Sagebrook Senior Living at San Francisco

Type of visit: Case Management - Other

On 09/15/2026, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced Case Management visit at the facility. LPA met with Administrator, Peter Nixdorff, and the purpose of the visit was explained. The purpose of this visit was to follow up on the "Decision and Order", effective of September 8, 2026, regarding the exclusion of Staff 1 (S1). During the visit, the Administrator confirmed that S1 is not employed and is not associated by the facility and that the licensee has received a copy of the Decision and Order. LPA toured the facility and reviewed and collected relevant documentation. The named individual S1 was not present on the premises. No citations are issued during the visit. Report is reviewed with Administrator and a copy is provided.the state’s words, verbatim · CDSS document, Sep 15, 2026

Type of visit: Case Management - Other

On 03/27/26 Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced case management visit. LPA met with Administrator, Peter Nixdorff, and explained the purpose of the visit. LPA conducted an inspection to verify receipt of the Decision and Order and to ensure that the named individual is no longer employed at or associated with the facility, effective as of the case management visit. LPA toured the facility and reviewed and collected relevant documentation. The named individual was not present on the premises. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Mar 27, 2026

Type of visit: POC

On 3/11/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a proof of correction(POC) visit. LPA Calandra was greeted by Peter Nixdorff, Executive Director and explained the purpose of the visit. On 3/11/2026, the Licensee was cited for a violation of Title 22, California Code of Regulations(CCR) 87411: Personnel Requirements-General regarding a client who was able to elope from the facility as S1 had not started their shift. Deficiency has been cleared. A proof of correction letter was delivered with this report to the facility representative and an exit interview was conducted.the state’s words, verbatim · CDSS document, Mar 11, 2026

Type of visit: Case Management - Other

On 3/11/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to an incident that occurred on February 19th, 2026 in which R1 was able to elope from the facility. According to the Administrator, R1 left the facility early in the morning before the concierge started and was located on the sidewalk in front of the facility. R1 stated to facility staff that they were going to get food. R1 was redirected back into the facility and no injuries were observed. R1 now has a 1:1 caregiver and has not eloped since the incident or shown wander seeking behaviors. A Type B citation was provided for this deficiency. During the visit, LPA received copies of R1's latest Appraisal of Needs and Services and the resident's latest Physician's report. An exit interview was conducted. A copy of the report along with Appeal Rights were provided.the state’s words, verbatim · CDSS document, Mar 11, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 874111(a) · Plan of correction due date: Mar 20, 2026

874111(a) Personnel Requirements-General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on record review, the Licensee did not ensure R1's safety (who is not allowed to leave the facility unassisted according to the LIC 602)the state’s words, verbatim · CDSS document, Mar 11, 2026

Plan of correction: Licensee has implemented 1:1 caregiver and concierge now starts earlier in the morning. Deficiency cleared during time of visit. when R1 was able to leave the facility as front desk staff had not started their shift yet, which is a potential health, safety, or personal rights risk to persons in care.

Type of visit: POC

On 1/5/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Proof of Correction(POC) visit in regards to citations issued during the Annual Inspection on 12/15/2025. LPA Calandra was greeted by Juvy Valera, Concierge and explained the purpose of the visit. On 12/15/2025, the Licensee was cited for a violation of Health and Safety Code 1569.32 Spot Inspections which states that "any duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, this chapter." At time of inspection, Licensee did not ensure that resident and personnel files were accessible and could be reviewed by the LPA for several hours. During POC visit, LPA observed that a second key has been made to the business office where files are kept and is accessible to the Concierge. Deficiency cleared during visit. On 12/15/2025, the Licensee was also cited for a violation of Health and Safety Code 1569.618: Administration and Management of Residential Care Facilities; substituted qualifications; employee scheduling as they did not ensure that at least one staff member per shift on duty and on premises with active CPR and First Aid training. During POC visit, LPA reviewed staff schedule and CPR and First Aid training certificates and found that at least one staff member per shift has active CPR and First Aid training. Deficiency cleared during visit. No deficiencies cited during today's visit. An exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 5, 2026

