facility. Records review revealed communication between R1's representative and the facility via care letter with a timeline of specific care needs and requests made by the representative that had been accommodated by the facility. Text messages between the representative and facility staff also showed the facility's responsiveness to the representative's requests. The investigation did not evidence that staff did not respond promptly to R1's representative's requests. It was alleged that staff did not have proper training to administer medications. Staff interviews revealed that the staff in question had the required training in place before administering medication. The staff in question informed that they were trained by a pharmacy at a different facility, and completed their training at this facility by shadowing and being observed by tenured medication technicians. Management confirmed that the staff in question had the required training prior to passing medications, and provided the staff's medication training credentials. Records review corroborated staff statements regarding the staff member's training, a completion certificate revealing that the staff member completed an 8-hour medication training with a pharmacy on 02/28/2024. Onboarding training documents showed that the staff member completed additional medication training specific to Dementia residents. The investigation did not evidence that the staff in question was not trained for medication administration, per requirement. R1 was unable to be interviewed due to no longer living at the facility. Records review and interviews showed that R1 was non-verbal and suffered from a major neurocognitive disorder, resulting in them being an invalid historian. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jul 3, 2025 · control 08-AS-20250306134947

Allegation investigated: Staff refused to provide assistive device to resident.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Marketing Manager/Administrator Maria Flores. On 03/14/25 it was alleged that staff refused to provide an assistive device to a resident. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, outside sources, and records review. Three (3) staff members with medication technician training who worked morning and evening shifts were interviewed regarding the allegation. Staff interviews did not corroborate the allegation, as staff informed that Resident 1 (R1) used the CPAP machine at night and staff always assisted or attempted to assist them with it. Staff informed that R1 maintained the ability to place the CPAP machine on themselves, and sometimes refused staff assistance. Staff interviews also revealed that R1 would, at times, remove the machine from their head after it was placed. Staff confirmed that the portion of the machine that made contact with R1's face was routinely cleaned during each use, and the parts that could not have contact with water were wiped down. (Continued on LIC9099 p.2) Unsubstantiated (Continued from LIC9099 p.1) Staff informed that R1's machine was kept clean and dry when not in use. Staff informed that R1 used their CPAP machine every night. Records review corroborated staff statements regarding R1's consistent use of the machine and its cleaning regimen. R1's Medication Administration Record (MAR) revealed that R1's CPAP machine was consistently administered each evening and cleaned. The record showed that the machine was checked each morning to ensure it was working effectively. Facility Narrative Charting and Outside Agency Reports showed communication between the facility, R1's Primary Care Physician, and R1's pharmacy regarding the CPAP machine. The records showed that the facility was in communication with all relevant agencies regarding R1's former CPAP machine being in disrepair. The records additionally showed that a hold was placed on R1's CPAP machine while R1's outside provider made arrangements for it to be repaired. No records were found to show that the machine was not cleaned after each use or that staff did not assist or attempt to assist R1 with putting the machine on each night. Two outside sources were interviewed regarding the allegation. An outside protective agency also investigated the claims and informed that no evidence was found to corroborate the allegation, and that R1's machine was observed to be clean and regularly administered by staff each night. A second outside source familiar with the issue informed that R1's CPAP machine was new and additional information was not provided regarding details of the claims such as witnesses, dates/times occurred, or specific staff members who had been accused. LPA directly observed R1's former and new CPAP machines during an unannounced facility visit. The formerly used machine showed wear, however, the nasal canal that made contact with R1's face was clean and dry. The new machine was not observed to have any wear and the nasal canal was clean and dry. Both machines were stored in individual, labeled boxes in a secure location. LPA also observed three (3) signs above R1's bed with detailed instructions regarding the CPAP machine's administration. The signs included photos and wording to show what the mask should look like when it is placed on correctly. R1 was not able to be interviewed due to not being at the facility during the visit. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager/Administrator Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Mar 21, 2025 · control 08-AS-20250314154803

