Savant of Santa Monica

Type of visit: Required - 1 Year

At 8:50 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct an annual inspection. LPA Allen was greeted by Francisco Orozco-Maintenance Director upon arrival. LPA introduced herself and explained the purpose of the visit,to Francisco Orozco who granted access into the facility. At 9:00 AM, Nathaniel Venzon- Administrator arrived and he was informed of the purpose of the visit. The facility is licensed to serve at the capacity of (174) age range 60 and over adults. The fire clearance is approved for (150) non-ambulatory, (24) bedridden residents and hospice waiver for 30. At 9:25 AM LPA reviewed ten (10) clients files for admission agreements, updated physician reports, and needs and services plans which were up to date. At 10:15 AM, LPA and Francisco Orozco toured the physical plant. There were no bodies of water or obstructions in the indoor and outdoor passageways, stairways, open areas, and other areas of potential hazard are free of obstructions. LPA also observed the common areas to have furniture that appeared to be in good repair and sufficient for clients and visitors. The facility also has a shaded patio area for smoking and non-smoking with seating that can accommodate clients and visitors. The fire extinguishers were fully charged, and the last fire drill was conducted on 2/28/2025. LPA toured five (5) bedrooms downstairs and five (5) bedrooms upstairs which all have the required furniture,storage areas, and the bathrooms appeared to be clean and operational. LPA and Francisco tested the water temperature in the ten (10) bedrooms which ranged from 105-115 degrees F. At 11:45 AM, LPA, conducted a tour of the kitchen and there was a menu available for review and there appeared to be enough perishable and non-perishable food available, which is stored properly and appeared to be sufficient for the number of clients in care. At 12:43 PM, LPA reviewed ten (10) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings which were all current. At 1:21 PM, LPA conducted a random audit for 6 (six) clients medications that appeared to be dispensed as prescribed by their physician and they were centrally stored and properly locked. The first aid kits and manual were checked and fully stocked. LPA observed that all window screens were clean and in good repair. Facility temperature is between 68° degrees and 85° degrees. Overall, the facility appeared to be clean, sanitary, and in good repair. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and this report was discussed and provided to Nathaniel Venzon- Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 19, 2025

Allegation investigated: Staff do not respond to resident's call for assistance in a timely manner. Staff are mismanaging resident medication. Staff are not meeting resident's hygiene needs. Staff are not keeping the facility clean or sanitary.

On 03/04/2025 Licensing Program Analyst (LPA) Elvira Gonzalez conducted a subsequent unannounced complaint visit to further investigate the allegations listed above and deliver findings. LPA met with Maintenance Director, Francisco Orozco, and the purpose of this visit was explained. LPA was granted entry to the facility. Executive Director, Nathaniel Venzon, joined LPA shortly after. The investigation consisted of the following: On 10/09/24, LPA Gonzalez obtained and reviewed the following documents: resident roster, staff roster, staff schedules for September 2024 and October 2024, facility maintenance schedule, and shower schedule. LPA Gonzalez conducted interviews with Narine Mertkhanyan, Administrator (A1), and staff #1 (S1), and conducted a tour of the facility. On 02/20/25, LPA Gonzalez received and reviewed the following documents: resident roster, staff roster, Admissions Agreement, Physician’s Report, Physician’s Order Report, Face Sheet, Personal Rights, and Medication Administration Records (MARs) for R2 dated: October 2024 – December 2024. Unsubstantiated Additionally, LPA Gonzalez inspected the Medication Room, and conducted interviews with staff #2-#5 (S2-S5), and residents #1-#6 (R1-R6). On 02/27/25, LPA Gonzalez conducted telephonic interviews with residents #7-9 (R7-R9). On 03/03/25 LPA received Medication Administration Records (MARs) dated: October 2024 – December 2024 for R10-R11. The investigation revealed the following: Allegation: Staff do not respond to resident's call for assistance in a timely manner. It is being alleged that residents are not attended to in a timely manner. On 10/09/24 between 10:45 AM – 11:30 AM LPA Gonzalez conducted interviews with A1 and S1, and on 02/20/25 between 09:30 AM – 11:30 AM LPA Gonzalez conducted interviews with S2-S5. Based on interviews conducted, 5 out of 6 staff interviewed denied the allegation. 6 out of 6 staff interviewed confirmed residents have a callbox located in their rooms. They use the call button to alert staff, that call will go to a central monitoring station that is in the reception area. The receptionist will then answer the call, and radio a care staff to respond to the resident requesting assistance. 5 out of 6 staff interviewed stated that they are responding to residents’ call button alerts in a timely manner. On 02/20/25 between 12:30 PM – 2:30 PM LPA Gonzalez conducted interviews with R1-R6 and on 02/27/25 between 02:05 PM – 02:45 PM LPA Gonzalez conducted interviews with R7-R9. Based on interviews conducted, 6 out of 9 residents interviewed stated that staff responds to their calls for assistance in a timely manner. 9 out of 9 residents interviewed stated that they are satisfied with the staff at this facility and the services provided to them. Based on interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. Continued on LIC9099-C Allegation: Staff are mismanaging resident medication. It is being alleged that resident’s medications are routinely late. On 10/09/24 between 10:45 AM – 11:30 AM LPA Gonzalez conducted interviews with A1 and S1, and on 02/20/25 between 09:30 AM – 11:30 AM LPA Gonzalez conducted interviews with S2-S5. Based on interviews conducted, 4 out of 6 staff interviewed denied the allegation. 5 out of 6 staff interviewed stated that all resident’s medications are dispensed according to the physician’s orders. On 02/20/25 between 12:30 PM – 2:30 PM LPA Gonzalez conducted interviews with R1-R6 and on 02/27/25 between 02:05 PM – 02:45 PM LPA Gonzalez conducted interviews with R7-R9. Based on interviews conducted, 7 out of 9 residents interviewed stated that staff administers their medication according to the physician’s orders. 7 out of 9 residents interviewed stated they have no issues with staff and their medications not being dispensed on time. LPA Gonzalez conducted a record review of the MARs (dated: 10/01/24 – 12/31/24) and did not observe any discrepancies or mismanaging of resident’s medication. Based on observation, interviews conducted, and records reviewed, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff are not meeting resident's hygiene needs. It is being alleged that there have been issues with the residents getting help with bathing. It is also being alleged that a resident was left soiled and unattended. A record review of the shower schedule for residents who require assistance revealed that residents are scheduled with an assisted shower 1 to 3 times a week. On 10/09/24 between 10:45 AM – 11:30 AM LPA Gonzalez conducted interviews with A1 and S1, and on 02/20/25 between 09:30 AM – 11:30 AM LPA Gonzalez conducted interviews with S2-S5. Based on interviews conducted, 6 out of 6 staff interviewed denied the allegation. 5 out of 6 staff interviewed stated that residents bathing service needs are being met. 6 out of 6 staff interviewed stated that residents are scheduled to shower 1-3 times a week, and as needed. On 02/20/25 between 12:30 PM – 2:30 PM LPA Gonzalez conducted interviews with R1-R6 and on 02/27/25 between 02:05 PM – 02:45 PM LPA Gonzalez conducted interviews with R7-R9. Based on interviews conducted 9-9 residents interviewed stated that they have not been left soiled and unattended by staff. 9 out of 9 residents interviewed stated that they are assisted with showering 1-3 times a week, and as needed. 9 out of 9 residents interviewed stated that they are satisfied with the staff at this facility and the services provided to them. Based on observation, interviews conducted, and records reviewed, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff are not keeping the facility clean or sanitary. It is being alleged that the carpet in a resident’s room is now black from spills. On 10/09/24 between 10:45 AM – 11:30 AM LPA Gonzalez conducted interviews with A1 and S1, and on 02/20/25 between 09:30 AM – 11:30 AM LPA Gonzalez conducted interviews with S2-S5. Based on interviews conducted, 6 out of 6 staff denied the allegation. 5 out of 6 staff stated that the facility is kept clean and sanitary. An interview with S2 communicated that the carpets are cleaned monthly and as needed. S2 stated that they have been working on removing the carpet from resident’s rooms and replacing it with wood flooring, and that they are averaging to do two rooms a month, sometimes three. On 02/20/25 between 12:30 PM – 2:30 PM LPA Gonzalez conducted interviews with R1-R6 and on 02/27/25 between 02:05 PM – 02:45 PM LPA Gonzalez conducted interviews with R7-R9. Based on interviews conducted 9 out of 9 residents interviewed denied the allegation. 9 out of 9 residents interviewed that the facility is kept clean and sanitary. On 10/09/24, LPA Gonzalez conducted a tour of the facility. LPA observed the facility to be clean and, sanitary and in good repair. LPA did not notice any black stains in the rooms that had carpet. Based on observation, interviews conducted, and records reviewed, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Executive Director, Nathaniel Venzon, and a copy of this report and appeal rights was provided.the state’s words, verbatim · CDSS document, Mar 4, 2025 · control 11-AS-20241002120926

