Sunny Hills Assisted Living (Memory Care)

Allegation investigated: Staff leave resident in soiled diaper for an extended period.

On 06/18/2026, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Complaint Visit to the facility listed above. LPA met with Jung Hee Kim, Executive Director, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of: During today's visit, LPA inspected the facility, interviewed Staff S1-S5, interviewed Residents R1-R7, and received and reviewed documents pertinent to the investigation. The following documents were received and reviewed Staff Roster, Resident Roster, Admission Agreement (dated 04/30/2025), Identification and Emergency Information (dated 04/30/2025), Physician’s Report (dated 07/16,2025), Needs and Service Plan (dated 01/27/2026), Physician’s Orders, and In-Service Logs (from 07/16/2025 through 06/17/2026). The investigation revealed the following: Unsubstantiated Allegation: Staff leave resident in soiled diaper for an extended period The allegation alleges that staff do not regularly change a resident’s diaper knowing the resident requires frequent changes. During the facility inspection, LPA observed a list of residents who require assistance with incontinent care posted behind the front desk. LPA observed caregivers taking residents to the restroom or checking to see if they need changed. During Record Review, LPA received and reviewed Staff In-Service Training logs regarding residents Personal Rights. S1 stated incontinent care is part of the of the staff Personal Rights Training. LPA received and reviewed training material for incontinent care. During interviews with Staff S1-S5, were asked how often residents are assisted with changing diapers or using the restroom, five (5) out of five (5) stated residents are checked every 2 hours to see if they need changed or use the restroom and they are cleaned and changed every four (4) hours. During interviews with Residents R1-R7, were asked if they have been left in soiled diapers for an extended period of time, four (4) out of seven (7) stated they have not been left in soiled diapers for an extended period of time. One (1) out of seven (7) shook their head yes, when asked if they were left in a diaper for an extended period of time. Two (2) out of seven (7) declined to be interviewed. During interviews with Residents Responsible Party’s W2, was asked if there was a time they have come to the facility and observed their resident in soiled diapers, W2 stated no, they have not observed that. Additionally, W2 was asked if they have any concerns regarding residents being left in soiled diapers, W2 stated no, they have no concerns. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. LPA did not observe or cite any deficiencies. An exit interview was conducted with Jung Hee Kim, Executive Director, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 18, 2026 · control 11-AS-20260611163254

Allegation investigated: Staff's behavior poses a health and safety risk to residents.

On 03/02/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to further investigate the allegation mentioned above, and deliver findings. LPA met with Administrator Jung Hee Kim, and the purpose of the visit was explained. LPA was granted entrance to the facility. The investigation consisted of the following: On 02/25/26, LPA Gonzalez requested the staff roster, and resident roster. LPA reviewed records for staff #5-#6 (S5-S6) and requested a copy of the following documents: Personnel Record (LIC501), and Department of Justice (DOJ) Background Clearance Form. Additionally, LPA Gonzalez conducted interviews with staff #1-#5 (S1-S5) and attempted to interview staff #6 (S6). Furthermore, on 03/02/26, LPA Gonzalez conducted interviews with resident #1-#6 (R1-R6), and a tour of the facility. Continued on LIC9099-C Unsubstantiated The investigation revealed the following: For the allegation: Staff's behavior poses a health and safety risk to residents. It is being alleged that a staff member at this facility is sexually harassing another staff member. It is also being alleged that staff members are not being treated fairly at his facility. On 02/25/26, LPA Gonzalez conducted interviews with S1-S5, and attempted to interview S6, but was unable to as they are no longer working at the facility. Of those interviewed, 5 out of 5 staff could not corroborate the allegation. 5 out of 5 staff said they are treated equally and fair at this facility. On 03/02/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate the allegation. 6 out of 6 residents said they are satisfied with the services provided to them at the facility. Based on observation, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of this report was provided to Jung Hee Kim, Administrator.the state’s words, verbatim · CDSS document, Mar 2, 2026 · control 11-AS-20260217085439

Allegation investigated: Staff's behavior poses a health and safety risk to residents.

** This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 02/25/26. ** On 03/02/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint investigation visit for the allegation listed above. LPA met with Administrator, Jung Hee Kim, and explained the purpose of this visit is to provide an amended copy of the LIC9099 report. On 02/25/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit to investigate the allegation mentioned above. LPA met with Administrator Jung Hee Kim, and the purpose of the visit was explained. LPA was granted entrance to the facility. Continued on LIC9099-C Unsubstantiated During today’s visit, LPA Gonzalez requested the staff roster, and resident roster. LPA reviewed records for staff #5-#6 (S5-S6) and requested a copies of various documents. Additionally, LPA Gonzalez conducted interviews with staff #1-#5 (S1-S5) and attempted to interview staff #6 (S6). Due to time constraints, and additional information needed, the above allegation needs further investigation. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 2, 2026 · control 11-AS-20260217085439

Allegation investigated: Staff does not ensure facility is free of pests.

