Southland Living

Allegation investigated: Staff do not ensure facility is free from pests

Licensing Program Analyst (LPA) Daniel Konishi conducted a initial unannounced complaint investigation visit regarding above allegation. LPA met with the Administrator, Victoria Tran and LPA explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of the following documents: Staff roster, client roster, and Orkin invoices. LPA toured the facility and conducted random rooms checks. LPA interviewed the Administrator, Resident #2 (R2) to Residents #9 (R9), Staff #1 (S1) to Staff #5 (S5) and Witness #1 (W1). LPA did not interview Resident #1 (R1) since it is confirmed per Administrator that R1 is currently a resident at the skilled nursing side of the facility. The investigation revealed the following: In regard to the allegation “Staff do not ensure facility is free from pests.” It is alleged that there is a rodent infestation in R1’s bedroom. Per interview with the Administrator, it is confirmed that R1 lives in the skilled nursing side of the facility. [Continue to LIC9099-C] Unsubstantiated LPA continued with the pest infestation allegation in the assisted living side of the facility. LPA interviewed six (6) out of eight (8) residents that denied the allegation stating not seeing rodents and rodent droppings in their bedroom, dining room, and common areas. LPA interviewed one (1) out of eight (8) residents corroborated with the allegation stating hearing but not seeing rodents and that the staff and Orkin technician went in the resident’s bedroom right away to observe and set traps and the staff and Orkin technician did not observe any rodents or rodent droppings. LPA interviewed a second resident that corroborated with the allegation stating witnessing a rodent in the hallway once that occurred last night but the resident did not report this to the staff. Per Administrator, the Orkin technician conducted a site visit today to inspect and set rodent traps and the Orkin technician observed no rodents on the property. LPA interviewed the Administrator, and staff five (5) out of five (5) staff that denied the allegation stating that they have not seen rodents or any droppings on the property. Administrator stated that facility gets treated by Orkin twice a month. LPA interviewed the W1 who stated that they conduct pest control services at the facility twice a month and W1 haven’t witnessed any rodents and rodent droppings during today or prior site visits. LPA toured the facility common areas, hallways, main kitchen, assisted living facility kitchen, dining hall, laundry room, activity room, outdoor courtyard area, and ten random bedroom and observed no rodents nor rodent droppings. LPA obtained Orkin invoices from the February 2026, March 2026, April 2026, and recent service in May 2026. Facility is actively taking pre-cautions by having pest control come to the facility twice a month. Therefore, there is not enough evidence to substantiate. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was held and a copy of this report was provided to the Administrator, Victoria Tran.the state’s words, verbatim · CDSS document, May 12, 2026 · control 28-AS-20260508082638

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Administrator Victoria Tran and explained the purpose for today’s visit. The facility is licensed to serve 75 Non-Ambulatory residents of which 10 may be bedridden. Approved bedridden rooms #2, 4, 5, 6, 7, 8, 9, 10, 11, and 12. Approved hospice waiver for 10 residents. There is currently 1 resident using hospice services and 0 bedridden. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: The facility maintains the required Infection Control Plan. Operational Requirements: The facility maintains the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably available. The resident rooms have signal systems located in each bathroom that were tested an operating properly. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. The fire extinguishers were observed throughout the facility and are fully charged. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested throughout the facility resident private bathrooms and measured within the required range of 105-120 degrees. Facility has shaded patio/garden areas for residents on each floor. Staffing: There appears to be sufficient staffing at all times in the facility. Personnel Records-Training: Staff have criminal record clearance, current First-Aid training along with training in postural supports, Alzheimer’s and Dementia, Hospice, care for Bedridden residents, medication assistance, and other ongoing training are documented in personnel files. LPA reviewed 5 staff files with no issues observed. Administrator Victoria Tran certificate expires on 4/15/2027. (Continued on LIC9099-C) Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 5 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted on each floor/section: Residents Rights, Complaint Poster, and Ombudsman. Planned Activities: Facility provides scheduled activities with a monthly calendar and the required full-time staff that conduct and evaluate planned activities. There is sufficient space both indoor and outdoor for activities. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored and are in their original containers. LPA reviewed 5 residents medications during visit with no issues. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. The last drill was conducted on 12/23/25. Residents with Special Health Needs: Facility admits residents with hospice care and that are bedridden, staff files reviewed today all have required training documented. Residents using oxygen had the required signs displayed outside and inside their rooms. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of this report was emailed to Victoria Tran.the state’s words, verbatim · CDSS document, Feb 20, 2026

Allegation investigated: Staff does not keep facility free from pests.