Allegation investigated: Staff did not provide resident with a 60 day notice prior to rate increase

On Februray 20, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced complaint visit to address the allegation listed above. LPA Lee met with Shiree McCutchen, Business Office Manager and explained the purpose of this visit. Brooke Lamotte, Welness Director subsequently joined to assist with visit. Investigation Consisted of the following: LPA conducted the following interviews: Business office Manager Interview (A1), Staff Interviews (S1-S3 ) and Resident’s Interviews (R1-R4). LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, Physicians Report for Residential Care Facilities for the Elderly for R1(Dated 3/7/24) Needs and Services Plan for R1 dated (1/25/25), copy of rate increase letter for R1 (dated 12/23/24), copy of email conversations between R1 and Business office manager (Dated 2/12/25 and 2/13/25). LPA reviewed R1's files. Page 1 of Unsubstantiated Allegation: Staff did not provide resident with a 60-day notice prior to rate increase The details of the complaint alleged that that R1 received a notice for a rate increase and that the facility did not give a 60 day notice. During an Interview with the Business Office Manager (A1), she stated that rent increases occurs annually, and that they give the letters 60-days prior to increase. Additionally, A1 stated that notices are provided to the residents via their mail boxes or in person. Letters are always sent in a timely manner. Lastly, A1 states that if a notification is missed, they would work with the resident and offer a payment plan if needed and/or modify the due date. During interviews with staff (S1-S3), (3 ) out ( 3 ) staff stated that residents receive their mail on time including notices about rate increases. (3) out of (3)state that there has been no complaints from residents regarding not receiving mail in a timely manner. During interviews with residents (R1-R4), ( 2 ) out of ( 4) stated that they get their rent increase notices on time. (1) out of (4) expressed that they didn't get their notices in time but it was resolved in a fair manner. LPA obtain/reviewed a copy of emailed conversations between R1 and the Business Office Manager (Dated 2/12/25 and 2/13/25) where R1 acknowledges that the situation was resolved to his satisfaction. During this investigation, LPA did not find sufficient evident to support the above-mentioned allegation. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Brooke Lamotte, Wellness Directorthe state’s words, verbatim · CDSS document, Feb 20, 2025 · control 11-AS-20250212094338

Allegation investigated: Illegal eviction.

On 01/22/24, Licensing Program Analyst (LPA) Lizeth Villegas conducted a subsequent visit in order to render investigation findings. LPA met with Business office manager Shiree McCutchen as the purpose of the visit was explained. The investigation consisted of the following: On 10/9/24 the department conducted an initial visit. On 1/22/25 the department spoke with Administrator (A1) and Staff #1 via telephone. On 1/22/25, the department was provided documents regarding the allegation such as a settlement agreement. The investigation consisted of the following: The department conducted a review of the eviction noticed served to R1 on 04/01/2024. The review of the eviction notice revealed R1 was being evicted for non-payment of the rent with a balance owed of $12,500. The eviction notice appeared to follow Title 22 Regulations for eviction procedures. On 1/22/2025, the department interviewed A1, A1 stated he just became the administrator and is aware R1 was issued an Unsubstantiated eviction but the corporate office would be able to provide additional details. On 1/22/2025, the department spoke with S1 regarding the allegation, S1 stated R1 was issued an eviction and did not leave so an unlawful detainer was filed. S1 stated the hearing was held late last year and a settlement agreement was reached. On 1/22/2025, LPA was unable to conduct interview with R1 as R1 refused interview. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of the Complaint Report was given to Business office manager Shiree McCutchen.the state’s words, verbatim · CDSS document, Jan 22, 2025 · control 11-AS-20241003091622

Allegation investigated: Staff are not addressing resident behavior.

On 12/4/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Narine Mertkhanyan /Administrator.LPA explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interview (S#1-S#6) and Resident’s Interview (R#1-R#8). LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, (R#1-R#4) Identification and Emergency Information, (R#1-R#4) Admissions agreements, (R#1-R#4) Physicians Report for Residential Care Facilities for the Elderly, (R#1-R#4) Needs and Services Plan, (R#1-R#4) Medication Administration Record (MAR) for the month of November 2024. Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Staff are not addressing resident behavior. The details of the complaint alleged that facility staff are not addressing resident disruptive behavior. During an Interview with the Administrator (A#1), she stated that we address the resident’s disruptive behavior when it is brought to our attention. Also, (A#1) stated that residents are not getting intoxicated and leaving the facility at night. The facility has not received complaints regarding residents getting intoxicated and leaving the facility at night. During interviews with staff (S#1-S#6), (6) out (6) stated that the facility is addressing residents’ disruptive behavior when it is brought to their attention or witnessed. Also, (6) out of (6) staff stated that the residents are not getting intoxicated and leaving the facility at nighttime. The facility has not gotten complaints regarding residents leaving the facility at nighttime intoxicated. During interviews with residents (R#1-R#8), (6) out of (8) stated that the facility is addressing residents’ disruptive behavior, and they have never witnessed residents getting intoxicated and leaving the facility at nighttime. During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations. Evaluation Report continues LIC 9099-C Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Narine Mertkhanyan /Administrator.the state’s words, verbatim · CDSS document, Dec 4, 2024 · control 11-AS-20241125101629

Allegation investigated: Staff are mismanaging resident's medication Staff did not ensure resident's room was cleaned Staff did not safeguard resident's clothing Staff did not ensure the a/c was not in disrepair Staff did not ensure the bathroom fan was not in disrepair

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Savant of Santa Monica Facility on 09/05/2024 and was greeted by Administrator Narine Mertkhanyan S1. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: LPA Calderon interviewed Administrator S1, staff S2-S4, residents R1-R7. On 09/04/2024 LPA Calderon requested and reviewed copies of the following: Pre-placement Report (dated 08/15/2024), Medication Administration Record (MAR) (date 08/2024), Overland Terrace Medical records (dated 08/15/2024), Admission Agreement (dated 08/15/2024), Market Pharmacy order form (dated 08/21/2024) for R1. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Staff are mismanaging residents’ medication. It is being alleged that staff neglected to provide medication to R1. LPA Calderon toured the facility with S2. LPA walked into the medication room and noted residents taking their medications. LPA also noted staff in the dining room giving medications to residents. Reviewed the MAR (dated 08/2024) for R1. Per the admission agreement (dated 08/15/2024 R1 moved into the facility and per the MAR staff started to give medication to R1 starting on 08/16/2024. Reviewed Market Pharmacy order form (dated 08/22/2024), drug Lacrollmus, last office visits 08/21/2024, message from NewRx, “not covered prior authorization required. We already send paperwork to MD office, please follow up with MD”. 4 out of 4 staff indicate that R1 was provided medication on time. 2 out of 2 staff indicate that R1 medication for R1 liver was rejected by R1 insurance company. 6 out of 7 residents indicate no issues with staff giving medications. 6 out of 7 residents indicate staff have never run out of their medications. Regarding Allegation #2: Staff did not ensure residents room was cleaned. It is being alleged that staff did not clean R1 room. LPA Calderon toured the facility with S2. LPA inspected all common areas and all areas appeared to be clean. LPA noted staff cleaning rooms and common areas. LPA inspected room 3, 17, 36, 46, 65 (R1 room), 76 and 85. All rooms appeared to be clean, bathrooms were clean, and trash was picked up. Per R1 admission agreement (dated 08/15/2024) page 9 “staff will clean residents’ room weekly”. 4 out of 4 staff indicate that staff do clean residents’ room weekly. 6 out of 7 residents indicate that staff do clean their rooms weekly and pick up trash daily. 6 out of 7 residents indicate no issues with facility staff cleaning their rooms. Regarding Allegation #3: Staff did not safeguard residents clothing. It is being alleged that staff washed and damaged R1 clothes. LPA Calderon toured the facility with S2. LPA inspected the laundry room and noted residents wash being cleaned. LPA also noticed staff transporting folded clothes in a basket to resident’s room. Reviewed admission agreement (dated 08/15/2024) for R1. Per page 8 "states that laundry will be provided weekly". 4 out 4 staff indicate that there have been no complaints regarding staff washing residents’ clothes. 6 out of 7 residents indicate no issues with staff washing their clothes. Regarding Allegation #4: Staff did not ensure the AC was not in disrepair. It is being alleged that the AC in R1 room was not working. LPA Calderon toured the facility with S2. LPA noted the AC working in the common areas. LPA inspected room 3, 36, 46, 65 (R1 room), 76 and 85. LPA noted that the AC was working in each room. 4 out of 4 staff indicate that there have been no issues with the AC unit and 4 out of 4 staff indicate that all AC units are working for each room. 6 out of 7 residents indicate that the AC in their room is working fine and they have no issues. Regarding Allegation #5: Staff did not ensure the bathroom fan was not in disrepair. It is being alleged that the bathroom fan in R1 room was not working. LPA Calderon toured the facility with S2. LPA inspected room 3, 17, 36, 46, 65 (R1 room), 76 and 85. LPA noted the fan in each bathroom and bedroom fan was working. 4 out of 4 staff indicate that all bathroom fans are working, and no complaints have been made. 6 out of 7 residents indicate that the bathroom fan in their room work fine and they have no issues. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff are mismanaging residents medication”, “staff did not ensure residents room was cleaned”, “staff did not safeguard residents clothing”, “staff did not ensure the AC was not in disrepair”, “staff did not ensure the bathroom fan was not in disrepair” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Narine Mertkhanyan S1.the state’s words, verbatim · CDSS document, Sep 5, 2024 · control 11-AS-20240827154736

