Select Senior Living I

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility unannounced to conduct a required annual visit at 10:22AM. LPA met with staff upon arrival and Administrators Kim Anderson and Dylan Hull who arrived shortly thereafter. Entrance interview conducted. Beginning at 10:34AM, the LPA, along with Administrator Anderson, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN/GARAGE: At 10:34AM, LPA inspected the kitchen/food service area. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility had a sufficient supply of perishable and non-perishable food and emergency food and water. Knives and sharps are stored inaccessible in a locked drawer. The garage is adjacent to the kitchen and is maintained locked and inaccessible. LPA observed cleaning supplies, additional refrigerator/freezer, and a washer and dryer in the garage. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private resident rooms and one (1) is designated as a staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All resident bedrooms have exits to the exterior and were equipped with functional auditory exit alarms. BATHROOMS: There are three (3) bathrooms. Two (2) are designated for resident use and one (1) is a staff/guest restroom. LPA observed bathrooms to be clean, sanitary, and in operating condition with slip-resistant surfaces and grab bars. Hot water temperatures were measured in bathrooms and were between 105.3-115.9 degrees F, which is within the required range. Report Continued on LIC 809-C COMMON AREAS: These include the living room and dining area. Common areas were appropriately furnished and in good condition. The facility maintained a comfortable temperature. Smoke detectors, fire doors, and carbon monoxide detector were tested at 10:50AM and were operable. LPA observed a fire extinguisher which was fully charged and purchased on 06/23/2025. Required posters were displayed throughout the common areas. Activities were observed in the common areas. A non-functional fireplace was noted in the living room. OUTDOOR AREA: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate that was equipped with a functional alarm. There is an outdoor storage area which contained additional supplies. There were no bodies of water noted at the time of the visit. MEDICATIONS: Medications review began at 10:55AM; medications are centrally stored and kept inaccessible in a locked cabinet by the kitchen. LPA reviewed medications for two (2) residents. All medications, including PRNs were labeled, stored, and locked inaccessible to residents. PRNs were properly documented and logged. Medications were observed to be properly documented on the centrally stored medications and destruction record and were in compliance with regulation, state, and federal law. RECORD REVIEW: LPA began record review at 11:10AM. LPA reviewed five (5) out of five (5) resident files for documents including, but not limited to: appraisals, medical records, admissions agreement, and consent forms. LPA reviewed four (4) personnel records for documents including, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All resident and personnel files were in order and had no missing documents. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 09/13/2025. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 17, 2025

Allegation investigated: Resident fell sustaining injuries due to staff neglect. Staff did not seek medical attention for resident. Staff are overmedicating resident. Staff are not meeting resident's needs.