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 11/04/2025 regarding the above allegation. During today’s visit LPA Ramirez was greeted by Administrator Victoria Tran and explained the purpose of the visit. During today’s visit, LPA Ramirez obtained a copy of the resident rosters dated 10/01/2025 and 10/31/2025, staff roster and interviewed two (2) staff. Interview with staff#1 (S1) revealed that resident#1(R1) does not reside at the facility and was never admitted into the facility. LPA Ramirez did not observe R1’s name in resident rosters. This agency has investigated the complaint alleging: Staff does not keep the facility free from pest. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. LPA Ramirez conducted an exit interview with Administrator Tran and provided a copy of this report. Unfoundedthe state’s words, verbatim · CDSS document, Nov 4, 2025 · control 28-AS-20251028093157

Type of visit: Case Management - Other

Licensing Program Analyst Nicol Wesley conducted an unannounced Case Management visit at the facility and met with Assistant Administrator Zach Miller and Wellness Director Michelle Adams to discuss the purpose for todays visit, which is to ensure the facility is in compliance with adding Dementia Care to their facility. During the visit Administrator Victoria Tran arrived and joined the visit. In regards to the facilities Dementia Care Plan, Items must be addressed to ensure the health and safety of the residents are being met. Here is a list of the following items that were observe to not meet the standards of Caring for a person with Dementia. Administrator training. Staff training(who is conducting the training). Emergency Disaster Plan(Address the dementia care). Outside middle of the facility(waterfall, not gated or secure). Outside on same campus SNF by the entrance of facility has stairs going. downward, and two waterfalls(1 gated) and 1 is not secure. Continued on LIC 9099C Upon Admission- at least annually(or change in condition). How many residents do you plan on receiving with Dementia? Title 22 section 87705(b) what is this section? Did you read it? Do you understand it? Title 22 section 87705(c)-(f) what is this section? Did you read it? Do you understand it? What are your intentions with the gate going downwards? How will you secure it? What are your intentions with the water fall at the SNF? How will you secure it? Trained staff will be available in sufficient numbers to meet the care and supervision of residents and take them on outings outside the facility. Right now the facility has 3 caregivers AM/PM shift, and 1 Med tech AM/PM. LIC 500 includes SNF staff(There is no interchange of duties) Emergency Disaster plan included names of staff form the SNF(There is no interchange of duties). Once the facility meets the Dementia Care Program Requirements, and submit the appropriate paperwork or corrections they will be granted a Dementia Care Plan to obtain Dementia Residents. A copy of this plan was given to the Administrator Victoria Tran during the exit interview.the state’s words, verbatim · CDSS document, Jul 14, 2025

Allegation investigated: Staff is under the influence of drugs while caring for residents Staff do not safeguard residents' medication

This report supersedes report dated 04/11/2025.The purpose of the visit is to provide additional information not included on the report dated 4/11/25, all findings remain the same. Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Victoria Tran and explained the purpose of the visit. The investigation consisted of the following: During the initial visit conducted on 01/28/2025, LPA conducted a health and safety check. LPA obtained copies of the following documents: staff roster, resident roster, and checked three (3) random residents’ medications for any errors or discrepancies. On 01/27/2025 our investigation branch (IB) assisted with this investigation. During today’s visit LPA Gutierrez interviewed Administrator Tran, staff 1 (S1) by telephone, S2-S6, residents R1-R5, and delivered findings. SEE 9099C Unsubstantiated In regard to the allegation “Staff is under the influence of drugs while caring for residents”, it is alleged that a staff member goes to work high while caring for residents. During interviews with staff five (5) out of five (5) all deny ever taking drugs or witnessing any staff do drugs. During interviews with residents five (5) out of five (5) all stated they never witnessed or felt staff were under the influence of drugs while caring for them. R1 stated that this is a nice facility, and all the staff is great. Investigator Dennis Douglas from the Investigation branch (IB) conducted interviews with Administrator and one (1) staff concerning the above allegation and found no discrepancies based on his two interviews. Staff in question was given a drug test on 12/27/2024 and the result was negative for all drugs tested. In addition, copies of incident reports were obtained from Downey PD by Investigator Real for the record. In regard to the allegation “Staff do not safeguard residents' medication”, it is alleged that staff has had empty cartons of medication with labels ripped off in their possession. During interviews with staff five (5) out of five (5) stated that there have been no problems with medication or any medication missing from med room or carts. Administrator stated some residents are able to keep medication in their rooms in a lock box and that none have reported any thing missing. During interviews with residents five (5) out of five (5) residents all stated they have never been missing any medication or had any problems with medications being dispensed by med -techs. During initial investigation LPA Gutierrez did a random medication check and there were no errors or discrepancies. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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 this report was given to Administrator Victoria Tran.the state’s words, verbatim · CDSS document, May 3, 2025 · control 28-AS-20250127105952