Allegation investigated: Staff did not ensure resident's showering needs were met

***This amended report supersedes the report dated 5/24/2024. This report is being created to remove unsubstantiated allegation “Staff did not ensure resident's showering needs were met." This unannounced subsequent complaint inspection is being conducted on 08/13/24 by Licensing Program Analyst (LPA) Wendy Gibbs, for the purpose of delivering findings for the investigation into the above identified complaint allegation. The LPA met with facility Administrator, Narine Mertkhanyan, and the purpose of today's visit was explained. On previous visits conducted on 05/24/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced 10-day complaint visit. LPA met with Administrator, Ruby Cruz, and the purpose of the day’s visit was explained. During the visit, LPA toured the facility, interviewed Staff S1-S5, interviewed Residents R1-R7, and received documents pertinent to the investigation. The documents include a Staff Roster, Resident Roster, Shower Log, Resident’s Physician Reports, Resident’s Pre-appraisal Evaluation, Resident Needs and Service Plan, and Staffing Notes for the past three (3) months. Substantiated Allegation: Staff did not ensure resident’s showering needs were met The allegation alleges a resident, who is a fall risk, did not receive assistance with a shower for 1 ½ months despite asking for assistance. During record review of the shower schedule for residents who require assistance, LPA observed that residents are scheduled with an assisted shower 1 to 3 times a week. LPA reviewed four (4) Residents Physician’s Report, Needs and Service Plan, and Appraisal to see they type of assistance Residents require. During record review of R1’s Admission Agreement, LPA observed under Basic Services, R1 initialed number 9 indicating the acceptance of services, which include assistance with bathing. Additionally, LPA reviewed R1’s Service Plan that indicates R1 will be assisted once a week with showering and bathing. LPA reviewed the facility Shower Schedule which indicates R1 is to be assisted with a shower once a week. During review of the facility Staff Notes, LPA did not see any notes regarding R1 receiving assistance with a shower. During interviews with Staff S1-S5, were asked if residents who require assistance with a shower receive assistance, five (5) out of five (5) stated residents who require assistance with a shower receive assistance. Additionally, five (5) out of five (5) stated if a resident who requires assistance with a shower requests a shower on a non-scheduled day the staff will accommodate the resident as soon as they are available, unless it is related to incontinence. During interviews with Residents R1-R7, were asked if they receive assistance with a shower, four (4) out of seven (7) stated they receive assistance with showers when scheduled and when need or requested. Additionally, Residents R1-R7, were asked if there was a time, they not receive assistance with a shower, three (3) out of seven (7) stated they require assistance and was not provided with it. Additionally, two (2) out of the seven (7) stated they have either gotten into the shower without assistance or have taken a shower without assistance while being a fall risk. During the course of the investigation, LPA was able to find evidence to support the allegation. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D. An exit interview was conducted with Administrator, Narine Mertkhanuan, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 13, 2024 · control 11-AS-20240520092651

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Aug 27, 2024

87464 Basic Services (f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and... as specified in Section 87608, Postural Supports. This was not met based on interviews and record review Administrator did not ensure resident R1 received assistance with a shower as indicated on Admission Agreement and Service Plan which could be a health and safety risk to the resident.the state’s words, verbatim · CDSS document, Aug 13, 2024

Plan of correction: Administrator will ensure residents receive assistance with showering according to resident’s Needs & Service Plan and keep shower log notes indicating residents take a shower or refused and email shower log to LPA, at wendy.gibbs@dss.ca.gov, by POC date.

Allegation investigated: Staff are stealing clients' personal food items Staff do not provide adequate amount of food. Staff pulled resident's hair. Staff inappropriately touched resident.

On 08/13/24, Licensing Program Analyst (LPA), Wendy Gibbs conducted and unannounced subsequent visit to the facility listed above to deliver findings for the complaint indicated above. LPA met with Administrator, Narine Mertkhanan, and the purpose of today’s visit was explained. During a previous visit conducted on 07/31/24, Licensing Program Analysts (LPAs), Wendy Gibbs and Deborah Lee, conducted an unannounced 10-day complaint visit to the facility listed above. LPAs met with Business Office Manager, Ashley Fernandez and the purpose of that visit was explained. We were later joined by Administrator, Narine Mertkhanan. During the visit, LPAs toured the facility, interviewed Staff S1-S8, interviewed Residents R2-R9, and received documents pertinent to the investigation. The following documents were received Staff Roster, Resident Roster, Weekly Menu’s, Nutritionist Menu Review, Alternative Meal Menu Selections, Snack Menu, Theft/Loss Policy, residents Admission Agreement, resident Safeguard of Valuables/Property, Staff Mandated Reporting Training, and Staff End of Shift book. The investigation revealed the following: Unsubstantiated Allegation: Staff did not safeguard residents’ personal property The complaint allegation alleges staff have been stealing residents personal belonging such as perfume. During record review, LPA reviewed the facility’s Theft/Loss Policy, that indicates that the resident or responsible party does have the option to refuse or disclose personal items being brought into the facility to be inventoried. LPA reviewed Resident’s R1, R2, R5, and R7 Client/Resident Personal Property and Valuables (LIC621) observed two of the residents opted not to have their personal items inventoried, and two (2) of the residents listed minimal personal belongings on the LIC621. LPA reviewed R1s LIC621 and did not observe perfume listed. During interviews with Resident’s R2-R9, were asked if they have had any personal items go missing, eight (8) out of eight (8) stated they have had no item go missing or that were stolen. During interviews with Staff S1, S2, S4-S8, were asked how staff help residents safeguard their personal belongings, seven (7) out of seven (7), stated they remind residents to lock their door when they leave their room. Additionally, two (2) of the seven (7) stated they encourage residents to keep their valuables in their room, so they do not get lost in the facility. During interviews with Staff S2, S4-S8, were asked if there were any reported missing or stolen items in the past two (2) months, four (4) out of six (6) stated two (2) residents have reported missing items. One resident reported a missing phone and money which were found in the resident’s room with staff assistance, and the other resident is R1, who according to staff, gives their belongings and money to other residents. (2) Continued On LIC9099-C During an interview with S2, they stated R1 was upset that a bottle of perfume was stolen by another resident. S2 and the former administrator spoke with R1 and was informed that R1 gave R2 a bottle of perfume, R2 did not like the perfume so R2 gave it away to someone else. LPAs asked R2 about the incident with a bottle of perfume R1 had given them and R2 stated “I sprayed it on myself, and I did not like it.” Additionally, two (2) out of six (6) stated they have witnessed R1 giving belongings away and have told R1, they do not have to give their belongings or money to other residents in the facility. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff do not provide adequate amount of food The complaint allegation alleges that the food received is minimal. During the facility visit, LPA’s observed kitchen staff making the plates for residents’ lunch. LPA’s observed ample portions of food on each plate. LPAs observed staff using measuring ladle for portioning the sides. During record review, LPAs received and reviewed a copy of the weekly menus and the Alternative Option Menu available if residents do not want what is on the menu. During interviews with Resident’s R2-R9, were asked if they are provided with enough food, seven (7) out of eight (8) stated they are provided with enough food to eat. Additionally, one resident stated they sometimes get hungry after dinner, (3) Continued on LIC9099-C and they don’t want to go downstairs to get a snack. During interviews with staff S2-S8 were asked if residents were provided with enough food throughout the day, seven (7) out of seven (7) stated yes residents are provided with 3 meals a day and snacks are always available. Additionally, during interviews with Staff S2-S8, were asked if there have been any complaints about the portion of food provided, six (6) out of seven (7) stated they have not heard any complaints. One staff stated there were a few complaints over a month ago that the portions were small, but no new current complaints. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff pulled resident’s hair The complaint allegation alleges a staff pulled residents hair out. During record review, LPAs reviewed and received staffs signed Mandated Reporting that states if they observe or suspect abuse occurring, they will report it. Additionally, LPAs received and reviewed a copy of the facility’s Employee Handbook stating, on pages 71-72, employees responsibility to report any incident of resident abuse, or suspected resident abuse. During interviews with Residents R2- R9, were asked if their hair has been pulled by staff or have been handled in a rough manner, eight (8) out of eight (8) stated staff has not pulled their hair nor have they been handled in a rough manner. (4) Continued on LIC9099-C During interviews with Staff S2, S4-S8, were asked if they have observed staff or if they have pulled a resident’s hair or have handled a resident in a rough manner, six (6) out of six (6) stated they have not pulled a resident’s hair or handled a resident in a rough manner, nor have they observed, or heard of that occurring. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff inappropriately touched resident The complaint allegation alleges a staff grabbed a resident’s butt. During record review, LPAs reviewed and received staffs signed Mandated Reporting that states if they observe or suspect abuse occurring, they will report it. Additionally, LPAs received and reviewed a copy of the facility’s Employee Handbook stating, on page 71-72, employees responsibility to report any incident of resident abuse, or suspected resident abuse. During interviews with Residents R2- R9, were asked if staff have touched them inappropriately, eight (8) out of eight (8) stated staff have not touched them inappropriately at any time. During interviews with Staff S2, S4-S8, were asked if they have observed staff, have heard of staff, or if they have touched a resident inappropriately, six (6) out of six (6) stated they have not seen or heard of a staff touching a resident inappropriately and if they did, they would report it to the Administrator immediately. Additionally, six (6) out of six (6) stated they have not touched a resident inappropriately. (5) Continued on LIC9099-C During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. During today's visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Narine Mertkhanan, and a copy of this report was provided. (6)the state’s words, verbatim · CDSS document, Aug 13, 2024 · control 11-AS-20240725205758