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced investigation visit for the allegations listed above. The LPA arrived at the facility and was greeted by staff, and the LPA informed them of the visit. The staff contacted the Licensee Dylan Dylan Hull on the phone to inform them of the visit. Kim Anderson Licensed Vocational Nurse (LVN) arrived and the LPA explained the reason for the visit. On 07/24/2023, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial investigation visit for the allegations listed above. The LPA arrived at the facility and met with Administrator Dylan Hull and Kim Anderson and explained the reason for the visit. At 11:30 a.m., the LPA interviewed the administrator, and staff and at 12:00 p.m., conducted record review pertinent to the investigation. At this time LPA Urena found that further investigation is needed. Continues on LIC 9099C ... Unsubstantiated Pg 2. Resident fell sustaining injuries due to staff neglect. On the allegation that the resident sustained a fall due to staff neglect, it is the concern of the Reporting Party (RP) that R1 has fallen a few times since R1 moved into the facility on 05/06/2023. RP stated that on 5/22/2023, R1 was taken to the ER due to a fall and brought back to the facility, only to fall again the next day. To investigate the allegation LPA Urena conducted interviews and record review. Record review of the Unusual /Injury/Incident Reports (LIC 624) submitted to the Regional Office (RO) indicated that R1 had an unwitnessed fall on 05/29/2023 at approximately 6:40 p.m. Staff found R1 on the floor trying to fix their shoe and noticed that R1 sustained two small skin tears to the top of their hand. Furthermore, on the second page of the LIC 624 indicates that Home Health was notified to provide wound care. Staff interviews revealed that they found R1 on the floor and after doing an assessment they noticed a skin tear to the top of the right hand. The staff contacted the licensee and the licensee contacted R1’s physician and home health were contacted to provide wound care to R1’s hand.Staff stated that during the day R1 was closely monitored to assist and tried to prevent falls. Record review of the Home Health “Visitor Care Notes”, revealed that Home Health was providing wound care for R1. On 07/24/2023, LPA Urena interviewed the Licensee. Per the licensee, R1 would get up at night and try to ambulate to the bathroom on their own, and this is the time when R1 sustained the falls. Night supervision is one (1) staff to six (6) residents. Motion detectors devices are placed in each room to detect residents getting up from there bed, consequently alerting the night staff. The LPA observed the motion detector monitor located in the living room and a voice is heard saying the name of the room where the movement was detected. Staff attended to the alert coming from the residents’ bedrooms. Although R1 fell and sustained a laceration to the top of the right hand due to a fall, the staff provided first aid and notified the licensee. The licensee in turn contacted the physician’s and order home health. Based on the information obtained through interviews and record review, there is insufficient evidence to find that staff were neglectful. Therefore, the allegation is deemed Unsubstantiated at this time. Continues on LIC 9099C... pg.3 Pg 3 Staff did not seek medical attention for resident. On the allegation that staff did not seek medical attention for R1, the RP stated that they visited R1 on 6/28/2023 and there were no signs that R1 was sick, however, when RP visited on 07/02/2023, R1 was unresponsive, had shallow breathing, and looked bad. RP stated that the staff didn’t know what to do and called the facility nurse. RP stated that the nurse came in and said, “What do you want me to do?” RP stated that they couldn’t believe that staff couldn’t tell there was something wrong with R1. RP stated that staff checked R1’s oxygen levels, and it was at 90%. RP stated that RP had to tell the staff to call 911. R1 was taken to the hospital, and R1 was diagnosed as having pneumonia. The staff interviews revealed that R1 appeared to be normal on the days preceding the incident, however, on 07/02/2023 R1 was lethargic during the day, however there were no signs of distress, no high temperature, skin looked normal. R1’s representative was visiting with R1 on 07/02/2023, and the representative noticed that R1 did not look well. Staff checked the R1’s oxygen level, which was measured at 90% (normal level is 95%). Staff contacted the facility’s LVN and told the LVN that R1’s representative was requesting to call 911 for R1. Staff called 911, and R1 was transported to the hospital for evaluation. R1 was diagnosed as having pneumonia. Based on the interviews, observation, record review, there is insufficient evidence to prove that staff failed to seek medical attention for resident. Therefore, the allegation is deemed Unsubstantiated at this time. Staff are over medicating resident. It is alleged that R1 was being over medicated by staff, however the RP does not know what was being given to R1 to cause R1 to appear sedated, and lethargic. To investigate the allegation, on 07/24/2023 and 11/19/2024, LPA Urena conducted record review of the Centrally Stored Medication and Destruction Record (LIC 622), and interviewed the administrator, the LVN, staff, and RP. The record review indicated that all the medications were prescribed by R1’s physician. One of the medications prescribed to R1, indicate that the side effects may be drowsiness, dizziness, nausea and headache. The staff interviews revealed that they assisted R1 with the medication per the instructions on the LIC 622. The facility LVN stated that R1 was prescribed Temazepam for agitation. The interview with the RP revealed that all medications being given to R1 were prescribed by R1's physician. Based on the information obtained through interviews and record review; staff was assisting R1 with medications as prescribed by R1’s physician. Therefore, the allegation is deemed Unsubstantiated at this time. Pg. 4 Staff are not meeting resident's needs. On the allegation that staff are not meeting the resident’s needs, it is the concern of the RP that although a home health care nurse was taking care of R1’s skin tear, RP had to take care of the wounds on the days home health nurse was not present, because the staff weren’t taking care of it properly. To investigate the allegation the LPA conducted interviews and record review. The interviews revealed that R1 sustained a skin tear on top of their hand, and Home Health was providing wound care. Record review revealed that home health was providing wound care every three days starting on 05/29/2023 through 06/29/2023. Facility staff understand that they are not skilled professional, consequently they cannot provide wound care. Staff kept wound dry by preventing it from getting wet during showers. Based on the interviews and record review, R1 was receiving wound care by a skilled professional as indicated by the physician’s orders. Therefore, the allegation is deemed Unsubstantiated at this time. No citations were issued. Exit interview was conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 19, 2024 · control 29-AS-20230718163058