Allegation investigated: Staff is under the influence of drugs while caring for residents Staff do not safeguard residents' medication

Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Victoria Tran and explained the purpose of the visit. The investigation consisted of the following: During the initial visit conducted on 01/28/2025, LPA conducted a health and safety check. LPA obtained copies of the following documents: staff roster, resident roster, and checked three (3) random residents’ medications for any errors or discrepancies. On 01/27/2025 our investigation branch (IB) assisted with this investigation. During today’s visit LPA Gutierrez interviewed Administrator Tran, staff 1 (S1) by telephone, S2-S6, residents R1-R5, and delivered findings. SEE 9099C Unsubstantiated In regard to the allegation “Staff is under the influence of drugs while caring for residents”, it is alleged that a staff member goes to work high while caring for residents. During interviews with staff five (5) out of five (5) all deny ever taking drugs or witnessing any staff do drugs. During interviews with residents five (5) out of five (5) all stated they never witnessed or felt staff were under the influence of drugs while caring for them. R1 stated that this is a nice facility, and all the staff is great. Investigator Dennis Douglas from the Investigation branch (IB) conducted interviews with Administrator and one (1) staff concerning the above allegation and found no discrepancies based on his two interviews. In regard to the allegation “Staff do not safeguard residents' medication”, it is alleged that staff has had empty cartons of medication with labels ripped off in their possession. During interviews with staff five (5) out of five (5) stated that there have been no problems with medication or any medication missing from med room or carts. Administrator stated some residents are able to keep medication in their rooms in a lock box and that none have reported any thing missing. During interviews with residents five (5) out of five (5) residents all stated they have never been missing any medication or had any problems with medications being dispensed by med -techs. During initial investigation LPA Gutierrez did a random medication check and there were no errors or discrepancies. Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. 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 this report was given to Administrator Victoria Tran.the state’s words, verbatim · CDSS document, Apr 11, 2025 · control 28-AS-20250127105952

Allegation investigated: Staff do not ensure that resident's incontinence needs are met. Staff do not answer resident's call button in a timely manner. Staff did not distribute resident's medication as prescribed. Staff did not consult with responsible party regarding resident's care. Staff handles residents in a rough manner.

Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegations listed above. LPA Wesley met with Administrator Victoria Tran and explained the purpose for todays visit. Investigation consisted of: requested a copy of the staff and resident roster, interviewed the Administrator, requested to see resident 1,2,3 files, and requested specific copies of documents, interviewed Regarding allegation: Staff do not ensure that resident's incontinence needs are met. LPA Wesley interviewed resident 4 out of 5 residents who indicated that the staff meets their incontinence needs and they dont have any problems. Resident #1 uses the restroom frequently and staff indicated that the resident called 20 times per day and they are constantly taking the resident to the restroom. Staff did not remember leaving the resident in soiled undergarments on 09/28/24 & 11/20/24 and residents #2-#5 all confirmed that continued on LIC 9099C page 2. Unsubstantiated they have never been left in soiled undergarments, and the staff are pretty good with changing them. Staff all said that they change the residents in a timely manner. Regarding allegation: Staff do not answer resident's call button in a timely manner. LPA Wesley interviewed Staff and they said that they answer all residents calls in a timely manner. LPA Wesley was in the facility and pressed the call button and it took staff one minute and twenty two seconds to come and assist. Resident #1 uses the restroom frequently and staff indicated that the resident called 20 times per day and they are constantly taking the resident to the restroom. Resident's #2-#5 where interviewed and they indicated that the staff answers their calls in a timely manner. Regarding allegation: Staff did not distribute resident's medication as prescribed. LPA Wesley interviewed residents #1-#5, and 4 out of 5 residents indicated that the Medical Technician gives the residents medication in a little medicine cup, with water on time, and they never missed any medication. On 10/30/24 resident #1 loved one saw a pill on the floor & 11/21/24 found a another pill on the floor. Staff said they think that the resident took the pill out of their mouth or the medication fell from the cup, but they did confirm that they give all medications as prescribed according to doctors orders. Regarding allegation: Staff did not consult with responsible party regarding resident's care. LPA Wesley interviewed the staff who said that resident #1's Primary Treating Physician kept requesting for the resident to see a Neurologist this has been going on for about 1 month and a half. So the Primary Treating Physician asked the Wellness Director to schedule the appointment and they consulted with Resident #1's loved one and she said that she would agree with the appointment as long as it is with a Spanish speaking Neurologist. The Wellness Director scheduled the appointment, and resident #1's loved one canceled the appointment because the appointment was in Orange County and she was afraid her mom would use the bathroom. LPA interviewed residents #2-#4 and they indicated they have never experienced a problem like that but if they did, it wouldn't be a problem because the facility staff cares about the residents and are seeking medical attention because they have to. Regarding allegation: Staff handles residents in a rough manner. Resident #1's loved one indicated that staff #3 handled resident in a rough manner and left bruises on her body, and they told LPA Wesley that staff #4 handled resident in a rough manner leaving bruises on her body. Continued on LIC 9099C Page 3. LPA Wesley Interviewed residents #2-#4 and they've indicated that staff #3 and #4 have never handled them in a rough manner and left bruises on them. LPA Wesley interviewed Staff #3 and #4 and they denied handling the residents in a rough manner, or Leaving bruises on them. Staff said that they have to perform body checks on residents during showers and changing and have never saw any bruises on resident #1 except for when she fell back in October 2024. LPA Wesley has no pictures of any bruising to resident #1's body. Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegation(s) is found to be Unsubstantiated. A copy of this report was given to Administrator Victoria Tran.the state’s words, verbatim · CDSS document, Mar 20, 2025 · control 28-AS-20250225153248

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Erik Zaragoza and Nicol Wesley conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Jocelyn Salvador, Caregiver for the facility, and explained the purpose of the visit. Administrator Victoria Tran arrived shortly thereafter. There are fifty-one (51) residents residing within the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices were observed. · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story building located in a residential neighborhood. It is licensed for a capacity of seventy-five (75) non-ambulatory residents, ten (10) of which may be bedridden, and a hospice waiver approved for ten (10) residents. The facility consists of a kitchen, a dining room, seventy-two (72) resident bedrooms, an activities room, a lobby area, two (2) offices, a lounge, a medication room, two (2) laundry rooms, along nine (9) fire extinguishers. Six (6) resident bedrooms were reviewed and were observed to have all their required furnishings, and the restrooms in all of the bedrooms had a hot water temperature that measured between 105 – 120 Degrees Fahrenheit. Facility was observed to be in good repair. All carbon monoxide detectors in the facility were fully operational. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for a capacity of seventy-five (75) non-ambulatory residents, ten (10) of which may be bedridden, and a hospice waiver approved for ten (10) residents. · Care and supervision to meet the clients’ needs was observed. Staffing: · Thirty-five (35) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · All staff records reviewed have health a health screening with a Tuberculosis clearance, and all staff have First Aid/CPR trainings that are active. · The administrator’s certificate expires on 4/15/2025. Resident Rights/Information: · Physician orders were reviewed for five (5) resident files. · Medications were also reviewed for five (5) residents. Resident Records/Incident Reports: · Five (5) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food supply. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan was publicly posted within the facility. · The last emergency and disaster drill was conducted on 11/5/2024. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs: · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 14, 2025

Allegation investigated: Due to lack of supervision, resident fell sustaining an injury. Staff did not notify authorized representative of incident. Staff did not seek timely medical care for resident.