Allegation investigated: Facility unlawfully evicted resident

On 5/29/24 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived at 10:15am and spoke to Administrator, Ruby Cruz and explained the purpose of the visit and was granted access to the facility. The investigation consisted of the following: On 5/29/24 LPA reviewed resident’s file and toured the facility. LPA requested and reviewed copies of the following records: LIC 500, Resident roster, 30day notice, ID and emergency information, face sheet, Admission Agreement, physicians report, resident appraisal, physician’s orders, resident charting notes, incident reports, memo of incident 10/22/23, and a release of personal property 5/21/24. The investigation revealed the following: Con'd 9099 Unsubstantiated Allegation: Facility unlawfully evicted resident It is being reported that this facility unlawfully evicted a resident. LPA Shirley reviewed the 30day notice dated 3/21/24. LPA Shirley observed that notice was issued again on 4/9/24. Notice was issued again as the first notice effective date fell on a Sunday. During file review, LPA observed resident’s charting notes in which R1 violated house rules four separate times. Per S1 resident was warned verbally to stop violating general policies of the facility. During the interview process and file review LPA learned that resident was sent to the hospital on 5/13/24. S1 stated while still in the eviction process, on 5/20/24, R1 called S2 to discharge himself from Savant of Santa Monica. S1 contacted the facility’s attorney and was told that they didn’t need to move forward as R1 discharged himself. On this same day 5/20/21, R1 asked to release their personal belongings to their friend W1. On 5/21/24, W1 came to pick up R1’s belongings and signed a release of personal property. LPA interviewed staff S-1 through S-7 (S-1 – S-7) LPA interviewed staff and ask, has this facility unlawfully evicted a resident. Of those interviewed 5 out of 7 answered no. LPA interviewed residents R-2 through R-7 (R-2 – R7). R1 is not available. LPA ask, does this facility unlawfully evict residents. Of those interviewed, 6 out of 6 answered no. Based on information gathered, the department did not find sufficient evidence to support allegations "Facility unlawfully evicted resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of the LIC 9099 was provided to the Administrator, Ruby Cruz.the state’s words, verbatim · CDSS document, May 29, 2024 · control 11-AS-20240523121300

Allegation investigated: Staff did not ensure resident's showering needs were met

On 05/24/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced 10-day complaint visit. LPA met with Administrator, Ruby Cruz, and the purpose of today’s visit was explained. During today’s visit, LPA toured the facility, interviewed Staff S1-S5, interviewed Residents R1-R7, and received documents pertinent to the investigation. The documents include a Staff Roster, Resident Roster, Shower Log, Resident’s Physician Reports, Resident’s Pre-appraisal Evaluation, Resident Needs and Service Plan, and Staffing Notes for the past three (3) months. The investigation revealed the following: Allegation: Staff did not ensure resident’s showering needs were met The allegation alleges a resident, who is a fall risk, did not receive assistance with a shower for 1 ½ months despite asking for assistance. CONTINUED ON LIC9099-C Unsubstantiated During record review of the shower schedule for residents who require assistance, LPA observed that residents are scheduled with an assisted shower 1 to 3 times a week. LPA reviewed four (4) Residents Physician’s Report, Needs and Service Plan, and Appraisal to see they type of assistance Residents require. During interviews with Staff S1-S5, were asked if residents who require assistance with a shower receive assistance, five (5) out of five (5) stated residents who require assistance with a shower receive assistance. Additionally, five (5) out of five (5) stated if a resident who requires assistance with a shower requests a shower on a non-scheduled day the staff will accommodate the resident as soon as they are available, unless it is related to incontinence. During interviews with Residents R1-R7, were asked if they receive assistance with a shower, four (4) out of seven (7) stated they receive assistance with showers when scheduled and when needed or requested. Additionally, Residents R1-R7, were asked if there was a time, they not receive assistance with a shower, three (3) out of seven (7) stated they require assistance and was not provided with it. Additionally, two (2) out of the seven (7) stated they have either gotten into the shower without assistance or have taken a shower without assistance while being a fall risk. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. During today's visit LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Ruby Cruz, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 24, 2024 · control 11-AS-20240520092651

Allegation investigated: Staff threatened a resident with eviction.

On 05/23/24, at 10:00am, Licensing Program Analyst (LPA) Perry Scott conducted a 10-day complaint visit to the facility and was greeted by Ruby Cruz, Administrator. LPA explained the purpose of this visit is to gather information about the complaint and deliver findings for the allegation mentioned above. The investigation consisted of the following: LPA investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S3) and residents (R1-R3). Resident Roster, Staff Roster, ID/Emergency Information, Physicians Report, and Charting Notes for R1 were obtained from the facility. The investigation revealed the following: Allegation #1- Staff threatened a resident with eviction. The details of the complaint alleged that on 05/16/24, R1 and another resident were having an argument and two staff members came into the room and threatened to evict R1 because of the argument. Report continued on LIC9099-C Unsubstantiated On 05/23/24, from 10:00am-1:00pm, LPA interviewed staff (S1-S3) and residents (R1-R3) regarding the allegation. 3 of 3 staff denied the allegation that the Staff threatened a resident with eviction. All staff (S1-S3) stated that no one has ever threatened to evict R1 with eviction. All staff (S1-S3) stated that on several occasions the staff has spoken to the resident about R1s behavior in the facility and emphasized following the house rules. But at no time has any one issued R1 an eviction notice or threatened R1 with an eviction notice. LPA interviewed R1 about the eviction notice and R1 stated that R1 had no knowledge of an eviction notice, nor did staff threaten R1 with an eviction notice. LPA interviewed R1-R3 about the allegation and 3 of 3 residents that were interviewed denied the allegation that Staff threatened a resident with eviction. All residents interviewed stated that they have not been issued or threatened with an eviction notice and are happy with the care and supervision the staff is providing them. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff threatened a resident with eviction. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted with Ruby Cruz, Administrator, and a hard copy of this report was provided.the state’s words, verbatim · CDSS document, May 23, 2024 · control 11-AS-20240516143559

Type of visit: Required - 1 Year

On 05/16/2024 Licensing Program Analyst (LPA), David España conducted an unannounced annual visit using the full care tools. LPA met with Administrator Ruby Cruz and the purpose of today's visit was explained. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections. The facility is licensed to serve (174) age range 60 and over adults. The fire clearance is approved for (150) non-ambulatory and (24) bedridden residents. LPA toured facility Kitchen, Dining Room, Living Room areas, (8) Bedrooms, (8) Bathrooms, Garage, and Patios with shaded areas. LPA observed sufficient storage areas for kitchen supplies, linens, medications (secured) and chemicals (secured). LPA observed the following during this visit: There is a locked centralized storage area for Resident medications. LPA reviewed 5 resident medications. LPA interviewed 7 residents in care. LPA interviewed 5 staff members. LPA observed the facility is clean, sanitary, and in good repair. Indoor and outdoor passageways, stairways, open areas, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68° degrees and 85° degrees. Open patios, and areas of potential hazard are well-lit. LIC809-C (cont) Carbon monoxide/Smoke detectors operate properly. No client bedroom is a passageway to another room, bath, or toilet. There is a bed for each client with a mattress, mattress pad, bedsprings, and pillow(s) which are clean and in good repair. There is dresser and closet space for each client that includes at least two (2) drawers of dresser space per client. There is a chair and lamp for each client and at least one (1) nightstand per two (2) clients. There are plenty toilets and washbasins for clients, family, and personnel. There are plenty showers for clients, family, and personnel. Hot water temperature is between 105°-120° degrees Fahrenheit. Bathrooms are located inside client bedrooms and common areas. Public restroom calling system is operational. There is a sufficient supply of clean linens to permit weekly changing or more of client top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. Dining room is near kitchen. Refrigerator and freezer are clean and have the capacity to store at least two (2) days of perishable foods. There is storage for seven (7) day supply of non-perishable food. There are enough tableware, tables, dishes, and utensils. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. There is confidential storage for personnel records at the facility. There is storage for Resident confidential information and records at the facility. The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. LIC809-c (cont) There is an outdoor activity space with a shaded area and furnished for outdoor use. There are at least 3 common areas available to clients for visitors. There are activities scheduled during the current month. There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. LPA observed a sign-in/sanitation station at the facility entry. There is hand sanitizer located at the entrance of the facility. Facility has screening process for all visitors, sanitizer/soap, paper towels, and additional PPE supplies are stored inside the facility. LPA observed fire extinguishers were fully charged and last serviced on 05/09/2024. Fire alarm and sprinkler system were last serviced on 04/29/2024. Carbon Monoxide detector was operable.LPA inspected the First Aid and found it contained all the required items. The elevator was last serviced on 04/28/2023. There was one technical assistance provided on today's visit. Resident Records/Incident Reports - Technical Assistance: 87506(b)(11) - LPA with Administrator Ruby Cruz did not observe resident #1 (R1) complete file. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. A exit interview was conducted with Ruby Cruz Administrator and a hard copy of a LIS 809s document was provided.the state’s words, verbatim · CDSS document, May 16, 2024