Allegation investigated: Licensee did not meet resident's incontinence needs.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced 10-day visit to initiate a complaint investigation and deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Administrator Genoveva Guerrero and Marketing Manager Maria Flores. On 02/21/2025 it was alleged that Licensee did not meet a resident's incontinence needs. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff, resident, outside sources, and records review. It was alleged that Resident 1 (R1) arrived at an outside care agency with soiled clothing, indicating that the Licensee had not provided incontinence care to the resident. The three staff members who were involved with preparing R1 for transport the day of the incident were privately interviewed. All three staff members provided a consistent timeline of events leading up to R1's transport at the facility. All staff members informed that R1 was clean and dry prior to being picked up for their appointment, and their incontinence needs had been met. (Continued on LIC9099-C p.2) Unsubstantiated (Continued from LIC9099 p.1) One of the staff interviewed directly changed R1 themselves prior to the appointment. Additionally, LPA was contacted by facility management prior to the incident, on 2/20/2025 regarding the situation. Management informed that Law Enforcement came to the facility to investigate the allegation and did not express any concerns regarding R1's care. Management informed that R1 was clean and dry prior to the appointment in question. Management also informed that R1 frequently refused to take their prescribed medication at the correct time, which would have prevented the frequent major incontinence episodes. Management informed that they had been trying to navigate this situation with R1 for some time, as they could not violate R1's personal rights by forcing R1 to take their medications; facility staff have been diligent with assisting R1 clean up after each incontinence episode. Review of facility records did not corroborate the allegation. The records reviewed corroborated staff statements regarding the timeline of events the day of incident. Review of R1's Medication Administration Record (MAR) corroborated staff statements that R1 refused to take the prescribed medication at the recommended time, 11:00am, in order to prevent incontinence episodes. The MAR showed that during the month of February 2025 to present day, R1 refused to take their medication at the recommended time 23 (twenty-three) out of 27 (twenty-seven) times. The MAR showed that R1 consistently accepted the medication at 12:00pm, after they had eaten instead of before, which resulted in the major incontinence episodes. R1 accepted the medication at the recommended time 4 (four) out of 27 (twenty-seven) times. Additional facility records show documentation of R1's medication refusals at the recommended time and refusals to shower after having subsequent incontinence episodes. The records showed that R1 was assessed for skin issues, incontinence needs, and showered/groomed the day of concern and the day prior to the incident. Outside source interviews did not corroborate the allegation. An outside agency involved with R1's care informed that R1 has presented to the agency for appointments soiled on different occasions, leading them to believe that the facility was not ensuring R1's incontinence needs were met prior to the appointments. However, the agency admitted that they did not reach out to the Licensee regarding their concerns and were not aware of R1's pattern of refusing the medications necessary to prevent the incontinence episodes. The agency admitted that they did not confirm if the facility had assisted R1 with incontinence care prior to transport, and an assumption was made regarding the facility not meeting R1's incontinence care needs. Requests to additional outside sources for interview were not returned. (Continued on LIC9099-C p.3) Continued from LIC9099-C p.2) LPA interviewed R1 privately during the visit. R1 informed that things were going well at the facility. R1 stated that staff assisted them with incontinence care when needed and helped them with hygiene care. R1 confirmed during interview that the Licensee was meeting all of their care needs. LPA directly observed R1 during this unannounced facility visit. R1 was observed to be clean, groomed, and appropriately dressed for the temperature. LPA did not observe any health or safety issues for R1. Additionally, LPA has directly observed and spoken with R1 during previous facility visits for unrelated circumstances. During past visits LPA observed R1 to be clean, groomed, and appropriately dressed for the temperature. LPA has not observed any health or safety issues for R1 during previous facility visits. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Genoveva Guerrero, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Feb 27, 2025 · control 08-AS-20250221111631

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit. LPA was greeted by and met with Licensee Jeffrey Settineri and Marketing Director Maria Flores to discuss the purpose of the visit. Today's visit is in response to the self reported death of Resident 1. Resident 1 passed away on 1/16/25. LPA conducted a wellness check at the facility; no health or safety issues were identified. No deficiencies were cited or observed on this date. An exit interview was conducted with Licensee Jeffrey Settineri and Marketing Manager Maria Flores who was provided with a copy of this report and Appeal Rights (LIC9056 03/22). Their signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jan 22, 2025

