Senior Living Lifestyle - Palos Verdes

Type of visit: Required - 1 Year

On 09/05/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Administrator, Robert Smith, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) residents aged 60 and up, five (5) of which may be non-ambulatory and one (1) bedridden, with an approved hospice waiver for four (4) residents. Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. The facility consists of three (3) resident bedrooms, 2 bathrooms, living room, dining room, office area, kitchen, and attached garage. In the back is a patio with table and chairs available for resident use. LPA did not observe any bodies of water on the premises. There are no security bars on the windows. Bedrooms LPA inspected the three (3) resident bedrooms and observed them to be clean and in good repair. LPA observed resident rooms have the required furniture, including beds, dresser, nightstand, chair, and storage space for resident’s personal belongings. LPA observed the resident beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens in good repair. Bathroom LPA inspected the bathrooms and observed them to meet Title 22 regulations. LPA observed the bathrooms are clean and operational. LPA observed there are secured safety handrails in the showers. LPA observed an ample supply of towels and hand towels. LPA observed an ample supply of hygiene supplies. The water temperature measured 110.5-degrees and 111.8-degrees Fahrenheit. LPA observed cleaning supplies secured in a locked cabinet Kitchen LPA observed the kitchen was clean and sanitary. LPA observed an ample supply of dishware, cookware, and cutlery. LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods. LPA observed knives and sharps secured in a locked cabinet. The water temperature measured 110.6-degrees Fahrenheit. Common Areas LPA observed the living room has a couch and recliner to accommodate residents. LPA observed a fireplace screened and inaccessible to residents. LPA observed the dining room has a large table and chairs to accommodate residents. LPA observed games and activities available for residents’ use. Medications LPA observed Centrally Stored Medications secured in a locked cabinet in the kitchen and are inaccessible to residents. LPA observed medications in their original packaging. LPA reviewed the medications and Medication Administration Record (MAR) for four (4) residents and observed four (4) out of four (4) resident medications are consistent with properly documented records. Safety LPA observed smoke and carbon monoxide detectors are operable and in compliance. LPA observed a fully charged fire extinguisher, last serviced on 12/09/2024, mounted in the kitchen. The last emergency drill was conducted on 06/18/2025. LPA observed the First Aid kit is fully stocked and has the required items. LPA observed the required documents are posted throughout the facility. The facility has a working landline telephone. LPA observed cleaning supplies secured in a locked cabinet. No firearms or ammunition are stored at the facility. File Review LPA reviewed the files for four (4) residents. LPA observed four (4) out of four (4) resident files contained the required documents. LPA reviewed the file for the administrator and one (1) staff. LPA observed staff have the required documents, training, and certification. The administrators Administrator Certificate is valid till 04/13/2026. LPA observed Licensing Fees are current. Infection Control LPA observed the facility’s infection control practices. Upon entry LPA observed a Sign-In Log at the entrance and hand sanitizer. LPA observed Infection Control signs posted throughout the facility. LPA observed a 30-day supply of PPEs. LPA did not observe or cite any deficiencies. An exit interview was conducted with Administrator, Robert Smith, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 5, 2025

Allegation investigated: Staff did not supervise residents resulting in multiple falls and injuries. Facility did not seek timely medical attention for resident. Staff are not meeting residents care needs.