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility staff are not assisting resident with bathing Facility staff are not assisting the resident with toileting Facility staff are not providing resident with an accessible toilet Facility staff are not providing resident with an accessible shower

On 02/29/2024 at 8:00 am Licensing Program Analyst (LPA) David España conducted a subsequent complaint continuation investigation visit for the allegation listed above to deliver findings. Upon arriving at the facility, LPA met with the Administrator Ruby Cruz and MarieAnn Chan, Business Office Manager who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections. During the records review on 02/15/2024, LPA observed and requested copies of the annual staff training for residents' personal rights. Also, LPA observed the rights posted on the facility walls. In addition, LPA observed and requested copies of the personal rights in the resident's admissions agreement; with signatures of representatives upon moving into the facility. Complaint Investigation Report LIC9099-C Unsubstantiated LPA requested copies of the following: Three (3) months copies of (1) The number of residents receiving in incontinent, diapers changed; (2) The number of residents receiving daily cleaning of their bathroom (log); (3) The number of residents who have received their showers, sinks or toilets repaired; (4) The amount of residents being provided assistant for incontinent care, diapers changes; (5) The facility log or record keeping of reported repairs of any bathroom within the facility; (6) The timeline of how long it takes to repair bathroom fixture; and (7) The list of residents in care who have not received services they have requested (i.e., outstanding). On 02/29/2024 LPA interviewed, observed, and reviewed facility room numbers #68, #24, #23, and #30 (photos) were found within Title 22 regulations. On 02/15/2024 LPA interviewed, observed, and reviewed facility room numbers #37, #86, #72, #28, and #29 were found within Title 22 regulations. At 10:30 am LPA confirmed that there are Fifty-One (51) residents in care at the time of visit. At 10:30 am LPA confirmed that there are Twenty-Six (26) staff members at the time of visit. LPA interviewed Five (5) out of Fifty-One (51) residents. LPA interviewed Five (5) out of Twenty-Six (26) staff members. LPA interviewed One (1) Witness (W#1) for the alleged Four (4) complaints listed. Allegation # 1: Facility staff are not assisting resident with bathing. It is alleged residents’ bathing needs are not being met. On 02/13/2024 LPA España at 10:10 am Licensing Program Analyst (LPA) David España met with Witness #1 (W1) to discuss the complaint investigation. Complaint Investigation Report LIC9099-C W1 explained that W1 finally reached the Executive Director on 12/19/23 and explained the needs for the modification W1 further stated that the facility would address the grab bars and look into a gray toilet, but they (facility) would not be able to pick up the vanity or install anything else that the resident could use. W1 stated that Adam (owner of the facility) did not address the shower. On 02/29/2024 LPA interviewed, observed, and reviewed facility room numbers #68, #24, #23, and #30 (photos) that were found within Title 22 regulations. On 02/15/2024 LPA interviewed, observed, and reviewed facility rooms numbers #37, #86, #72, #28, and #29 that were found within Title 22 regulations. LPA interviewed Five (5) out of Fifty-One (51) residents. LPA interviewed Five (5) out of Twenty-Six (26) staff members. During the records review, LPA reviewed staff yearly training regarding residents' personal rights. All staff have taken the training. During an interview with the Executive Director, Narine Mertkanyan and Five (5) out of Twenty-Six (26) staff members, per Executive Director, Narine Mertkanyan stated that all staff know the residents' rights and do annual training. During interviews with Four (4) out Fifty-One (51) residents stated that they personally have not had issue with a staff member at the facility, and facility staff are assisting resident with bathing. During interviews with W1, they disagreed facility staff are assisting resident with bathing. During interview(s) with Executive Director, Narine Mertkanyan,“Savant senior living has a motion in place, and it will be addressed on Monday 02/26/2024 with regional maintenance regarding our wheelchair bound residents and their bathroom sinks. Here are the following Rooms that will need to be worked on #68, #24, #23, and #30.” Complaint Investigation Report LIC9099-C Based on interviews, observations, record reviewed there is insufficient evidence to support the allegation: Facility staff are not assisting resident with bathing. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is Unsubstantiated. Allegation # 2: Facility staff are not assisting the resident with toileting. It is alleged facility staff are not assisting the resident with toileting. It was reported that the staff is not providing proper toileting services to the residents. When interviewed Five (5) out of Twenty-Six (26) staff members and Four (4) out Fifty-One (51) residents all denied the allegation. During interviews with Four (4) out Fifty-One (51) residents stated that the resident’s toilet work and if assistance was needed, they (residents) believe they would receive it from staff members. Five (5) out of Twenty-Six (26) staff members also stated that they were not aware of other residents having issues with sanitary wipes, toileting, and that the facility has more than enough for the residents. R1 did not confirm those stated, LPA took photos of the bathroom and did not observe a portable toilet in R1’s bedroom or room. Four (4) out Fifty-One (51) residents reported that they are not considered incontinent and do not require those types of services. During an interview with the Executive Director, Narine Mertkanyan and Five (5) out of Twenty-Six (26) staff members, per Executive Director, Narine Mertkanyan stated that all staff know the residents' rights and do annual training. During interviews with Four (4) out Fifty-One (51) residents stated that they personally have not had issue with a staff member at the facility, and facility staff are assisting resident with toileting. Cont'd LIC-9099-C Per W1 the facility stated that they (facility) were working on the other toilet seat, and they (facility) were unlikely to modify anything else. W1 followed up with the resident in February and found out that the grab bars were installed and nothing else. On 02/29/2024 LPA interviewed, observed, and reviewed facility room numbers #68, #24, #23, and #30 (photos) that were found within Title 22 regulations. On 02/15/2024 LPA interviewed, observed, and reviewed facility rooms numbers #37, #86, #72, #28, and #29 that were found within Title 22 regulations. Per Title 22, Division 6 Chapter 8 Article 05. Physical Environments and Accommodations 87307 Personal Accommodations and Services, LPA has observed toilets and bathrooms conveniently located. LPA observed at least one toilet and washbasin for each six (6) persons, which include residents, family and personnel. LPA observed at least one bathtub or shower for each ten (10) persons, which includes residents, family and live-in personnel. LPA observed individual privacy being provided in all toilet, bath and shower areas. LPA observed space and safety provisions provided by the facility. LPA observed each room that accommodates residents being served in a comfort and safety environment. LPA observed the premises being maintained in a state of good repair and is providing a safe and healthful environment. Based on interviews, observations, record reviewed there is insufficient evidence to support the allegation: Staff is not providing proper toileting services to resident in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is Unsubstantiated. Cont'd LIC-9099-C Allegation # 3: Facility staff are not providing residents with an accessible toilet. It is alleged staff are not providing residents with an accessible toilet. On 02/13/2024 at 10:10 am Licensing Program Analyst (LPA) David España interviewed Witness #1 (W1) to discuss the complaint investigation. The interview with W1 revealed that the grab bars, raised toilet seat and bathroom counter have not been addressed or corrected. Per W1 CEO Adam stated that the facility believed that the facility would address the grab bars and possibly the toilet seat, but it is unlikely the facility would take out the vanity and install a new sink. On 02/29/2024 LPA interviewed, observed, and reviewed facility room numbers #68, #24, #23, and #30 (photos) that were found within Title 22 regulations. On 02/15/2024 LPA interviewed, observed, and reviewed facility room numbers #37, #86, #72, #28, and #29 that were found within Title 22 regulations. When interviewed Five (5) out of Twenty-Six (26) staff members and Four (4) out Fifty-One (51) residents all denied the allegation. During interviews with Four (4) out Fifty-One (51) residents stated that the resident’s toilet is accessible and if assistance needed, they (residents) believe they would receive facility help. Five (5) out of Twenty-Six (26) staff members also stated that they were not aware of other residents having issues accessing their toilet. Based on interviews, observations, record reviewed there is insufficient evidence to support the allegation: Facility staff are not providing residents with an accessible toilet. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is Unsubstantiated. Cont'd LIC-9099-C Allegation # 4: Facility staff are not providing resident with an accessible shower. It is alleged staff are not providing residents with an accessible shower. LPA interview with Resident 1 (R1) who stated that the alleged violation “Facility staff are not providing resident with an accessible shower,” has occurred and location. R1 stated they (facility) agreed to move R1 to another room because of accessibility concerns. LPA took photos of R1 wheelchair accessibility while interviewing. Based on interviews, observations, and record reviewed, and the facility (i.e., Adam Zenou) acknowledged progress at the facility which has been made due to rebranding of the facility, namely, the restrooms being wheelchair accessible at the facility. W1 stated that the resident is unable to maneuver in his wheelchair and the bathroom. On 02/29/2024 LPA interviewed, observed, and reviewed facility room numbers #68, #24, #23, and #30 (photos) that were found within Title 22 regulations. On 02/15/2024 LPA interviewed, observed, and reviewed facility rooms numbers #37, #86, #72, #28, and #29 that were found within Title 22 regulations. The R1 stated they required assistance getting into the shower and required a shower seat to use in the restroom. R1 stated services are being provided, caregivers are accessible for showers “they are great and hard working.” When interviewed Five (5) out of Twenty-Six (26) staff members and Four (4) out Fifty-One (51) residents all denied the allegation. During interviews with Four (4) out Fifty-One (51) residents stated that the resident’s showers are accessible and if assistance needed, they (residents) believe they would receive facility help. Five (5) out of Twenty-Six (26) staff members also stated that they were not aware of other residents having issues accessing their showers. Based on interviews, observations, record reviewed there is insufficient evidence to support the allegation: Facility staff are not providing resident with an accessible shower. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is Unsubstantiated. No deficiencies were cited. A exit interview was conducted with AnnMarie Chan, Business Office Manager and hard copy of the report was provided.the state’s words, verbatim · CDSS document, Feb 29, 2024 · control 11-AS-20240209152909