Type of visit: Required - 1 Year

On 12/15/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Juvy Valera, Receptionist and explained the purpose of the visit. Peter Nixdorff, Executive Director arrived later during the visit. LPA toured the physical plant. This is a 3-story building with 78 bedrooms, 74 bathrooms, a kitchen, backyard, and common spaces. All bedrooms had the required furniture and sufficient lighting. All bathrooms had slip resistant flooring and grab bars. The facility was maintained at a comfortable temperature. No accessible bodies of water or hazards were observed. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility's fire alarm and carbon monoxide detector were observed to be in working order. The facility's first aid kit had the required items. All soap, sharp objects, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 5 resident files and 6 staff files. All were observed to be complete. This facility does not handle cash resources. LPA received copies of the following documents while at the facility: Administrator's Certificate Current LIC 500-staff roster and resident roster Liability Insurance A review of Centrally Stored Medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication Records(CSMR) kept at the facility. In addition, per conversation with the Executive Director the facility has 1 staff member per shift that has active CPR and First Aid Training. During document review, LPA was not provided with documentation. A Type B citation was provided for this deficiency. When LPA arrived at the facility to conduct the Annual Audit, LPA asked to review staff and resident records. LPA was told by S1 that no one at the facility currently could access said files. Two hours after the LPA arrived at the facility, files were made accessible. A Type B citation was provided for this deficiency. Deficiencies are cited under the California Code of Regulations. Failure to correct the deficiencies by the POC due date may result in Civil Penalties. An exit interview was conducted. This report was reviewed with facility representative and a copy provided.the state’s words, verbatim · CDSS document, Dec 15, 2025

Type of visit: Case Management - Incident

On 9/24/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Case Management visit in regards to an incident report received by the Department on 9/19/2025 in which a resident eloped while in the community. LPA was greeted by Peter Nixdorff, Executive Director and explained the purpose of the visit. LPA toured the physical plant. All exit doors and door alarms were observed to be fully operational. In addition, LPA conducted interviews. Based on interviews, R1 was attending a medical appointment under the supervision of R1's responsible party when R1 was able to elope. Peter Nixdorff, Executive Director called the police, local hospitals, and other locations to locate the resident but R1 has not been found at the time of the visit. No deficiencies cited during today's visit. An exit interview was conducted. This report reviewed with the Executive Director and a copy of the report provided to facility representative.the state’s words, verbatim · CDSS document, Sep 24, 2025

Allegation investigated: Resident sustained multiple injuries due to neglect/lack of supervision

On 4/10/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Executive Director, Peter Nixdorff. LPA toured the facility, interviewed staff and outside parties and reviewed resident records during the course of the investigation. Complaint alleges resident sustained multiple injuries due to neglect/lack of supervision. Based upon review of R1’s records it is determined that R1 had sustained three separate incidents in which R1 had been involved in multiple unwitnessed falls. The facility completed an updated care appraisal, implementing an increased level of care for more frequent room checks, staff escort to activities and common spaces, transferring from sitting to standing and use of a walker due to the identified high fall risk, confusion and diagnoses of Parkinson's and major neurocognitive disorder. Facility however, failed to update R1's medical assessment corresponding to R1's updated needs. Interviews with staff further indicated that staff were notified and aware of R1's high fall risk and changes of condition, However staff stated being busy and not present during R1's unwitnessed fall located in facility common area leading to fracture of R1's hip and wrist. LPA found that staff did not provide appropriate care and supervision according to R1's care appraisal resulting in injury. Continued onto LIC9099-C Substantiated Allegation, above is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. Civil Penalty was assessed for incident resulting in injury of resident.the state’s words, verbatim · CDSS document, Apr 10, 2025 · control 14-AS-20250113143203

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Apr 10, 2025

87464(f)(1) 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 was not met as evidence by**: Based upon facility incident report, interviews with staff and a review of facility incident reports, resident records and interviews with staff the facility failed to ensure staff had provided necessary services of care and supervision to meet resident R1's resutling in injury to R1.the state’s words, verbatim · CDSS document, Apr 10, 2025

Plan of correction: Licensee/administrator shall submit a plan in writing on how to ensure staff provide proper care and supervision to all residents. Plan must include training, staffing, observation of resident, addressing changes in condition. Plan shall be submitted to CCLD by 4/11/25. An immediate Civil Penalty of $250 was assessed for repeated violations within a 12-month period.