On 11/2/24 The Department conducted a subsequent complaint visit to render findings of the allegations listed above. The Department met with Robert Smith/Licensee and the purpose of today’s visit was explained. The Complaint was assigned to Community Care Licensing (CCLD) staff on 01/13/23. The investigation consisted of the following: On 01/26/2022, The Department initiated an unannounced complaint visit investigation and requested records which included physicians report, needs and service plan/appraisal, ID/face sheet, medication administration records, facility resident roster and facility staff roster. The Department interviewed staff (S1-S2) and residents (R1-R2). A plant inspection of the facility was conducted. On 01/27/2022, Community Care Licensing (CCLD) staff continued this complaint investigation and requested resident records. Evaluation Report continues LIC 9099-C... Substantiated Investigation Revealed the Following: Allegation #2: Staff did not supervise residents resulting in multiple falls and injuries. Regarding the allegation “Staff did not supervise residents resulting in multiple falls and injuries.” It is being alleged that resident was admitted to Torrance Memorial Hospital, on 12/4/21, for a fall that result in a left hip fracture and a left femur fracture. This investigation revealed resident #1 (R1) was admitted to Senior Living Lifestyle – Palos Verdes on 07/24/21. An interview was conducted with Licensee/Robert Smith who stated R#1’s first fall occurred approximately (1) week after R#1’s admission. The department found this fall resulted in serious injuries to the head, hip, and ribs. The Licensee stated that during R#1’s admission to the facility, R#1 was assessed and deemed a “fall risk”. The Licensee stated that after the fall in August of 2021, the facility failed to employ a fall risk plan. The department found on 12/01/21, R#1 fell again at the facility and the fall resulted in a hip and femur fracture. The Licensee stated after the second fall occurred preventative measures were put in place for R#1 when R#1 returned to the facility from skilled nursing in January of 2022. The department conducted and interview with R#1 and R#1 did not recall the falls that occurred while residing in the facility. Based on the departments review of medical records, supporting documentation, and interviews conducted; the department found the facility failed to provide R#1 the appropriate level of care and supervision and this resulted in R#1 sustaining injures due to falls. Allegation #3: Facility did not seek timely medical attention for resident. This complaint alleges that the facility did not seek timely medical attention for Resident R1 after R1 fell and sustained serious injuries on 12/1/21. On 12/01/21, Resident (R#1) fell at the facility, and this resulted in a left hip and femur fracture. The department conducted an interview with Licensee/Robert Smith, who stated he contacted 911 following R#1’s fall; however, the department was unable to find records of this call. Evaluation Report continues LIC 9099-C The department found the Licensee did contact R#1’s Home Healthcare agency on 12/1/21 to conduct an evaluation of R#1 after the fall. On 12/1/21, the Home Health agency conducted the evaluation and found no signs of injury. The Licensee states he also contacted R#1’s family member on 12/2/21 to report the fall. The family member requested Home Health perform an x-ray. The family member visited the facility on 12/4/21 to transport R#1 to the hospital due to Home Health not having the equipment to perform an x-ray on R#1. The department found R#1 fell on 12/1/21 and did not receive medical attention until 12/4/21; therefore, R#1 did not receive timely medical attention for injuries sustained. Additionally, The Licensee did not arrange for R#1’s medical needs to be met or provide transportation. Allegation #4: Staff are not meeting residents care needs. It is alleged that staff are not meeting residents care needs, resulting in resident #1 (R1) sustaining injuries. The department found that Resident #1 (R1) was admitted to the hospital 8/5/21 after a un-witnessed fall. On 01/27/21, the Licensee Richard Smith stated to department that R1 could independently transfer to and from bed and did not need assistance. The Department reviewed R1’s Physician’s report LIC 602A (dated 07/11/21) and Functional Capability Assessment form (dated 07/11/21) which indicated that R1 could not engage in self-care. R1 needs assistance