Allegation investigated: Staff yell at resident(s) in care. Staff speak inappropriately to resident(s) in care. Staff member smokes marijuana on facility premises. Facility does not have an Administrator.

On 12/20/2023 at 09:00 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation visit for the allegation listed above. Upon arriving at the facility, LPA met with S#1 and later S#2 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is not clear of Covid-19 infection (Has one case). LPA was granted access and allowed to enter the facility to conduct inspections. During the records review, LPA observed and requested copies of the annual staff training for residents' personal rights. Also, LPA observed the rights posted on the facility walls. In addition, LPA observed and requested copies of the personal rights in the resident's admissions agreement; with signatures of representatives upon moving into the facility. LPA requested copies of the following: Staff and Resident Roster, staff ratios, Physician report, Needs and Service, incident reports of residents (see LIC-811s). Continued on LIC9099-C. Unsubstantiated On 12/20/2023 Licensing Program Analyst (LPA) David España conducted interviews with Eight (8) out of Twelve (12) current staff members working at the time of visit with a total of Twenty-One (21) staff member employed. At 10:30 am LPA confirmed that there are Forty-Three (43) residents in care at the time of visit. LPA confirmed there are Twenty-One (21) total staff employed as of 12/20/2023. LPA confirmed there is only Four (4) resident in care who receive oxygen as of 12/20/2023. LPA confirmed there are only One (1) total resident in care with dementia at the time of visit 12/20/2023. LPA confirmed there are Six (6) total residents in care with wheelchairs at the time of visit 12/20/2023. LPA confirmed there are Ten (10) total residents in care with diapers at the time of visit 12/20/2023. Investigation Revealed the Following: Allegation: Staff yell at resident(s) in care. The details of the complaint alleged that a staff member yelled at a resident in care. During the records review, LPA reviewed staff yearly training regarding residents' personal rights. All staff have taken the training. During an interview with the Administrator (A#1) and Seven (7) out of Twelve (12) staff members, per A#1 stated that all staff know the residents' rights and do annual training. In addition, per (A#1), she said no staff has yelled at a resident before. (A#1) said, "We do not scream or yell at our residents; we only speak loudly to them when they have a hard time hearing us." During interviews with Four (4) out of Forty-Three (43) residents stated that they personally have not had issue with a staff member at the facility, and no staff has ever yelled or screamed at them. During interviews with Eight (8) out of Twelve (12) current staff members stated that they are familiar with the resident's rights, and Eight (8) out of Twelve (12) current staff members stated that they have never yelled or screamed at a resident. Based on information gathered, LPA did not find sufficient evidence to support allegation " Staff yell at resident(s) in care.” Investigation Revealed the Following: Allegation: Staff speak inappropriately to resident(s) in care. The details of the complaint alleged that a Staff speaks inappropriately to resident(s) in care. LPA interviewed Administrator Narine Mertkhanyan who stated she has not received any reports of staff speaking to a resident inappropriately. LPA interviewed with Four (4) out of Forty-Three (43) residents regarding the allegation. Of those interviewed, Four (4) out of Forty-Three (43) residents stated staff do not speak inappropriately to them with one not being able to answer due to their diagnosis. Eight (8) out of Twelve (12) staff interviewed, Eight (8) out of Twelve (12) staff stated there has not been any issues with staff speaking inappropriately to resident. LPA also interviewed Four (4) out of Forty-Three (43) residents stated there were no issues with staff speaking inappropriately to resident. Based on information gathered, LPA did not find sufficient evidence to support allegation " Staff speak inappropriately to resident(s) in care. Investigation Revealed the Following: Allegation: Staff member smokes marijuana on facility premises. Based on the interviews conducted with Four (4) out of Forty-Three (43) residents, statements obtained did not corroborate this allegation. Eight (8) out of Twelve (12) staff interviewed statements obtained did not corroborate this allegation. The details of this allegations state that staff smoke marijuana on the premises - when staff works in a rooms where staff closes door and smokes marijuana in a room. LPA toured the facility with staff, namely rooms #15, #17, #77, #71, #34, and #19. Based on the interviews conducted with Four (4) out of Forty-Three (43) residents, statements obtained did not corroborate this allegation. Eight (8) out of Twelve (12) staff interviewed have not observed Marijuana smoke coming out of rooms or facility. Based on the information gathered, there is not sufficient evidence to support this allegation " Staff member smokes marijuana on facility premises.” Investigation Revealed the Following: Allegation: Facility does not have an Administrator. Based on the interviews conducted with Four (4) out of Forty-Three (43) residents, statements obtained did not corroborate this allegation. Based on the interviews conducted with Eight (8) out of Twelve (12) staff interviewed statements obtained did not corroborate this allegation. Based on the interviews conducted with Four (4) out of Forty-Three (43) residents they have met with certified Administrator. Based on the interviews conducted with Four (4) out of Forty-Three (43) residents stated that the Administrator should devote more time. Continued on LIC9099-C. Based on the interviews conducted with Four (4) out of Forty-Three (43) residents stated that the Administrator manages two facility at this time of visit. Based on the interviews conducted with Four (4) out of Forty-Three (43) residents felt that there should be sufficient number of hours to permit adequate attention to residents. Based on the interviews conducted with Eight (8) out of Twelve (12) staff stated the Administrator does provide adequate time and personal integrity to the facility. Eight (8) out of Twelve (12) staff stated that they are provided guidance from the Administrator for the standard care and supervision of Forty-Three (43) residents in care. Based on information gathered, LPA did not find sufficient evidence to support allegation "Facility does not have an Administrator.” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator Narine Mertkhanyan and a hard copy was provided the Administrator.the state’s words, verbatim · CDSS document, Dec 20, 2023 · control 11-AS-20231214094855

Allegation investigated: Staff did not respond in writing regarding any action or inaction taken in response to resident council concerns or recommendations within 14 calendar days.