Allegation investigated: Facility failed to issue a refund Facility failed to comply with resident's admission agreement

This is an amended report. On 10/22/2024, Licensing Program Analyst (LPA) Kelly Dulek met with Facility Designee Kim Anderson with the purpose of issuing final findings on the allegations above. Administrator/Licensee Dylan Hull arrived at 10:05AM. Entrance interview conducted. Licensing Program Analyst (LPA) Esther Cortez (Cortez) conducted an unannounced initial complaint visit to the facility above on 08/16/2023 from 09:40am to 03:45pm. LPA Cortez met with Kim Anderson, Facility Designee. LPA Cortez interviewed staff and residents. LPA Cortez toured the inside and outside of the facility. LPA Erika Miller conducted additional interviews on 10/15/2024. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated This is an amended report. On the allegations: Facility failed to issue a refund and facility failed to comply with resident's admission agreement This is an amended report. On the allegations: Facility failed to issue a refund and facility failed to comply with resident's admission agreement. Reporting Party (RP) alleges that on 07/02/2023, R1 was hospitalized for 8 days. RP alleges that they advised S1 on 07/06/2023 that R1 will not return to facility, due to their medical condition. R1 was discharged from the hospital and moved into a skilled nursing facility. RP alleges that S1 advised, if R1’s personal items are removed, R1 will be entitled to a refund. On 07/06/2023, RP removed R1 personal belongings from facility. Dylan Hull, Licensee, subsequently refused to issue a refund, citing that RP was required to provide the facility a 30-day prior notice before vacating. R1 was admitted to facility on May 6, 2023, and was taken to hospital on July 2, 2023. A pre-admission refund was provided as required by Title 22 Regulations. LPA Miller reviewed the Admission Agreement dated May 1, 2023, which states in part, “All charges will be refunded on a prorated basis upon notice that the Resident’s medical condition will not allow a return to the facility when all the resident’s personal belongings are removed from the facility and the personal property form (LIC621) is completed. If the resident leaves the facility other than a medical condition, a thirty (30) day notice to the facility is required.” The admission agreement does not contain explicit language stating which “medical conditions” meet the degree to which a 30-day notice is no longer required and does not state that the medical condition must be a restricted or prohibited condition. The contract language is vague and ambiguous. R1 suffered a medical emergency on 07/02/2023 and was transported the hospital after a 9-1-1 call was placed. R1 was diagnosed with pneumonia and was subsequently discharged to a skilled nursing facility on 07/10/2023. Licensee acknowledged in a prior interview that the facility cannot provide the same level of care as a skilled nursing facility (SNF). The resident’s belongings were removed on 07/06/2023. R1 remained at the SNF until 08/15/2023. Report Continued on LIC 9099-C This is an amended report This is an amended report. LPA obtained documentation consisting of a copy of the 07/10/2023 hospital discharge that reflects, “Discharge Disposition: Skilled Nursing Fac” and the discharge summary from Post Acute care that confirms R1 stayed in a SNF from 07/10/2023 through 08/15/2023. LPA also reviewed 09/05/2023 correspondence from their physician that states, “patient is unable to return to board and care facility due to [their] medical condition” and R1 requires 24/7 supervision due to their dementia. The document does not specify any medical condition other than dementia. Licensee stated they were verbally notified around 07/06/2023 that R1 would not be returning after being sent to the hospital. However, a written 30-day notice was not submitted. Although the documentation from 09/05/2023 states R1 was unable to return to the board and care facility due to their “medical condition,” it only states R1 needed 24/7 supervision due to their dementia, which would be within the scope of this facility. Additionally, this documentation is from approximately 2 months after R1 entered the SNF, at which time R1’s condition could have changed. Licensee stated they were willing to take R1 back from the hospital with pneumonia and would have implemented additional care as needed to meet their needs. Licensee also stated R1 did not have a prohibited health condition. The admission agreement states a 30-day notice was required unless the resident’s medical condition did not allow them to return to the facility. The investigation revealed no medical documentation indicating R1 could not return to the facility from on or around 07/06/2023, when RP removed R1’s personal belongings from the facility and provided verbal notice that R1 would not be returning to the facility. The Licensee maintains they could have met R1’s needs. The investigation determined the admission agreement was followed and R1 was not owed a refund. 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 allegations are UNSUBSTANTIATED at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 22, 2024 · control 29-AS-20230811095354