Allegation investigated: Neglect resulted in bodily injury. Staff did not seek medical attention for resident. Licensee did not report resident's change in condition to responsible party.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced themselves and disclosed the purpose of the visit to Marketing Manager Maria Flores. On 2/21/23 it was alleged that staff neglect resulted in bodily injury, staff did not seek medical attention for a resident, and Licensee did not report a resident's change in condition to responsible party. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Regarding the allegation, "Staff neglect resulted in bodily injury ", it was alleged that neglectful care led to significant bruising of Resident 1 (R1). Eight (8) of 8 staff involved and/or with knowledge of the incident consistently reported the circumstances of the event. (Continued on LIC9099-C p.2) Unsubstantiated (Continued from LIC9099 p.1) Staff informed that the incident occurred when the caregiver involved, Staff 1 (S1), was assisting R1 with an Activity of Daily Living (ADL). Interviews revealed that S1 followed the 1-person assist procedures by ensuring that R1's walker was in front of them prior to the assist with both hands positioned on the walker. Interviews further revealed that R1's legs buckled under them during the ADL, causing them to start falling forward. S1 was able to catch R1 on their left side, preventing them from falling to the ground. Additionally, staff interviews revealed that the incident was elevated internally, documented, and timely notifications were made to the Department, Hospice, and R1’s Responsible Party. Management staff informed that after the incident R1's care plan was updated to require 2-person ADL assistance. While interviews confirmed that R1 suffered bruising from the incident, the injury was not a result of neglectful treatment, but of staff properly following ADL procedures, which prevented R1 from falling to the ground and suffering greater injury. Interviews further revealed that R1 was prescribed blood thinners, which caused them to easily bruise. Staff interviews did not show that staff were neglectful in R1's care, or that lack of care resulted in R1's bodily injury. Records review revealed that the Licensee submitted an Unusual Incident/Injury Report to the Department on 2/24/23, within the required timeframe. The Incident Report was consistent with staff statements regarding the event and showed that the Licensee contacted the hospice agency and R1's family regarding the bruises. Written communication between the hospice agency and the facility showed that R1's bruising was being monitored after the incident. Hospice x-ray records dated 2/22/23 showed no fracture had occurred from the incident. Internal facility documentation revealed written, consistent, staff accounts of the incident. Hospice and facility records showed that R1 was prescribed blood thinners, which were placed on hold after the incident due to the bruise spreading. Three (3) outside sources were interviewed during the investigation, including R1's Responsible Party and the hospice agency involved in R1's care. Outside sources revealed that the facility elevated the incident after the bruises from the incident began to develop. Outside sources revealed that staff informed the family of the bruising the morning of the incident, and that a care conference was held between the facility, R1's family, and Hospice the next day, where the family declined to have R1 sent out to the hospital. Outside source statements confirmed that x-rays were taken on 2/22/23, revealing no fractures. (Continued on LIC9099-C p.3) (Continued from LIC9099 p.2) Regarding the allegation, “Staff did not seek medical attention for resident”, it was alleged that facility staff did not call for emergency medical care after R1’s incident. Staff interviews revealed that R1's bruise did not immediately present after the incident but developed throughout the day. Staff interviews revealed that S1 caught R1 during the incident and R1 did not show indication that they were in pain or injured. Staff interviews further revealed that the hospice agency and the family were notified the morning of incident when the bruising was observed by R1’s shower aide; the hospice agency assessed R1 on 2/17/23. Staff interviews additionally revealed that staff were in continuous communication with the hospice agency and the family days after the incident, including a care conference where the family declined to have R1 sent out to the hospital. Staff consistently stated that mobile x-rays were requested by the facility and arranged by the hospice agency; the x-rays were taken on 2/22/23 and confirmed that R1 did not suffer a fracture from the incident. Review of facility records corroborated staff statements, revealing that the family and facility requested x-rays for R1, and the hospice agency arranged for x-rays to be taken on 2/22/23. The x-rays showed that R1 did not suffer fractures from the incident. Facility records showed that staff remained in communication with the hospice agency and assisted with monitoring R1 days after the incident. Additionally, facility records showed that R1's care plan was updated after the fall, upgrading them from a 1-person assist to 2-person assist