with walking i.e. walker/wheelchair and needs help repositioning in bed from side to side as well as help with personal hygiene tasks. On 12/01/21, when the resident tried to transfer from one bed to another bed, it resulted in a fall. As a result of the fall, R1 sustained a broken left hip and a fractured femur. Licensee Richard Smith did not contact emergency personnel, nor did he transport R1 to the hospital instead he called the resident’s home health agency. According to the home health agency, they did not find any visible injuries; however, on 12/04/21, a family member transported R1 to Torrance Memorial Hospital where R1 was diagnosed with left hip fracture as well as a left femur fracture. Subsequently, the facility did not have a preventative measures plan in place to keep R1 safe, considering this was the second fall that occurred at the facility. Evaluation Report continues LIC 9099-C During this investigation, LPA found sufficient evidence to support the above-mentioned allegation(s). 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 SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D). -An immediate civil penalty of $500 is warranted accordance with California Health and Safety Code. See LIC421IM. An exit interview was conducted, and a copy of the Complaint Report was given to Robert Smith/Licensee. Investigation Revealed the Following: Allegation#1: Resident (R1) sustained pressure injury while in care. This complaint alleges that R1 developed a stage 2 pressure injury after an injury that occurred on 12/4/21. The department interviewed the licensee Richard Smith (S1). The Licensee indicated that the resident #1 (R1) was admitted to Senior Living Lifestyle- Palos Verdes on 07/24/21. R1’s Physician Report (LIC602A) dated 07/11/21 revealed that (R1) is ambulatory and requires assistance with daily living activities and had no pressure injuries and no history of pressure injuries. The department found (R1) resided in the facility from 7/24/21-1/29/22. During this time R1 was hospitalized for a fall that occurred at the facility on 12/4/21. The department reviewed hospital records and found no evidence of a pressure injury when R1 was hospitalized. The department was unable to find facility records to support R1 sustained a pressure injury or R1 developing a pressure injury while residing at this facility. Additionally, on 01/14/21, R1 was discharged from the hospital without a care plan for pressure injuries as R1 was not diagnosed with a pressure injury while hospitalized. Allegation #5: Facility are not providing residents with food of good quality. The investigation revealed the following: Regarding the allegation: Facility staff are not providing residents with food of good quality, it is being alleged that resident #1 (R1) did not get receive food of good quality, resulting in malnutrition. On 01/27/21, The department interviewed the Licensee Richard Smith (S1) and two residents (R1-R2). The department found 2 out of 2 residents were interviewed and stated that they eat three meals daily, never deprived of food and stated the food is terrific. The Department staff witnessed the residents enjoying their meals, while the licensee assisted in R1 & R2 with their meals. Evaluation Report continues LIC 9099-C Allegation #6: Staff are mismanaging resident’s medication. Regarding the allegation, “Staff are mismanaging resident’s medication,” it is being alleged that Resident #1 (R1) did not receive the correct medication. The resident R1’s Physician’s Report (LIC 602A) dated 07/11/21 revealed that R1 cannot self-care and requires assistance with activities of daily living and medication administration. The Department records review indicated that the facility consistently assists with administering medication to R1 since R1 was admitted at Senior Living Lifestyle—Palos Verdes on 07/24/21. According to the Identification and Emergency Information (dated 07/11/21). The Department records reviews dated 07/12/21 to 01/20/22, indicated no mismanagement on the Medication Administration Record (MAR). The Department did not observe any discrepancy. There is insufficient evidence to support the allegation of staff mismanaging resident’s medication. During this investigation, the Department did not find sufficient evident to support the above-mentioned allegations. 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 Robert Smith /Licensee.the state’s words, verbatim · CDSS document, Nov 2, 2024 · control 11-AS-20220125095503