Type of visit: Case Management - Incident

On 4/10/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of following up on a facility reported incident involving resident (R1). Incident indicates R1 leaving the facility unassisted. LPA interviewed staff and reviewed resident records. R1 was newly admitted to the facility and was in the process of transitioning to supervised care. R1 had left the facility through a kitchen exit not operated by caregivers. R1 was safely located and returned to the facility with no injuries or change of condition. Executive Director had implemented in-service training, updated signeage on exits/elevators and held multiple care conferences with R1 and R1's responsible party for updated care. R1 has since relocated and residing elsewhere. LPA found that the facility responded appropriately to the incident to ensure prevention and discussed further implementation of staff supervision with Executive Director. Technical violation issued during today's visit.the state’s words, verbatim · CDSS document, Apr 10, 2025

Allegation investigated: Staff did not maintain a comfortable temperature for residents in care Facility is in disrepair

On 1/8/2025, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Executive Director, Peter NIxdorff (S1). LPA toured the facility, interviewed staff, resident and outside party, reviewed facility records and made observations during the course of the investigation. Complaint alleges staff did not maintain a comfortable temperature for residents in care after facility heating system had become damaged. Based upon tour of the facility, LPA found that the heating system only allows an "on and off" control with no thermostat to indicate exact temperature. During LPA's multiple facility visits, the facility was found to be at a comfortable temperature and not observed to be cold or signs of residents in discomfort. In addition, the facility had provided additional blankets and individual space heaters to residents affected. Interviews with Maintenance Director (S2) it was found that bedrooms 300, 301, 302 and 304 had been affected by the heating system damages. Upon inspection of bedrooms, LPA found that the heaters in rooms 301 and 302 had been restored to working condition with heaters observed to be on and the bedrooms warm and comfortable. Continued onto LIC9099-C Unsubstantiated Upon inspection of bedrooms 300 and 304, LPA found that the facility is still undergoing repairs. However, LPA observed residents' rooms to be equipped with personal space heaters and additional blankets. LPA was able to interview resident (R1) located in room 300. R1 did not have any concerns or report being cold and stated that they felt fine. R1 was observed on their bed and showed LPA the additional blankets they were using. R1's space heater was off during the inspection but was tested and in working order. In addition both rooms (300 and 304) did not appear to be cold or at a discomforting temperature. LPA contacted San Francisco Ombudsman Officer, (O1) who also confirmed that they had conducted a facility inspection in response to the allegations. O1 indicated that the facility had provided additional blankets and space heaters for resident bedroom still in need of services. O1 also stated that during their visit, they were not able to conduct/determine a temperature reading due to no thermostat. Lastly, O1 reported the facility to have responded appropriately and in a timely manner. Complaint alleges facility is in disrepair after facility heating system had become damaged. Based upon interviews with staff (S1,S2) it was determined that the facility heating system had become damaged due to the boiler flooding and effecting the heaters. The facility became aware on 11/17/2024 and began repair requests immediately. Interview with Maintenance Director (S2) indicated that service repairs were submitted the following day. LPA was provided the invoice for the first repair service to the boiler. In addition, residents who's bedrooms were affected and had no working heater, were provided additional blankets and portable space heaters to accommodate while the facility repairs were in place. LPA was informed by Maintenance Director (S2) that the bedrooms 300, 301, 302 and 304 had been affected by the heating system damages. Upon inspection of bedrooms, LPA found that the heaters in rooms 301 and 302 had been restored to working condition with heaters observed to be on and the bedrooms warm and comfortable. Upon inspection of bedrooms 300 and 304, LPA found that the facility is still undergoing repairs with the remaining two bedroom heaters, but had provided appropriate accommodations. Although the facility had undergone damages to the heating system, LPA found that the facility had responded appropriately and timely in order to have the system restored. Due to contradicting information gathered during the course of the investigation the allegation is found to be unsubstantiated. A finding that the complaint allegations, staff did not maintain a comfortable temperature for residents in care and facility is in disrepair are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited.the state’s words, verbatim · CDSS document, Jan 8, 2025 · control 14-AS-20241120150635