On 02/29/24 Licensing Program Manager, Ulysses Coronel (LPM), and Licensing Program Analyst (LPA), Mario Leon, arrived at the facility to deliver an amended document. This is an ammendment of the complaint investigation report delivered on 12/04/23. The purpose of this amendment is to provide additional information. LPM and LPA were met by Anne Marie Chan, Business Office Manager and there have been no changes to the initial findings. On 12/04/23 LPA requested facility documents and toured the facility. LPA interviewed four (4) out of forty-four (44) residents and three (3) out of nineteen (19) staff. The investigation consisted of the following: 12/04/23 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unanounced, complaint visit at the above-mentioned facility. LPA was met by Ashley Trimble, Activities Director, and later by Narine Metkhanyan, Administrator (S1). Report continues see LIC9099C Substantiated The investigation revealed the following: Regarding the allegation: "Staff did not respond in writing regarding any action or inaction taken in response to resident council concerns or recommendations within 14 calendar days.". It has been alleged that Administrator, Narine Mertkhanyan (S1) had not responded to the resident council's request on 10/31/23. LPA interviewed three (3) staff (S1-S3). One (1) staff has denied the allegation, one (1) staff agrees with the allegation and one (1) staff was unaware of the allegation. LPA interviewed four residents (R1-R4). All residents have agreed with the allegation. Record reviews revealed that the email sent to the above-mentioned facility, from resident council at 11:20AM on 10/31/23, did not contain any response from facility staff members. The same email, presented to LPA from the facility, did not present any element of response, in writing, made to the resident council. Based on record reviews and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title twenty-two (22), Division six (6) is being cited on the attached LIC9099D. An exit interview was conducted on 12/04/23 with Narine Mertkhanyan, Administrator, and a copy of facilities’ appeal rights and this report has been provided to Anne Marie Chan, on 02/29/24, Business Office Manager.the state’s words, verbatim · CDSS document, Dec 4, 2023 · control 11-AS-20231128163348

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(24)(c) · Plan of correction due date: Dec 14, 2023

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1,....shall have all of the following personal rights: (24) To organize and participate in a resident council...HSC1569.157. (c)If a resident council submits written concerns..respond in writing..within 14 calendar days. This has not been met as evidenced by: LPA observed email written to Administrator(S1) on 10/31/23. S1 forwarded email to fellow staff, not respond to resident(s) in writingthe state’s words, verbatim · CDSS document, Dec 4, 2023

Plan of correction: LPA and Administrator have agreed that, moving forward, facility will respond in writing to residents' concerns or recommendations. Town-hall meetings will address the concerns and recommendations presented by residents. Each monthly flyer will display topic(s) to be discussed, including residents' concerns and recommendations. Monthly flyer(s) will be sent to Mario.Leon@DSS.CA.GOV.

Allegation investigated: Licensee does not ensure the facility is free from pest. Licensee does not provide adequate food services for residents.

**This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 11/15/23. On 11/15/23 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA Shirley arrived at 10:26am and spoke to Wellness Director Amber Lollar and explained the purpose of the visit is to deliver findings for the allegations mentioned above and was granted access to the facility. The investigation consisted of the following: On 11/1/23 LPA reviewed resident files and toured the facility. LPA reviewed and requested copies of the following records: Client Roster, Staff roster, LIC 500, weekly menus, fumigation service records, and staff training. Con'd on 9099-C Unsubstantiated The investigation revealed the following: Allegation: Licensee does not ensure the facility is free from pests On 11/1/23 LPA conducted interviews with both staff and residents. LPA Shirley reviewed the service reports from Orkin for the months of September and October of 2023. During review, LPA observed that the facility is serviced every 2 weeks. There is a comment section on the report where the technician list the services and treatments done for the days serviced. LPA did observe ongoing treatment for termites and cockroaches, but there is no activity found on service dates. LPA interviewed staff, staff 1 – staff 4 (S-1 – S-4). LPA asked if they had observed termites or cockroaches in the facility. Of those interviewed 4 out of 4 stated no. LPA interviewed residents 1 – resident 6 (R-1 – R-6). LPA asked residents, if they had observed termites or cockroaches in the facility. Of those interviewed, 4 out of 6 answered, No. Based on information gathered, the department did not find sufficient evidence to support allegations "Licensee does not ensure the facility is free from pests. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Allegation: Licensee does not provide adequate food services for residents On 11/1/23 LPA conducted interviews with both staff and residents. LPA Shirley reviewed kitchen staff files and observed that both food handlers are accredited with certificates of completion for California Food Handlers. Cont'd on 9099-C LPA reviewed weekly menus and found that there are nutritionally balanced meals listed and a healthy balance of both cold and hot meals. There are also available options listed on the bottom of weekly menus offering both hot and cold deli sandwiches. LPA observed hair nets on kitchen staff during interviews as it is a requirement to enter the kitchen. LPA interviewed staff and ask them if they believed that the meals are well balanced and nutritious. LPA interviewed staff S-1 through S-4 (S-1 – S-4). Of those interviewed 4 out of 4 answered yes. LPA interviewed residents R-1 through R-6 (R-1 – R6). LPA ask, do you think meals are nutritious? Of those interviewed, 3 out of 6 answered yes. Based on information gathered, the department did not find sufficient evidence to support allegations "Licensee does not provide adequate food services for residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of the LIC 9099 was provided to Ruby Cruz, Business Office Manager.the state’s words, verbatim · CDSS document, Nov 15, 2023 · control 11-AS-20231025163724

Allegation investigated: Facility staff is not properly managing residents medication. Staff did not ensure residents received prescribed medications. Staff are not responding to residents call button in a timely manner. Facility is falsely advertising services to prospective residents.

The investigation consisted of the following: LPA observed facility, as well as common areas of the facility. A comfortable temperature is maintained throughout the facility. LPA observed the facility to be operational and in good repair, LPA reviewed pertinent documents pertaining to the investigation. The following documents were gathered or reviewed: Staff and Client Rosters, file for resident (R1) and any other pertinent documentation needs and service, physician report, residency agreement, medication records for R1. On 11/01/2023 LPA Randle interviewed Narine Mertkhanyan Administrator (S1). On 11/01/2023 LPA interviewed residents (R1-R4). LPA requested, received, and reviewed the following information: file of R1, Staff roster, Resident roster, and other documents relevant to the investigation. LPA received the following pertinent documents pertaining to the investigation: Resident Roster, Staff Roster, Admissions Agreement, Needs and Services Plan, LPA reviewed Staff schedule, resident generated CALL ALERT signal times were not available due to system design, On 11/2/2023 LPA interviewed staff (S2-S5) and resident (R5). regarding the allegations listed above. Unsubstantiated Cont. The investigation revealed the following: Allegation: Facility staff is not properly managing residents’ medication. LPA interviewed staff (S1-S5) and residents (R1-R5) regarding the allegation listed above. Staff S1and staff S2- S5 denied the allegation and confirmed use of central pharmacy were all resident using the facility for medication assistance and electronic recording MAR, LPA observed MARS of random resident and found no errors. Residents R2-R5 interviewed denied the allegation and all stated they did not have any issues with receiving medications on time or not having medication or receiving the wrong medication. R1 was interviewed regarding the allegation when R1 was asked if the facility was not properly managing his medication R1 stated to LPA “I handle my own medication, and I order my own medication the facility is not doing that for me I am independent”. During the course of the investigation, LPA was unable to find any documents or witnesses supporting the allegation above. LPA reviewed a copy of the R1’s admissions agreement, needs and services plan and physician report. All staff S1-S5 and residents R2-R5 denied the allegation and stated there were no issues or concerns about the facility staff not properly managing residents’ medication. Cont. Based on information gathered, the department did not find sufficient evidence to support the allegation. Although the allegation 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. Allegation: Staff did not ensure residents received prescribed medications. LPA interviewed staff (S1-S5) all denied the allegation. LPA interviewed residents (R1-R5) regarding the allegation listed above, residents R2-R5 denied the allegation. Staff S1 and Staff S2- S5 confirmed use of central pharmacy were all resident using the facility for medication assistance receives their medication. Residents R2-R5 interviewed denied the allegation and all stated they did not have any issues with receiving medications on time or not having medication per physician order. R1 was interviewed regarding the allegation when R1 was asked if the facility was not properly ordering R1’s medication, R1 stated to LPA “I handle my own medication, and I order my own medication the facility is not doing that for me I am independent”. During the course of the investigation, LPA was unable to find any documents or witnesses supporting the allegation above. LPA reviewed a copy of the R1’s admissions agreement, needs and services plan and physician report. LPA reviewed med cart for medication of random residents there were no cases were medication was not available for residents as prescribed. All staff and residents R2-R5 denied the allegation and stated there were no issues or concerns about the facility staff not ensuring residents received prescribed medications.. Based on information gathered, the department did not find sufficient evidence to support the allegation. Although the allegation 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. Cont. Allegation: Staff are not responding to residents’ call button in a timely manner. LPA interviewed staff (S1-S5) and residents (R1-R5) regarding the allegation listed above. Staff S1- S5 confirmed residents use of centralized call system when residents have needs, or general announcement for activities meals, and or emergency notification. Staff S2-S5 interviewed denied the allegation and all staff stated, staff are responding to residents’ call button in a timely manner. Residents R2-R5 interviewed denied the allegation and all stated they did not have any issues with staff are not responding to residents’ call button in a timely manner. S1 stated to LPA “residents indeed activate there call buttons often for assistance for care and staff responds to the calls for assistance timely”. S1 stated to LPA that S1 was unaware of any complaints from R1 or any other resident regarding delayed assistance and denies the allegation. LPA interviewed resident R1. R1 stated to LPA “I used the call button twice” LPA asked if R1 recalled why R1 used the call button, R1 stated to LPA “I don’t remember when or why I used the button the first time, but the second time I think it was because someone knocked at my door”. LPA interviewed Staff S, S1 stated to LPA all the staff responds timely to every call for assistance from all the residents. LPA interviewed staff (S2-S5) and staff confirmed they respond quickly to the call alerts from residents promptly as trained. LPA interviewed residents (R2-R5). regarding allegations listed above -Staff did not answer resident's call button in a timely manner, residents R2-R5 interviewed by LPA reported they had not encountered a problem with staff not responding timely. Based on information gathered, the department did not find sufficient evidence to support the allegation. Although the allegation 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. Cont. Allegation: The facility is falsely advertising services to prospective residents. LPA interviewed S1, S1 denied the allegation. S1 stated all residents, or their responsible party are given a pamphlet of services and are required to sign admission agreement and care plans incorporated into their agreement and a provided a copy at the time of admission or shortly thereafter. LPA interviewed Business Office Manager S2, S2 denied the allegation. S2 confirmed all residents, or their responsible party are given a pamphlet of services and are required to sign admission agreement and care plans incorporated into their agreement and a provided a copy at the time of admission or shortly thereafter. S1 was asked by LPA if R1 made any request for services and if services advertised were denied S1 stated “no”. LPA asked Staff S2 if R1 made any request for services and if services advertised were denied S2 stated “no”. LPA reviewed resident R1’s file and required documents were in the file and signed. LPA interviewed R1, R1 was asked if he received a copy of his admissions agreement R1 stated to LPA ‘I think I have a copy of my paperwork’. R1 was asked how he heard about the facility R1 stated “ I think from a web site Caring dot com”. LPA asked R1 if R1 remembers seeing any advertising form this facility R1 stated “ I did not see any advertising about this place”. LPA interviewed resident (R2-R5) all denied the allegation, Resident R2- R5 confirmed that they have had no issues regarding false advertising or not receiving services.. Based on information gathered, the department did not find sufficient evidence to support the allegation. Although the allegation 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. Findings Based on information gathered, the department did not find sufficient evidence to support the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted and a copy of the LIC 9099 was provided to Narine Mertkhanyan Administrator (S1the state’s words, verbatim · CDSS document, Nov 2, 2023 · control 11-AS-20231025152757