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Nov 4, 2024

87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional, and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When…any. This requirement was not met as evidenced by: Based on interview and record reviews, the licensee failed to provide R1 with more assistance and supervision following discharge from the hospital on 08/07/20021 due to being a high fall risk. R1 continued to experience multiple falls that resulted to a left hip fracture on 12/05/2021, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 2, 2024

Plan of correction: The administrator shall read Title 22, section entitled, “Observation of the Resident” and send a plan of correction to LPA Antonine Richard via email to Antonine.Richard@dss.ca.gov.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(d) · Plan of correction due date: Nov 4, 2024

87411 Personnel Requirements – General (d) All personnel shall be given on-the-job training or have related experience in the job assigned to them. This… following, as … evidenced by safe and effective job performance: (5) Knowledge necessary to recognize early signs of illness and the need for professional help. This requirement was not met as evidenced by: Based on interview and record reviews, the licensee failed to ensure that staff recognize early signs of the need for professional help, R1 continued to experience multiple falls that resulted to a left hip fracture on 12/05/2021, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 2, 2024

Plan of correction: The administrator shall read Title 22, section entitled, “Personnel Requirements – General” and send a plan of correction to LPA Antonine Richard via email to Antonine.Richard@dss.ca.gov.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(2) · Plan of correction due date: Nov 4, 2024

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement was not met as evidenced by: Based on interview and record reviews, the licensee failed to arrange for R#1’s medical needs to be met or provide transportation. , which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 2, 2024

Plan of correction: The administrator shall read Title 22, section entitled, “ Incidental Medical and Dental Care ” and send a plan of correction to LPA Antonine Richard via email to Antonine.Richard@dss.ca.gov.

Type of visit: Required - 1 Year

On 08/28/2024 at around 10:00 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Licensee/Administrator Robert Smith. LPA explained the purpose of the visit and was accompanied by Licensee inside and outside the facility during this inspection. This facility is licensed to serve 6 non-ambulatory adults ages 60 and above, of which 1 may bedridden. This facility is approved for 4 hospice residents. A total of 3 residents are currently residing in this facility. The Annual Licensing Fees are current. The facility is a one-story house located in a residential street. The home consists of 3 resident bedrooms, 2 bathrooms, 1 living room, 1 dining/office room, 1 kitchen, 1 attached garage (has been converted to 2 rooms and is under construction), and 1 backyard patio area. Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. LPA observed clutter (items that were in the garage such as, bikes and several household items) in the backyard, walkways around the home, and the facility’s back door leading to the trail is in disrepair. There are no security bars or weapons on the premises. LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet. LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. First aid kit is fully stocked. Smoke and carbon monoxide detectors were in compliance and operational. The fire extinguisher is in the kitchen area and was last serviced on 12/08/2023. There is a videoconferencing device (laptop) and a land line telephone dedicated for client use in the office area. LPA observed clutter (miscellaneous household items on counter-tops, office table, and floor) in the living room, dining/kitchen area. 1 staff record was reviewed, 1 out of 1 staff record had required documentation. 3 resident records were reviewed and, 3 out of 3 resident records had required documentation. Technical Assistance is being issued regarding California Code of Regulation (CCR), Title 22, Alteration to Existing Building, 87305(a). Licensee will connect with his Licensing Program Analyst, Mario Leon. 1) Licensee will have their local authority (city) inspect their new construction and receive approval for their new construction. 2) Licensee will email approval of their new construction and an updated facility sketch (LIC 999) to Mario.Leon@dss.ca.gov. A deficiency is being cited based on LPA observation in accordance with the CCR, Title 22. A violation regarding CCR, Title 22, Maintenance and Operation, 87303(a). An exit interview was conducted, a copy of this report was left with the Licensee along with their appeal rights.the state’s words, verbatim · CDSS document, Aug 28, 2024

Allegation investigated: Staff does not accord resident privacy.