for transfers and ADLs. Hospice records dated 2/3/23 showed that the facility had a fall mat, hi/low hospital bed, wheelchair, and over the bed table in place for R1 due to their medical condition. Outside source and facility records showed that based on the timeline of events, the hospice agency and family were informed of the incident and subsequent bruising within approximately two (2) hours of the event occurring. Records showed that facility staff followed the protocol for residents on hospice by notifying the hospice agency and following the instruction given. Outside source interviews corroborated staff statements that the family declined for R1 to be sent out to the hospital following the incident. Outside source interviews also corroborated staff interviews and records, which evidenced that R1 received x-rays on 2/22/23 with no finding of a fracture. Resident interview- Interview was attempted with R1, however R1 did not respond to any of the questions asked. Records and interviews showed that R1 was non-verbal and unable to communicate with words. (Continued on LIC9099-C p.4) (Continued from LIC9099-C p.3) Regarding the allegation, “Licensee did not report resident's change in condition to Responsible Party”, it was alleged that R1’s Responsible Party was not notified of the near-falling incident with subsequent bruising. Staff interviews further revealed that the incident occurred between 6:30am to 7:30am, when S1 was assisting R1 before breakfast; during this time bruises had not developed and R1 did not show signs of injury or pain. Staff interviews further revealed that at approximately 9:30am R1’s shower aide arrived to the facility, observed bruises developing under R1’s arm, and notified S1 who elevated the incident to the Medical Technician (Med Tech), S2. S2 then notified the hospice agency. During this time R1’s family member arrived to the facility and was informed of the incident and bruising by S2. This family member took photos of R1’s bruises at 10:46am and sent them to R1’s Responsible Party. Staff interviews revealed that the family was in communication with the facility the day of the incident and the family declined to have R1 sent out to the hospital during a care conference on 2/17/23. Staff interviews showed that the timeframe between the incident occurring and R1’s family member arriving to the facility was approximately two (2) hours. Outside source interviews were inconsistent regarding the timeline of family notifications and from whom the requests for medical interventions/assessments were made. Outside source interviews revealed contradictory statements regarding when or if the Responsible Party was notified and if the family decision not to send R1 to the hospital was made directly by the Responsible Party or through the visiting family member. Outside source interviews revealed that R1’s visiting family member first notified R1’s Responsible Party of the bruising because the family member was at the facility as the staff were discovering that bruises had developed. Outside sources informed that the visiting family member arrived at the facility the day of the incident at approximately 9:30am and was immediately informed by S2 of the bruising. This family member took photos and sent them to R1’s Responsible Party at 10:46am, confirmed by photograph timestamps. Outside interviews revealed that R1's Responsible Party was making decisions through the visiting family member, and that a care conference was held between the family and facility the day after the incident. Review of facility charting notes dated 2/16/23 showed that R1's family was present at the facility during the PM shift the day of the fall. The facility submitted Unusual Incident/Injury Reports to the Department dated 6/21/23 and 6/24/23; the reports stated that S2 notified the hospice agency and R1's Responsible Party and that the family requested additional x-rays to chest and ribs for R1. (Continued on LIC9099-C p.5) (Continued from LIC9099-C p.4) Photos of the bruises taken by R1's family member showed a timestamp of 10:46am on 2/16/23, the day of the incident. Resident interview- Interview was attempted with R1, however R1 did not respond to any of the questions asked. Records showed that R1 was non-verbal and unable to communicate with words. While the evidence found does not clearly show when R1’s Responsible Party was directly made aware of the incident by the Licensee, the evidence confirms that R1’s Responsible Party was making decisions the day of the incident, was present at the facility the day of the incident, and was involved in the care conference the day after the incident. The evidence also showed that the facility honored the Responsible Party’s decisions regarding R1’s care directly after the incident. The evidence does not show that the facility significantly or intentionally delayed notification to R1’s Responsible Party regarding the incident. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 20, 2024 · control 08-AS-20230221091854