Type of visit: Required - 1 Year

On 1/8/2025, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Executive Director, Peter Nixdorff. The facility currently provides care for 62 residents, 4 of which are receiving hospice services, along with a designated memory care unit. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located on each resident floor and kitchen were found to be last charged. Carbon monoxide detectors were located at each hallway tested and functioning. Smoke and sprinkler systems are interconnected with a fire safety inspection conducted by separate outside agency. Water at faucets accessible to residents were measured and found to be within regulation. All resident restrooms are equipped with non-slip mats and grab bars for accessibility. During the inspection, LPA observed oxygen tank in resident bedroom without appropriate signage posted. Executive Director immediately contacted staff to place sign indicating oxygen in use. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations, with food stored in the kitchen, sufficient for residents in care. Food supply is replenished three times per week and stored properly. Facility provides a wide variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked closets throughout each floor, and housekeeping/maintenance rooms all of which were secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. During inspection of resident bedroom, LPA located a tool bag left by residents family that held items potentially dangerous to residents in care. Executive Director immediately contacted resident's family member notifying of the concern and placed the tool bag in a secured staff office. Executive Director agrees to further discuss with resident family on safety risks. Technical Violation issued. Continued onto LIC809-C Residents that were awake during the inspection were observed interacting with staff, fellow residents and visitors in the common areas, or in their bedrooms resting. The facility encourages regular family visits and utilizes a wide variety of activities with LPA observing staff engaging continuously with residents, offering activities based on individualized preferences. LPA found that staff and resident engagement is well practiced with activities observed throughout the day. Residents were observed to have a positive and personable relationship with staff and Executive Director and were often out in the community during the inspection. There is a large outdoor patio for resident use, equipped with appropriate shading. A spot check of medications was conducted and found that all medication counts and records are in order. Medtech staff were knowledgeable of all medication administration and destruction procedures. LPA conducted a sample file review for residents and found all items to be in order including medical assessments and needs & service plans. Upon a spot check of staff files, LPA found that caregiver staff have current 1st aid and CPR on file. Peter Nixdorff's Administrator Certificate 7014086740 is currently active through 1/26/2025. LPA requested the following documents be sent to CCL by COB 1/22/2024: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan Liability Insurancethe state’s words, verbatim · CDSS document, Jan 8, 2025