Allegation investigated: Facility is not maintaining a comfortable temperature for residents in care. Staff did not ensure that facility vents were cleaned. Facility laundry appliances are in disrepair

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Friday, October 27, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Wellness Director Amber Lollar. LPA Bunker explained the purpose of today's visit. The investigation consisted of the following: Interviews were conducted with staff members 1-5 (S1-S5) and residents 1-5 (R1-R5). LPA Bunker posed relevant inquiries pertaining to the nature of the complaint. Accompanied by Ms. Amber, LPA Bunker inspected the laundry room, meticulously assessing the operational status of the washers and dryers. We diligently inspected the facility's ventilation system and air filters. The facility's thermostat was verified to be set at a comfortable room temperature of 74 degrees. During the visit, LPA Bunker carefully assessed the cleanliness, safety, sanitation, and general state of repair of the facility's vents, all of which were found to be in compliance with Title 22 Regulation standards, promoting the safety and well-being of clients, employees, and visitors. LPA Bunker formally requested copies of the staff and residents' roster. See continued LIC9099-C page 2 Unsubstantiated Continued LIC9099-C page 2 Allegation #1: Facility is not maintaining a comfortable temperature for residents in care. Staff members 1-5 (S1-S5) and residents 2-5 (R2-R5) unequivocally affirmed that the facility consistently maintains a comfortable room temperature for its residents. S1-S5 and R2-R5 further affirmed that the facility's environment remains cool, ensuring a comfortable range, even lower than the ambient outside temperature. Additionally, S1-S5 and R2-R5 stated that staff proactively adjust the thermostatic controls to ensure residents are comfortable at all times. During our investigation, we meticulously examined the facility's room temperature and confirmed that the thermostat was set at a comfortable 74 degrees. However, Resident 1 (R1) raised a concern, asserting that the temperature inside the facility reached an uncomfortably high 94 degrees. Allegation #2: Staff did not ensure that facility vents were cleaned. S1-S5 and R2-R5 asserted that the facility's vents are consistently cleaned, with no residents experiencing bronchial cough symptoms. S1-S3 stated they had no physician reports, medical records, or documentation indicating residents with bronchial cough issues. S5 attested to taking proactive measures by cleaning the vents, replacing filters, and ordering new ones. S5 stated the facility underwent a change in ownership, and the previous owner had engaged an AC company to service all 17 units. S5 stated he is currently in charge of maintenance, and assured that the vents are clean, and filters have been ordered and replaced. Our inspection confirmed the operational condition of the facility's ventilation system and air filters. R1 contended that the facility's vents had not been cleaned and filters had not been changed, resulting in residents developing bronchial cough symptoms. S1-S5 and R2-S5 staunchly denied this allegation. Allegation #3: Facility laundry appliances are in disrepair. S1-S5 and R2-R5 affirmed that the facility's washers and dryers are fully operational, with housekeeping staff washing residents' clothing and linen on a daily basis or as needed. Our inspection of the facility's washer and dryers validated their working condition. However, R1 claimed that the facility's washing machine and dryers were non-functional. S1-S5 and R2-S5 firmly refuted this allegation. Investigation revealed the following: The investigation yielded consistent responses from staff members 1-5 (S1-S5) and residents 2-5 (R2-R5), all of whom adamantly denied the veracity of the allegations. S1-S5, in particular, emphasized the facility's commitment to maintaining a comfortable room temperature for residents, ensuring the cleanliness of vents, and upholding the functionality of laundry room appliances. Our inspection further corroborated these assertions, as the ventilation system and air filters were found to be both clean and operational, and the laundry room's washers and dryers were in working order. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. There were no deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Oct 27, 2023 · control 11-AS-20231026162040

Type of visit: Prelicensing

On 5/17/23 Licensing Program Analysts (LPA)/Alfonso Iniguez conducted a pre-licensing evaluation for an RCFE (Residential Care Facility for the Elderly) facility type. Today’s pre-licensing evaluation was conducted with licensee/Adam Zenou. The licensee has applied for a license to serve (174) age range 60 and over adults. The fire clearance is approved for (150) non-ambulatory and (24) bedridden residents. LPA toured facility Kitchen, Dining Room, Living Room areas, (8) Bedrooms, (8) Bathrooms, Garage, and Patios with shaded areas. LPA observed sufficient storage areas for kitchen supplies, linens, medications (secured) and chemicals (secured). LPA observed the following during this visit: MEDICATIONS There is a locked centralized storage area for Resident medications. PHYSICAL PLANT LPA observed the facility is clean, sanitary, and in good repair. Indoor and outdoor passageways, stairways, open areas, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68° degrees and 85° degrees. Open patios, and areas of potential hazard are well-lit. Carbon monoxide/Smoke detectors operate properly. BEDROOMS No client bedroom is a passageway to another room, bath, or toilet. There is a bed for each client with a mattress, mattress pad, bedsprings, and pillow(s) which are clean and in good repair. There is dresser and closet space for each client that includes at least two (2) drawers of dresser space per client. There is a chair and lamp for each client and at least one (1) nightstand per two (2) clients. CONTINUE ON LIC 809C BATHROOMS There are plenty toilets and washbasins for clients, family, and personnel. There are plenty showers for clients, family, and personnel. Hot water temperature is between 105°-120° degrees Fahrenheit. Bathrooms are located inside client bedrooms and common areas. Public restroom calling system is operational. SUPPLIES There is a sufficient supply of clean linens to permit weekly changing or more of client top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE Dining room is near kitchen. Refrigerator and freezer are clean and have the capacity to store at least two (2) days of perishable foods. There is storage for seven (7) day supply of non-perishable food. There are enough tableware, tables, dishes, and utensils. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. RECORDS There is confidential storage for personnel records at the facility. There is storage for Resident confidential information and records at the facility. ADMINISTRATION The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES There is an outdoor activity space with a shaded area and furnished for outdoor use. There are at least 3 common areas available to clients for visitors. There are activities scheduled during the current month. CONTINUE ON LIC 809C MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. LPA observed a sign-in/sanitation station at the facility entry. There is hand sanitizer located at the entrance of the facility. Facility has screening process for all visitors, sanitizer/soap, paper towels, and additional PPE supplies are stored inside the facility. During this pre-licensing inspection, LPA Iniguez did not find corrections are needed. LPA conducted the Component III Orientation with the Licensee and copy of this report was provided. A copy of the facility evaluation report will be available to the Central Applications Unit (CAU) for review.the state’s words, verbatim · CDSS document, May 17, 2023

Type of visit: Office

Facility Type: Residential Care Facility for the Elderly Application Type: Initial Capacity: 174 Census (if any clients in care): 22 COMP II Participants: Adam Zenou Interview Method: Telephone interview On April 05, 2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restricted/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 5, 2023