Allegation investigated: Staff did not treat resident with dignity.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced themselves and disclosed the purpose of the visit to Marketing Manager Maria Flores. On 10/03/2024 it was alleged that staff did not treat Resident 1 (R1) with dignity. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Staff interviews revealed that management had not received reports from residents or staff about lack of dignity or rough handling by a staff member. Staff interviews revealed that the staff member named in the complaint was a per diem caregiver and had not had a shift at the facility since October 2023; this information was corroborated by staff schedules. Staff interviews further revealed that due to R1's gender preference, certain caregivers typically did not provide care to R1, which reduced the likelihood that R1 and the staff member in question had interacted. (Continued on LIC9099-C p.2) Unsubstantiated (Continued from LIC9099 p.1) Five (5) of five staff members interviewed had not observed any staff member interacting with a resident in a taunting manner or in a way that did not maintain their dignity. Staff interviews revealed that R1 exhibited manipulative behaviors and had been attempting to get a hospital bed prescribed to them, informing they would continue to complain against the facility until they received the bed; R1 was not medically indicated for a hospital bed. Staff interviews further revealed that R1 exhibited aggressive and threatening behavior toward staff when they did not get their way. Three (3) attempts were made to interview the staff in question, without success. Interview with R1 did not corroborate the allegation. R1 informed they enjoyed living at the facility and that staff treated them well. Four (4) outside sources were interviewed during the investigation; the interviews did not corroborate the allegation. Outside sources informed being aware of the allegation but did not believe it had actually occurred. Outside sources believed that the claims were made as either a form of manipulation by R1, or a misperception of interactions that had occurred. Outside sources informed that R1 was assessed after the claims were made and no evidence of physical harm existed. Outside sources denied ever seeing staff handle a resident roughly or treat a resident without dignity. An outside agency conducted an investigation into the claims and found no corroboration that the events occurred. Another outside source corroborated that R1 was not medically indicated for a hospital bed. Records review revealed that the staff member in question, S1, had not been scheduled to work at the facility since October 2023, corroborating staff statements that S1 was per diem and rarely worked at the facility. Records review also revealed that R1 was admitted to the facility on 11/29/23, approximately one month after S1's last shift at the facility. This shows that R1 and S1 had never met or interacted with each other. During two unannounced facility visits LPA observed staff providing care to residents in different areas in the building, when the staff were unaware of LPAs presence. LPA did not observe any staff member assist or engage with a resident in a way that was taunting, undignified, or unwelcome to the resident. LPA directly observed staff's interactions with R1 during unannounced visits and no observations were seen of staff treating R1 without dignity. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 20, 2024 · control 08-AS-20241003111853

Allegation investigated: Staff did not treat resident with dignity. Staff handled resident in a rough manner.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced themselves and disclosed the purpose of the visit to Marketing Manager Maria Flores. On 6/12/2024 it was alleged that staff did not treat a resident with dignity and staff handled a resident in a rough manner. The Department’s investigation consisted of unannounced facility visits, interviews with facility staff, residents, outside sources, and records review. Staff interviews did not corroborate the allegations. Five (5) of five staff members interviewed did not observe any staff member handle Resident 1 (R1) roughly or interact with R1 in a way that did not maintain their dignity. Staff interviews consistently revealed that R1 exhibited aggressive and manipulative behaviors toward staff, and was frequently resistant to being provided care. (Continued on LIC9099-C p.2) Unsubstantiated (Continued from LIC9099 p.1) Staff informed that they did not engage during R1's behavior episodes and backed away until they allowed care to be given. Management conducted an internal investigation and followed the required reporting timeframe. The facility's internal investigation did not produce evidence that the claims occurred, as the source was unable to provide details, descriptions, date/time, or any other information that would give evidence that the complaint was true. Management staff informed that R1 was assessed after the claims were made and did not have any marks, bruising, or injuries. Resident interviews did not corroborate the allegation. Residents interviewed informed that they enjoyed living at the facility and were treated well. Residents were observed to be clean, groomed and properly dressed for the temperature. Interview with R1 did not provide evidence that the allegations were true or that the events occurred. Outside sources did not corroborate the allegations. Outside sources had not observed any staff treat any client without dignity or handle them roughly. An outside source familiar with the allegations informed that the person who made the claims did not provide any additional details such as the person(s) involved, date/time of the occurrence, or other information that would give evidence that the claim was valid. Outside sources expressed concern that the claims were made with motive of manipulation. Outside sources did not have concerns regarding resident care at the facility. Records review revealed that management submitted the required reports for the alleged abuse, showing that they conducted an internal investigation. The records showed no corroboration that the events occurred. During an unannounced facility visit LPA directly observed the resident in question. The resident was noted to have no bruising, scratches, or marks indicating injury. LPA observed the resident using full range of motion within the area of concern. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 20, 2024 · control 08-AS-20240612143814