Licensing Program Analyst (LPA) Tena Herrera made an unannounced subsequent visit to deliver findings on the above allegations. LPA met with Assistant Administrator Zach Miller and explained the reason for the visit. - The investigation consisted of the following: During initial visit dated 7/23/24 LPA obtained copies of Resident Roster, Face Sheet, Hospitalization Census List (from Skilled Nursing Facility (SNF) – Southland Care Center - that is separate from Assisted Living) and interviewed both Administrator at Southland Living and Administrator at Southland Care Center (SNF). Based on interviews conducted and review of rosters and review of Resident #1’s (R1) admission record, it was determined that R1 resides at Southland Care Center not Southland Living. It was also determined that R1 has never resided at Southland Living. - Based on the information gathered during this visit, the allegations are deemed UNFOUNDED. A finding of UNFOUNDED means that the allegation is either false, could not have happened, and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted and a copy of this report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Aug 6, 2024 · control 28-AS-20240723101048

Allegation investigated: Resident was sexually assaulted while in care.

***This report serves as an amendment and supersedes the complaint investigation report dated 05/06/24. The purpose of the Amendment is to correct confidential. The findings remain as Unsubstantiated. *** On 6/18/2024 LPA Baptiste conducted an unannounced visit to deliver findings on an amended complaint. During today’s visit LPA Baptiste met with Wellness Director Michelle Adams and Assistant Administrator Zach Miller and explained the reason for the visit. On 5/6/2024 Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced subsequent visit to deliver findings for a complaint investigation for the allegation listed above. LPA met with Assistant Administrator Zach Miller and later met with Administrator Victoria Tran to discuss the purpose for today’s visit. (Report Cointued on 9099C) Unsubstantiated ***This report serves as an amendment and supersedes the complaint investigation report dated 05/06/24. The purpose of the Amendment is to correct confidential. The findings remain as Unsubstantiated. *** During the initial inspection conducted by LPA Wesley. The following documents was obtained: staff roster, resident roster, Report information and victims bill of rights from Sheriff department, Admissions agreement for Resident #1(R1) and Resident #2 (R2), Medication review report for R1 and R2 and R1’s resident appraisal. IB investigator Juan Lozano interviewed the Administrator, Wellness Director, Staff #1-#2, Resident #1-#5, and requested a copy of staff roster, and resident roster. IB investigator Juan Lozano indicated R2 disclosed that they voluntary allowed R1 into their room to show them the refrigerator. According to R2, while R1 was inside of the room, for an unknown reason grabbed they tried to squeeze the right breast of R2 and kiss R2. R2 denied that they notified Southland Living Staff that was going to have R1 in the room. R1 denied the allegation stating they did not try to grab R2’s breast. This incident was reported several weeks after it allegedly happened. Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegation is found to be Unsubstantiated. A copy of this report was given to the Wellness Director and Assistant Administrator.the state’s words, verbatim · CDSS document, May 6, 2024 · control 28-AS-20231128110105

Allegation investigated: Staff leave resident in bed for prolonged periods of time.