This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 3/6/2024. LPA’s Darneisha Cross and Alfonso Iniguez conducted an unannounced complaint visit. LPAs Iniguez met with Robert Smith /Administrator. LPAs explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Resident’s interviews (R#1-R#4) and Reporting Party Interview (RP) and witnesses interviews (W#1-W#4). LPA obtained and reviewed the following documents: Personnel Roster, Staff Roster, (R#1-R#4) Identification and Emergency Information, (R#1-R#4), (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). Evaluation Report continues LIC 9099-C Unsubstantiated This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 3/6/2024. Investigation Revealed the Following: Allegation: Staff does not accord resident privacy. The details of the complaint alleged that facility staff does not accord resident’s privacy. During the records review, LPA Iniguez and Cross reviewed the following documents: (R#1-R#4) Admissions Agreement, in which The Right to Privacy in Accommodations clause was written. The clause states that “the statutory and regulatory resident and personal rights agreement included with the agreement to allow residents a “reasonable level of privacy in accommodations” as outlined in health and safety.” LPAs observed the resident or legal representative signs this clause. In addition, LPAs observed the Resident/Personal Rights clause, in the clause it is stated that “The resident and the resident’s representative, if any, is entitled under California State law to receive a copy of the resident’s rights pertaining to admission and retention in this facility.” LPAs observed that the resident or legal representative signs this clause. During the facility tour, LPA Iniguez observed the residents’ rights posted in a prominent area where residents, family, and visitors can access them. During an interview with the Administrator (A#1), he stated that he is aware of the residents’ rights and that the residents in care are getting their private conversations respected by facility staff. In addition, (A#1) stated that he only stays with the residents if they ask me to stay when they do not know the person asking them questions. Also, (A#1) stated that he has always respected residents’ private conversations. Moreover, (A#1) stated that he had observed instances where the Long-term Care Ombudsman-LTCO does not follow the house rules while visiting the residents. Specifically, they knock on the door and do not wait for (A#1) to sign them in, instead they directly enter the residents' rooms. In such situations, (A#1) asks the residents if they would prefer to speak to the LTCO alone or if they would like (A#1) to be present during the conversation. (A#1) respects their choice and stays accordingly. Also, (A#1) stated that when residents in care received visits or phone calls, he respects their privacy. Evaluation Report continues LIC 9099-C This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created on 3/6/2024. During interviews with residents (R#1-R#4), (4) out of (4) stated that they are aware of their rights, and (4) out of (4) stated that they feel facility staff respect their rights. In addition, (3) out of (4) state that no facility staff has ever not respected their private conversations. When LPA Cross interviewed (R#2), LPA observed (R#2) watching TV and eating breakfast; LPA Cross noticed (R#2) needed to be more engaging in the questions LPA was asking them. Moreover, (4) out of (4) residents stated that when the Long-term Care Ombudsman comes to the facility to see them, they have private conversation with them, and the facility administrator is not present during these conversations. Also (4) out of (4) stated that when they received telephone calls or visits from friends and family members, the facility administrator gives them privacy. During a phone interview with witnesses (W#1-W#4), (4) out of (4) stated that the facility values and respects residents' privacy. Visitors can enjoy the peace of mind that they can confidently talk to their loved ones without any interference from the administrator. During this investigation, LPAs did not find sufficient evident to support the above-mentioned allegation(s). 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, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of the Complaint Report was given to Robert Smith /Administrator.the state’s words, verbatim · CDSS document, Mar 6, 2024 · control 11-AS-20240305082401

Type of visit: Required - 1 Year

On 1/6/2023 at around 10:20 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Licensee/Administrator Robert Smith. LPA explained the purpose of the visit and was accompanied by Licensee inside and outside the facility during this inspection. This facility is licensed to serve 6 non-ambulatory adults ages 60 and above, of which 1 may bedridden. This facility is approved for 4 hospice residents. A total of 4 residents are currently residing in this facility, of which 1 is a non-ambulatory resident. The Annual Licensing Fees are current. The facility is a one-story house located in a residential street. The home consists of 3 resident bedrooms, 2 bathrooms, 1 living room, 1 dining/office room, 1 kitchen, 1 attached garage, and 1 backyard patio area with shaded seating. Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet. LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. First aid kit is fully stocked. Smoke and carbon monoxide detectors were in compliance and operational. The fire extinguisher is in the kitchen area and was last serviced on 12/08/2023. There is a videoconferencing device (laptop) and a land line telephone dedicated for client use in the office area. 3 out of 3 resident’s bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit. This facility provides residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. 1 staff record was reviewed, 1 out of 1 staff record had a Criminal Record Clearance, Job Application, and signed Employee Rights. 4 resident records were reviewed and, 4 out of 4 resident records had Admission Agreements, Medical Assessments Consent Forms, Weight Record, Emergency Information, Appraisal & Needs Service Plan, Tuberculosis Test, Centrally Stored Medication Destruction Record, and Personal Rights. No deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and a copy of this report was left with the Licensee.the state’s words, verbatim · CDSS document, Jan 6, 2024

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.