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Marketing Manager Maria Flores. The facility's license shows a maximum capacity of forty-two (42) non-ambulatory residents, of which 8 may be bedridden, ages 60 and over. During today’s inspection there were twenty-five (25) residents in care. LPA, Marketing Manager Maria Flores, and Manager Wendy Diaz toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Marketing Manager Maria Flores, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and clients, and reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Marketing Manager Maria Flores to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Jun 18, 2024

Allegation investigated: Staff inappropriately touched resident.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to initiate a complaint investigation and deliver findings regarding the above mentioned allegation. LPA introduced herself and disclosed the purpose of the visit to Marketing Manager Maria Flores and Manager Wendy Diaz. On 3/8/24 it was alleged that staff inappropriately touched resident 1 (R1). CCLD’s investigation involved an unannounced facility visit, review of facility and outside source records, interviews with facility staff, residents, outside sources, and LPA observations. Staff interviews did not corroborate the allegation, staff members interviewed consistently stated that they had never been informed of or observed any staff inappropriately touching a resident. Staff interviews revealed that R1 has had increased agitation and hallucinations about things that did not, or could not possibly have happened. Outside source interviews did not corroborate the allegation, outside sources informed no knowledge or observations of any staff mistreatment toward a resident. (Continued on LIC9099-C) Unfounded (Continued from LIC9099 p.1) Outside sources further revealed direct observations of R1 making statements about fictional and/or public figures that could not have occurred. R1's Responsible Party (POA) was interviewed for the investigation and informed that R1 recanted their accusation, informing that the incident did not occur and they recalled a dream in confusion that did not happen in real life. During the course of staff/outside source/agency interviews, LPA observed that staff and outside sources were given different versions of the same story by R1, which conflicted in details, people involved, and the substance of the events. Records review revealed documentation of R1 having increased agitation and behavior issues, including incidents of unprovoked physical aggression toward staff and other residents. Records review further revealed that the Licensee has been in communication with R1's family and requested a care conference and updated assessment to address the new behaviors. A previous investigation was conducted by the Department in July 2023 regarding claims made by R1 that found to be without evidence that the event occurred. Interview with R1 did not corroborate the allegation. R1 stated that staff were very nice and no staff had ever done anything to physically harm or mistreat them. Interview with R1 also revealed conflicting recollection of the accounts they made to outside sources and staff. R1 did not recall making any accusations against staff members. Based on records and interviews, the allegation that staff inappropriately touched resident 1 (R1) is unfounded, meaning it was false, could not have happened, and/or is without a reasonable basis. The allegation has therefore been dismissed. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Mar 14, 2024 · control 08-AS-20240308153356

Allegation investigated: Neglect resulting in resident being severely malnourished Neglect resulting in resident suffering dehydration Neglect resulting in resident sustaining multiple pressure injuries Neglect resulting in resident sustaining serious injury Staff did not observe change in condition

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Marketing Manager Maria Flores. On 7/12/23 the following allegations were made against the Licensee regarding Resident 1 (R1): neglect resulting in resident being severely malnourished, neglect resulting in resident suffering dehydration, neglect resulting in resident sustaining multiple pressure injuries, neglect resulting in resident sustaining serious injury, staff did not observe change in condition. The Department’s investigation consisted of unannounced facility visits, review of facility and outside source records, interviews with facility staff, residents, outside sources, and direct observations. (Continued on LIC9099-C) Unsubstantiated (Continued from LIC9099) Regarding the allegation, "Neglect resulting in resident being severely malnourished", staff interview revealed consistent accounts of Resident 1 (R1) refusing to eat, often becoming agitated and spitting food out. Staff