Allegation investigated: Lack of Supervision

On 9/13/2024, Licensing Program Analyst (LPA) conducted an unannounced visit to delivery the complaint investigation findings. LPA met with Program Director, Peter Nixdorff and explained the purpose of today's visit. Regarding to the allegation of lack of supervision- the reporting party stated that memory care staff leaves the residents in the lunch hall for an extended periods of time so they don't have to move the residents back and forth from their rooms, and if the residents soiled themselves while waiting, the staff leaves the residents until after lunch to change them. The reporting party also reported that a resident with vision problem isolates him/herself in the room because its the only environment that he/she can navigate independently. In addition, a resident slipped out of the wheelchair while getting fresh air. As part of the investigation, LPA Han and LPA Tobola interviewed Memory Care Director, facility staff, resident #1(R1), resident #2(R2), and other residents. Continued onto LIC9099-C Unsubstantiated According to the Memory Care Director, there are 2 caregivers and 1 Medication Technician (Med Tech) on the unit for the AM and PM shifts and 2 caregivers and 1 Med Tech on the night shift. The Memory Care Director stated that there should always be a staff in the dining room to supervise the residents and if the residents needed to be change, and/or wanted to go back to their rooms, the caregivers would provide the assistance while the Med Tech stayed in the dining room. LPAs interviewed the facility staff members who stated there is always someone providing supervision in the dining room. They also stated that they would bring the residents to the bathroom and/or back to their rooms after the meals but if the residents needed to go to the bathroom or to be changed prior to their meals, they would assist the residents. Furthermore, they stated that some residents would walk back and forth from the dining room to the hallway and back and sometimes they would redirect them to stay in the dining room for their meals. LPA interviewed R1 who slipped out of the wheelchair while getting some fresh air and R1 stated that it was an accident and several staff members helped and responded to the incident right away. R1 also stated that staff members were responsive but sometimes the response time took a longer because they were busy. LPAs interviewed R2 who stated that due to his/her vision problem, it would be a big challenge in the morning if he/she was assigned to a caregiver who did not know the routines such as an agency staff. During the interview with R2, LPAs attempted to obtain additional details regarding to being isolated in the room as the reporting party reported, however, R2 did not want to provide any information. LPAs interviewed the Resident Service Director who was aware of R2's health condition and stated that most of the time, R2 is being assigned to a regular caregiver. However, when there were sick calls, they had to readjust their schedule and get someone from the agency and resulted R2 not being assigned to a regular staff. Based on documents provided, LPA observed R2 required additional assistance and the Resident Service Director is meeting with R2 on a regular basis to ensure R2's needs are being met. LPA interviewed other residents and they stated that they liked the facility, and staff members were caring and assisting them with their needs. After the investigation, this allegation is deemed to be unsubstantiated. Although the above investigations 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 allegation is UNSUBSTANTIATED. This report is reviewed and discussed with the Director.the state’s words, verbatim · CDSS document, Sep 13, 2024 · control 14-AS-20240731085313

Type of visit: Case Management - Incident

On 9/13/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of following up on a facility reported incident and met with Program Director Peter Nixdorff. The incident occurred on 8/25/2024 involving resident (R1) eloping from the facility without supervision. R1 had been observed in the facility common area the previous evening on 8/24/2024. During morning medication pass, staff did not observe R1 in their bedroom. Program Director immediately notified local police department, R1's responsible party and Community Care Licensing. R1 was located at a nearby medical center and found to have no injuries or significant changes of condition. Upon review of records, it is found that R1 is unable to leave the facility unassisted. The facility has updated R1's level of care including more frequent room checks, updated R1's physician's report and will be meeting with R1's responsible party for revised needs & service plans. In addition the facility has implemented front door security with secured door hours from 4pm - 8am, and utilizing overnight front desk attendance. R1 has not demonstrated any further behaviors of exit seeking and the facility has implemented appropriate measures to ensure no further incidents occur. Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Sep 13, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Sep 14, 2024

87464(f)(1) 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 was not met as evidence by**: Based upon facility incident report, interviews with staff and a review of resident records, it was found that R1 had AWOL from the facility without staff supervision. This serves a potential health & safety risk to resident in care.the state’s words, verbatim · CDSS document, Sep 13, 2024

Plan of correction: The facility has implemented multiple preventative measures to increase monitoring for R1, secure exit parameters for safety during evening hours and update R1's level of care and documentation. The facility continues to monitor R1 for additional changes. LPA finds that the faciltiy has responded appropriately for corrections. Deficiency cleared at the time of visit.

Type of visit: Case Management - Other

On February 23, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a case management health and safety inspection. LPA Calandra met with Jennine Chan, Assistant Executive Director and explained the purpose of his visit. During the visit, LPA Calandra toured the physical plant. LPA Calandra toured the facility kitchen, living and dining room, and 3 floors. LPA Calandra observed that the facility had sufficient perishable and non-perishables on hand and the community was observed to be in good physical condition. LPA Calandra also spoke with Stephanie Hall, Executive Director via the phone. LPA Calandra interviewed 2 residents and 2 staff. No deficiencies were cited during today's visit. The report was reviewed with Jennine Chan, Assistant Executive Director and a copy was emailed to Jennine. LPA confirmed receipt of email prior to leaving the facility.the state’s words, verbatim · CDSS document, Feb 23, 2024