From the deficiency page — Deficiency type: Type B · Section cited: CCR 00000 · Plan of correction due date: Nov 5, 2024

Citation has been removedthe state’s words, verbatim · CDSS document, Oct 22, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit and entered the facility at 9:55 a.m. Upon arrival, LPA Mosley was greeted by Kimberly Anderson, Administrator and explained the reason for the visit. Administrator/ Licensee Dylan Hall arrived shortly after. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Upon arrival LPA observed residents finishing up breakfast followed by activities such as puzzles. KITCHEN: The LPA inspected the kitchen/food service area at 9:58 a.m. Knives and sharps were observed in a locked drawer. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) day perishable and seven (7) day non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. COMMON AREAS: At the time of the visit, furniture in the common areas was observed to be in good condition. The facility maintained a comfortable temperature. At 11:29 a.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was observed to be purchased and fully charged on 06/28/2024. The LPA observed required postings throughout the common space. The last emergency disaster drill took place on 08/22/2024 and conducted monthly. Activities were observed in the common areas. A non-functional fireplace was noted in the living room. Report Continued on LIC 809C... Report Continued from LIC 809... RESTROOMS: There are three (3) bathrooms. Two (2) are designated for resident use and one (1) is a staff/guest restroom. Resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels. The hot water temperature was measured in all bathrooms and measured from approx. 10:06 am – 10:30am and measured between 109.9 – 112.7 degrees Fahrenheit all within the required range. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private resident rooms and one (1) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. GARAGE/BACKYARD: The garage is maintained locked at all times. There is a washer and dryer on premises. LPA observed an adequate amount of emergency food and water. Cleaning supplies, PPE and incontinence supplies are kept in the garage locked and inaccessible to residents in care. The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. LPA observed one (1) self-latching gate. There were no bodies of water noted at the time of the visit. RECORDS: Resident Records were reviewed beginning at 10:25 a.m. and personnel records at 11:00 a.m. Six (6) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Four (4) personnel files including the Administrator’s file were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All records were in order. Report Continued on LIC 809C... Report Continued from LIC 809C... MEDICATIONS: Medications review began at approximately 12:30 p.m. The medications are locked in a cabinet adjacent to the kitchen. Medications for four (4) clients were reviewed. Medications reviewed were found to be self-administered as prescribed and documented on the centrally stored medication and destruction records. INTERVIEWS: Two (2) staff interviews were conducted. Two (2) resident interviews were conducted during the inspection. LPA obtained the following documents: LIC 500, LIC9040, and current liability insurance. No deficiencies were cited during today’s inspection. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 4, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived unannounced to conduct a required annual visit. The LPA initially met with facility staff. Administrator Dylan Hull was contacted via telephone and arrived at 11:20AM. LPA explained the reason for the visit. Entrance interview conducted. Beginning at 11:30AM, the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguisher is fully charged and purchased on 05/15/2023. Hardwired combination smoke/carbon monoxide detectors and fire doors were tested at 01:48 PM and were functional. A copy of the current liability insurance was obtained during today's visit. COMMON AREAS: This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. An non-functional fireplace was noted in the living room. BEDROOMS: There are seven (7) total bedrooms in the facility; six (6) bedrooms are designated as private resident rooms and one (1) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. BATHROOMS: There are three (3) bathrooms. Two (2) are designated for resident use and one (1) is a staff/guest restroom. Resident restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in both resident bathrooms and measured within the required range. Report Continued on LIC 809-C OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water on the premises. KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Cleaning supplies are located in a locked cabinet under the kitchen sink. Knives are stored in a locked kitchen drawer. GARAGE: Garage was observed locked and contained laundry area, extra food, PPE and incontinence supplies, and emergency food and water. RECORD REVIEW: Began at 11:55AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All five (5) staff files and five (5) resident files observed were in compliance with regulation. MEDICATION REVIEW: Began at 12:57PM. Medications for two (2) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last drill conducted on 09/28/2023. Emergency disaster plan was observed to be complete and updated annually, as required. INTERVIEWS: During today's visit, LPA interviewed two (2) staff and two (2) residents. No deficiencies cited. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Oct 22, 2023