Licensing Program Analyst (LPA) V. Maldonado made an unannounced susequent visit to the facility for the purpose of continuing the investigation regarding the above-mentioned allegeation. LPA Maldonado met with Wellness Director, Michelle Adams, and explained the purpose for the visit. Administrator, Victoria Tran, arrived shortly after to assist with the visit. On 4/11/23, LPA Ashley Calderon conducted an initial visit and met with Wellness Director, Michelle Adams, and Administrator, Victoria Tran. The visit consisted of the following: LPA Calderon obtained a copy of the resident/staff roster, Resident #1 (R1) Admission's Agreement, Physician's Report, Appraisal Needs/Service-Care Plan- 603A/Level of Care Plan, Progress Notes, Hospice Care Plan, and Special Incident Reports. Rooms 4,11,21,23,32,47, and dining/activity room were toured with Administrator and interviews were conducted with Administrator Victoria Tran, Staff #1-#4 (S1-S4) and Residents #1-#5 (R1-R5). Telephone interviews were also conducted with R1's Guardian/Conservator and Hospice Care company. During today's visit, LPA Maldonado obtained additional progress notes for R1 regarding refusal/unwillingness to cooperate with transfers out of bed. (Report continued on LIC9099-C...) Unsubstantiated The investigation revealed the following: Regarding allegation: Staff leave resident in bed for prolonged periods of time. It is alleged that R1 reported to have been left in bed for 3 weeks and had not been outside. Per interviews conducted with staff, (5) of (5) staff denied the allegation and stated R1 required a (2) to (4) person assist when transferring, but was not willing to cooperate with staff during the transfers and would throw self back during the assists, making it more difficult to transfer. Staff stated they had no issues with transferring other residents that required the assistance. Per resident interviews, (4) of (5) residents could not corroborate the allegation. After review of R1's Care Plan, it was noted that R1 requires a (2) to (4) person assist to transfer. Per R1's Physician's Report, R1 is non-ambulatory and is unable to transfer out of bed on their own. R1's Appraisal/Needs and Services Plan indicates R1 requires maximum assistance with mobility and transferring in and out of bed/chair. Per Hospice Notes and facility Progress Notes, it was discovered that on 2/05/23, R1 was assisted by facility staff with standing. On 2/10/23, R1 was assisted by (2) facility staff with transferring to chair, but was throwing self back even while being assisted. On 2/22/23, R1 refused to be assisted by facility staff with care. On 03/02/23, assistance with transfer was provided by (3) staff, and R1's guardian was later notified of R1's refusal to care despite being provided with a (2) person assist. On 4/25/23, while R1 was moving out of the facility, R1 had a (4) person assist, and although R1 was able to get up, R1 then refused to be assisted into the car that was picking R1 up. Per interview conducted with R1's hospice agency, and per hospice record review, there was no written order for use of a hoyer lift to assist with R1's transfers, although the hospice care physician only made a verbal recommendation that a hoyer lift could help. The facility is not required to have a hoyer lift, and per interview with Administrator, none of the facility staff are trained to use a hoyer lift due to the facility not using or owning one. There are no residents in the facility who require assistance with transfer by hoyer lift. 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 this report was provided.the state’s words, verbatim · CDSS document, Feb 1, 2024 · control 28-AS-20230403135945

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nicol Wesley conducted the unannounced annual inspection at the facility. LPA met with Wellness Director Michelle Adams, and later Administrator Victoria Tran and assisted with the visit. The facility is licensed to serve 75 non-ambulatory residents, of which 10 may be bedridden. The approved bedridden rooms are #2,#4 through #12. The hospice waiver is approved for 10 residents. LPA conducted a complete tour of the facility, and observe the supply of food. Resident medications, and medication logs were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed the 7 fire extinguishers to be fully charged and serviced. The water temperature was tested and measured 114.6 degrees F. The Last fire drill was conducted on 01/17/24. LPA Wesley interviewed 6 residents and 5 staff. The smoke detectors/carbon monoxide detector are operable. The facility mitigation plan is on file. There are no deficiencies cited per the California Code of Regulations, Title 22. Exit interview conducted, and a copy of the report was given to Victoria Tran.the state’s words, verbatim · CDSS document, Jan 19, 2024

Allegation investigated: Facility had a fire. Facility telephones are not working. Facility lights are not operating properly.

Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced subsequent visit and upon arrival met with Housekeeper Guadalupe Sanchez and shortly after with Med-Tech/ Caregiver Abigial Reyes. Reyes paged Assistant Administrator Zachary Miller to assist with the visit. LPA met Assistant Administrator at 10:00am, LPA discussed the purpose of today's visit. At 11:15am Administrator Victoria Tran arrived to assist with the visit. On 5/23/22, LPA Wesley interviewed Administrator and Forman from Southern California Edison and conducted a tour of the facility alongside with Administrator. Today's investigation conducted on 12/21/23 consisted of the following: LPA Calderon collected a staff and resident roster for 2022 and Special Incident Report (SIR) dated 5/6/22. LPA alongside with Staff #1 and Assistant Administrator observed the area of the city explosion, observed Emergency Disaster Plane in Place, observed emergency disaster kit in medication room including flight light(s). LPA conducted interviews with Administrator via telephonically, Staff #1- Staff #4 (S1-S4) and Resident #1- Resident#5 (R1-R5). (Continuation on 9099-C) Unsubstantiated Regarding allegations: Facility had a fire. The following was revealed: LPA Wesley and Administrator on 5/23/22, toured the facility and did not observed any indications that a fire occurred inside of the building. LPA Wesley interview conducted with Foreman from Southern California Edison (SCE), confirmed that there was an underground circuit that caused an explosion due to a faulty transformer that had blown. SCE Foreman advised LPA Wesley that the explosion (fire) caused a power outage and hundreds of neighbors and businesses were affected. Interviews conducted by LPA Calderon with Administrator and S1-S4, and interviewed R1-R5, revealed explosion/ transformer blow out occurred on streets and not on the facility premises. LPA Calderon was informed that the Assisted Living facility lost power due to city transformer blow out. (5) out of (5) interviews conducted with residents who were present in 2022 informed LPA that facility did not have a fire and what occurred was a transform blow out in the city. On 12/21/23, LPA Calderon observed explosion area, based on observation and interviews explosion occurred on the streets of City of Norwalk and did not occur on facility perimeter. Regarding allegation: Facility telephones are not working. The following was revealed: Administrator Tran advised LPA Wesley on 5/23/22, that there was an underground electrical explosion occurred outside of the facility premises and did not affect the telephone lines. LPA Calderon conducted interviews with Administrator and S1-S4 revealed facility had working land lines and facility had power back up. (5) out of (5) interviews LPA Calderon conducted with residents revealed residents were unable to collaborate to this allegation due to residents having their own personal cell phones. (Continuation 9099-C) Regarding allegation: Facility lights are not operating properly. The following was revealed: (4) out of (5) staff interviews conducted by LPA Calderon revealed facility used electricity power and generator from the Southland Skilled Nursing Facility (SNF) side to provide power and lighting in Assisted Living facility hallways. Based on interviews with (5) staff and (5) residents, there was a facility power outage due to a city transformer explosion and resident's had emergency back up lighting. LPA Calderon was informed that the SNF side were not affected by the power outage due to being on different transformer. Investigation revealed that lights were not working property due to city issue/ incident that occurred near facility. Administrator Tran advised LPA Wesley on 5/23/22, that the facility placed back up lighting throughout the hallways, portable lights in residents rooms to those who needed it. LPA observed Emergency exit lights thought the facility, emergency oxygen tanks, disaster kit in medication and flashlight(s. LPA Calderon reviewed SIR regarding city transformer incident, that was reported to Licensing in a timely manner during time of incident. SIR states facility provided flashlights, provided resident's choice to be placed else where if needed, had emergency oxygen tanks and city was aware of incident and city was working on fixing the program. Investigation revealed facility took measures in to place to provide resident's with a safe and healthy environment during time of incident occurring outside near facility that was a city issue that affected residents, city problem was out of the control of the facility. LPA Calderon observed Emergency Disaster Plan in place during time of visit. 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 is unsubstantiated. No deficiencies were cited during todays visit. A copy of the licensing report was given during the exit Interview.the state’s words, verbatim · CDSS document, Dec 21, 2023 · control 28-AS-20220506112905

Allegation investigated: Staff are permitting resident to smoke in their room.

Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation listed above. LPA met with Administrator Victoria Tran to discuss the purpose for todays visit. LPA toured the physical plant, interviewed the administrator, staff #1-#2, resident #1-#5, and requested a copy of staff roster, and resident roster. Regarding allegation: Staff are permitting resident to smoke in their room. LPA Wesley interviewed Administrator Victoria Tran who stated that resident #1 doesn't smoke in their room, LPA interviewed the Wellness directors who said that resident #1 doesn't smoke in their room because her staff would tell her when they do their rounds. Wellness director also indicated that resident #2 brags and tells staff that she calls licensing all the time. LPA interviewed resident #1 and they said they do not smoke in their room. (Continued on LIC 9099C) continued on LIC 9099C. Unsubstantiated Resident #1 also denied drinking in their room getting drunk, and said their neck is not broken but it is fractured and they have hardware in place. If an individual were to look at the resident they couldn't tell their neck was broken and they are in an electric wheelchair. LPA Wesley went to resident #1's room and did not observe an odor or didn't see any indication that there was liquor(bottles in trash, cigarette buds trash, ash tray, ashes, cigarette holes in the bedding). Resident #2 said they have a fear of fires and purchased a fire extinguisher in case a fire breaks out in the facility. Staff confirmed that resident #2 had a fear of fires from childhood and may be paranoid that a fire will break out. Residents #3-#5 were interviewed and said they do not smell any smoke or didn't see, or hear of any residents getting drunk in the facility. LPA Wesley interviewed staff #2 who is a caregiver. They have indicated the resident smells like cigarettes because it lingers in their clothing, when they are out of their room it doesn't smell like cigarettes and they have never seen or heard of the resident drinking or getting drunk in the facility. Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegation is found to be Unsubstantiated. A copy of this report was given to the Administrator Victoria Tran.the state’s words, verbatim · CDSS document, Nov 3, 2023 · control 28-AS-20231027123826

Allegation investigated: Staff are making inapprorpiate comments towards resident. Staff yelled at resident. Staff are not providing resident with comfortable accomodations. Staff are not applying resident's medication. Staff are not meeting resident's walking needs. Staff are not providing adequate food service to resident.

Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation(s) listed above. LPA met with Administrator Victoria Tran to discuss the purpose for todays visit. LPA toured the physical plant, interviewed the administrator, staff #1-#2, interview Administrator, and requested a copy of staff roster, resident roster. Regarding allegation:Staff are making inapprorpiate comments towards resident, Staff yelled at resident, Staff are not providing resident with comfortable accomodations, Staff are not applying resident's medication, Staff are not meeting resident's walking needs, Staff are not providing adequate food service to resident. During the interview with Administrator she advised that none of her staff are required to walk the residents. LPA then looked at the resident roster and staff roster and did not see any of the names on the list that was continued on LIC 9099C. Unfounded spoken about on the back on the LIC 802(Complaint Report). The complaint is for the SNF(Skilled Nursing Facility) that is located next door. Based on the information gathered during this visit, the allegation(s): Staff are making inappropriate comments towards resident, Staff yelled at resident, Staff are not providing resident with comfortable accommodations, Staff are not applying resident's medication, Staff are not meeting resident's walking needs, Staff are not providing adequate food service to resident are deemed UNFOUNDED. A finding of UNFOUNDED means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Therefore, we have dismissed the complaint. Exit interview conducted with Administrator Victoria Tran and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 20, 2023 · control 28-AS-20231013090742

Allegation investigated: Staff made resident feel uncomfortable. Staff is stealing resident personal belongings.

Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation(s) listed above. LPA met with Administrator Victoria Tran to discuss the purpose for todays visit. LPA toured the physical plant, interviewed residents #2-#6 and staff #1-#2, interview Administrator, and requested a copy of staff roster, resident roster, and copy of the check form for body check conducted on 08/14/23. LPA attempted to interview resident #1 via phone and in person but was not successfull. Regarding allegation: Staff made resident feel uncomfortable. LPA Wesley interview #2 out of #6 residents who stated they wasn't uncomfortable with the body checks that were conducted, Interviewed staff #1 who stated resident #1 approached her and staff #2 in their office and told them I heard you were looking for me to do a body check, and the resident took all of her clothes off and bent over. She said I dont want to catch (Continued on LIC 9099C) Unsubstantiated any of that. The interview with staff #2 was consistent with staff #1 and she also said, just go ahead a check me. The body checks that were conducted were voluntary and the resident can deny if they wanted. Regarding allegation: Staff is stealing resident personal belongings. LPA interviewed staff #2-staff #6 and they all stated that the staff has not stolen any of their personal belongings, haven't heard of the staff stealing anyone's personal belongings. LPA Interviewed the administrator, staff #1, and staff #2 and they indicated that they have never stolen any resident personal belongings, never heard of any residents stealing anyone's personal belongings, and would notify and report it to someone if they did hear of them stealing. Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegations are found to be Unsubstantiated. A copy of this report was given to the Administrator Victoria Tran.the state’s words, verbatim · CDSS document, Sep 28, 2023 · control 28-AS-20230920143231