Type of visit: POC

On January 31, 2024, Licensing Program Analyst(LPA) John Calandra, arrived at the facility at 8:16 AM to conduct a Plan of Correction(POC) visit. LPA Calandra met with Fili Igafo, Executive Director and explained the purpose of his visit. No deficiencies were cited during today's visit. The report and POC clearance letter was reviewed with Fili Howard, Executive Director and a copy left at the facility.the state’s words, verbatim · CDSS document, Jan 31, 2024

Type of visit: Case Management - Annual Continuation

On January 31, 2024 at 8:17 AM, Licensing Program Analyst(LPA) John Calandra arrived at the facility to continue the Annual 1-year required inspection. LPA Calandra was greeted by Juvy Valera, Concierge at the door and explained the purpose of his visit. Faimafili Igafo, Executive Director joined the visit later. LPA Calandra interviewed 3 staff and 4 residents. LPA Calandra reviewed 5 resident records which were observed to be complete and 5 staff records which were all observed to be complete. No deficiencies were cited during today's visit. The report was reviewed with Faimafili Igafo, Executive Director and a copy left at the facility.the state’s words, verbatim · CDSS document, Jan 31, 2024

Type of visit: Required - 1 Year

On January 11, 2024, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:04 AM to conduct an unannounced Annual 1-year required inspection. LPA Calandra met with Laura Richardson, Program Director. Faimfili Howard, Executive Director arrived later and joined the visit. LPA Calandra toured the physical plant. This is a 3-story building that consists of 79 rooms and 79 bathrooms. Water in all bathrooms was measured between the required 105-120 degrees Fahrenheit. Bathrooms were observed to have the required grab bars and anti-skid mats. Fire extinguishers in the facility were observed to be fully charged and last checked on July 6, 2023. The facility had the required 7 days of non-perishables and 2 days of perishables on site. No food was expired. The kitchen refrigerators and freezers temperature was within the required range. All bedrooms were sufficiently lit and had the required furniture. The backyard was clear from obstructions. No accessible bodies of water or hazards were observed. The facility's first aid was observed to be complete. The facility does not handle any cash resources at this time. LPA Calandra received Consolidated Emergency Response/Contingency Plan and Floor plans. All knives and sharp objects were observed to be locked and in-accessible to persons in care. All medications, soaps, and detergents were observed to be locked and in-accessible to persons in care. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA Calandra requested the following documents from the facility be sent via email or fax to the RO: -Job description/Personnel policies/on-the-job training -Fire Clearance -Health Screening Reports-Facility Personnel(LIC 503) -Plan of Operation -Plan for Incidental Medical and Dental Care -Qualifications of Administrator-Admin Certificate -Affidavit Regarding Client/Resident Cash Resources (LIC 400) During the tour of the physical plant, LPA observed S1 sitting on a bench in the hallway of Assisted Living, Floor 2. LPA asked staff member, their name, and S1 stated their name. LPA checked Facility Personnel Summary Report and could not find a staff member listed with that name. During a tour of the Assisted Living dining room, LPA stopped and spoke with S2 and asked S2 their name. S2 stated their name and LPA looked at the Facility Personnel Summary Report but again could not find anyone listed. LPA then called the RO and asked support staff to look up both staff. Support staff could not find S1 associated to the facility and S2 does not have criminal record/fingerprint clearance. LPA spoke to Executive Director about S1 and S2 and explained that until S2 has fingerprint/criminal record clearance, they cannot work. LPA explained that civil penalties would be assessed for both deficiencies. During today's visit a Civil Penalty of $1,000 was assessed for failure to ensure all individuals subject to a criminal record review were approved for a transfer of a criminal record exemption, as specified in Section 87355 and failure to obtain a California clearance or a criminal record exemption as required by the Department. Civil Penalty is $100 a day per staff member (2x) for the period of 1/6/2024-1/11/2024. The Annual will be completed at a later date. Deficiencies are cited under California Code of Regulations, Title, 22 cited on the LIC 809D. Failure to correct the deficiencies may result in civil penalties. The report was reviewed with Executive Director, Fili Howard and a copy along with Appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jan 11, 2024