interview further revealed that the Licensee had ongoing contact with R1's doctor and responsible party regarding the lack of food intake, which resulted in adjustments that increased R1's nutrition intake. Outside source interview was consistent with staff interviews regarding R1's resistance and agitation with food and beverages. Outside source interviews did not express concern regarding the care being provided to R1 at the facility. Records review was consistent with staff interviews regarding R1's eating issues, revealing alternate prescribed interventions by R1's physicians to assist with nutrition and fluids. Interview attempts with R1 were unsuccessful. Regarding the allegation, "Neglect resulting in resident suffering dehydration", staff interview revealed that in addition to meals, R1 also frequently refused offers to drink water and became agitated. The Licensee advised R1's doctor, and a plan was made to increase R1's liquid intake. Outside source interviews did not corroborate the allegation. Records review was consistent with staff interviews regarding R1's drinking challenges and gave evidence to the interventions prescribed by R1's physician to help with liquids intake. Interview attempts with R1 were unsuccessful. Regarding the allegation, "Neglect resulting in resident sustaining multiple pressure injuries", staff interview revealed that R1 was not ambulatory and the Licensee was active in attempting to prevent pressure injuries by obtaining a special cushion for sitting, as well as a low air mattress bed. Staff interview further revealed that the Licensee took the appropriate steps to notify R1's medical professionals regarding pressure wounds that began to develop. Outside source interviews revealed that the pressure injuries sustained by R1 were not a result of the care being provided by the facility. Outside source interviews did not express concern regarding the care provided to R1 by the Licensee. Interview attempts with R1 were unsuccessful. Regarding the allegation, "Neglect resulting in resident sustaining serious injury", staff interview revealed that the noted injuries sustained by R1 were due to multiple falls that occurred prior to their admittance to Ranchview Senior Assisted Living. Staff statements were corroborated with resident records. (Continued on LIC9099-C) (Continued from LIC9099-C) Outside sources interviewed did not express concern regarding R1's care and treatment at the facility; outside sources informed that R1 sometimes forgot that they were non-ambulatory and attempted to walk. Interview attempts with R1 were unsuccessful. Regarding the allegation, "Staff did not observe change in condition", staff interview revealed that staff checked on R1 every 1-2 hours due to being a fall risk. Staff interview further revealed that staff immediately contacted 911 and provided direct care to R1 after a fall at the facility. Records review corroborated staff statements and revealed that staff did observe R1's changes in condition and contacted R1's responsible party and physician timely. Interview attempts with R1 were unsuccessful. Based on interviews, direct observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 21, 2023 · control 08-AS-20230712162633

Allegation investigated: Staff are using a belt to restrain resident in a chair

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver the finding in the above mention complaint allegations. LPA Domingo identified herself and discussed the purpose of the visit with Manager Wendy Diaz. During the investigation, LPA Domingo collected pertinent resident records as well as facility documentation and conducted interviews with staff, residents and outside sources. It was alleged that staff were using a belt to restrain a resident in a chair. LPA Domingo observed 4 Residents during meal time. Resident 1 (R1) through Resident 3 (R3) (See LIC811 Confidential Names list). Resident 1 (R1) was observed with a soft positioning foam. R1's medical record was reviewed and there was an order for the soft positioning foam to be used. Continue on LIC9099C Unsubstantiated [Continued from LIC9099] Resident 2 (R2) was observed to have a side positioning foams while sitting in the wheelchair. R2 medical record was reviewed and there was a Doctor's order for the side positioning cushions. Resident 3 (R3) was observed to have a safety belt around the body. LPA Domingo observed closer and the safety belt was a positioning cushion that was holding the cushion on the wheelchair. R3's records were reviewed and there was a Doctor's order for the positioning cushion that was being held in place with a safety belt which was not around R3's body. LPA Domingo observations of R1 through R3 concur with the Medical Record and Doctor's orders for the positioning cushions. Interview with outside source 1 (OS1) observed resident's with the safety cushions being held onto the wheelchair was positioning. OS1 confirmed that there was no observation of staff using a belt to restrain residents. Interview with outside source 2 (OS2) stated that that there was never any observations of staff using a belt to restrain a resident. Based on LPA's observations and interviews with outside sources and records reviewed there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with the Manager Wendy Diaz, to whom a copy of this report, and the Licensee Appeal Rights (LIC 9058 03/22) were provided.the state’s words, verbatim · CDSS document, Nov 29, 2023 · control 08-AS-20231020145534