Duplicate complaint. On 01/22/26, LPA Gonzalez conducted an unannounced complaint investigation visit for the allegation listed above. LPA met with Jung Hee Kim, Administrator, and explained the purpose of the visit. LPA was granted access to the facility. The investigation consisted of the following: On 01/22/26, LPA Gonzalez collected the following documents: staff roster, resident roster, and service invoices from OK Exterminators (dated:11/07/25, 12/12/25) and National Exterminator Company (dated: 01/09/26). LPA conducted interviews with staff #1-#5 (S1-S5), and residents #1-#6 (R1-R6). Additionally, LPA conducted a tour of the entire facility, and inspected resident rooms, kitchen and common areas. Unsubstantiated The investigation revealed the following: For the allegation: Staff does not ensure facility is free of pests. It is being alleged that there are bedbugs and cockroaches in the facility. On 01/22/26, LPA Gonzalez conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff denied the allegation. 5 out 5 staff said pest control services are provided monthly. On 01/22/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate with the allegation. During a records review conducted on 01/22/26, LPA reviewed pest control service invoices from Ok Exterminators dated 11/07/25 and 12/12/25, and National Exterminator Company dated 01/09/26. Documentation reflected that general pest control services were performed on the referenced dates. On 01/22/26, LPA and Jung Hee Kim conducted a tour of the facility and inspected rooms #102 and #113 on the first floor, rooms #206 and #217 on the second floor, rooms #302 and #306 on the third floor, as well as the kitchen and common areas. LPA observed the inspected areas to be clean, sanitary, and free of pests. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of this report was provided to Jung Hee Kim, Administrator.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 11-AS-20260112152629

Allegation investigated: Staff does not ensure facility is free of pests.

On 01/22/26, LPA Gonzalez conducted an unannounced complaint investigation visit for the allegation listed above. LPA met with Jung Hee Kim, Administrator, and explained the purpose of the visit. LPA was granted access to the facility. The investigation consisted of the following: On 01/22/26, LPA Gonzalez collected the following documents: staff roster, resident roster, and service invoices from OK Exterminators (dated:11/07/25, 12/12/25) and National Exterminator Company (dated: 01/09/26). LPA conducted interviews with staff #1-#5 (S1-S5), and residents #1-#6 (R1-R6). Additionally, LPA conducted a tour of the entire facility, and inspected resident rooms, kitchen and common areas. Continued on LIC9099-C Unsubstantiated The investigation revealed the following: For the allegation: Staff does not ensure facility is free of pests. It is being alleged that there are bedbugs and cockroaches in the facility. On 01/22/26, LPA Gonzalez conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff denied the allegation. 5 out 5 staff said pest control services are provided monthly. On 01/22/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate with the allegation. During a records review conducted on 01/22/26, LPA reviewed pest control service invoices from Ok Exterminators dated 11/07/25 and 12/12/25, and National Exterminator Company dated 01/09/26. Documentation reflected that general pest control services were performed on the referenced dates. On 01/22/26, LPA and Jung Hee Kim conducted a tour of the facility and inspected rooms #102 and #113 on the first floor, rooms #206 and #217 on the second floor, rooms #302 and #306 on the third floor, as well as the kitchen and common areas. LPA observed the inspected areas to be clean, sanitary, and free of pests. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of this report was provided to Jung Hee Kim, Administrator.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 11-AS-20260112152629

Allegation investigated: Staff does not ensure facility is free of pests.

On 01/22/26, LPA Gonzalez conducted an unannounced complaint investigation visit for the allegation listed above. LPA met with Jung Hee Kim, Administrator, and explained the purpose of the visit. LPA was granted access to the facility. The investigation consisted of the following: On 01/22/26, LPA Gonzalez collected the following documents: staff roster, resident roster, and service invoices from OK Exterminators (dated:11/07/25, 12/12/25) and National Exterminator Company (dated: 01/09/26). LPA conducted interviews with staff #1-#5 (S1-S5), and residents #1-#6 (R1-R6). Additionally, LPA conducted a tour of the entire facility, and inspected resident rooms, kitchen and common areas. Continued on LIC9099-C Unsubstantiated The investigation revealed the following: For the allegation: Staff does not ensure facility is free of pests. It is being alleged that there are bedbugs and cockroaches in the facility. On 01/22/26, LPA Gonzalez conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff denied the allegation. 5 out 5 staff said pest control services are provided monthly. On 01/22/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate with the allegation. During a records review conducted on 01/22/26, LPA reviewed pest control service invoices from Ok Exterminators dated 11/07/25 and 12/12/25, and National Exterminator Company dated 01/09/26. Documentation reflected that general pest control services were performed on the referenced dates. On 01/22/26, LPA and Jung Hee Kim conducted a tour of the facility and inspected rooms #102 and #113 on the first floor, rooms #206 and #217 on the second floor, rooms #302 and #306 on the third floor, as well as the kitchen and common areas. LPA observed the inspected areas to be clean, sanitary, and free of pests. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of this report was provided to Jung Hee Kim, Administrator.the state’s words, verbatim · CDSS document, Jan 22, 2026 · control 11-AS-20260112152629

Type of visit: Required - 1 Year

On 01/22/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Jung Hee Kim, Administrator, and explained the purpose of the visit. LPA was granted access to the facility. The facility is licensed to serve (120) elderly adults ages 60 and above, of which (120) can be non-ambulatory and (35) bedridden on rooms:100-116,228,302-329. The facility has an approved hospice waiver for (10). The facility is a four-story building located on a main street. The basement/first floor consists of a parking garage. The second floor consists of the medicine room, industrial kitchen, office, front desk, dining room, common room, patio area with shaded seating, and resident rooms for assisted living. The third floor consists of resident rooms for assisted living, and community rooms. The fourth floor consists of the memory care unit, the bedridden unit, and resident bedrooms. LPA Gonzalez and Jung Hee Kim toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of six (6) bedrooms and six (6) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were , operational. The water temperature properly measured between 105.0°F and 120°F. LPA Gonzalez observed that the facility to be clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, and properly maintained. Fire extinguishers were charged and operable. Smoke and carbon monoxide detectors were in operable condition. The last Fire/Disaster Drills were conducted on 12/26/25. A review of (6) residents' service files and (5) staff personnel files was maintained in order. LPA reviewed (3) Medication Administration Records (MARs) and found no discrepancies. Medications are centrally stored in the facility's medication room. The facility is equipped with fully stocked first aid kits with manuals. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance was provided to LPA. Facility Annual Fess current. No citations were issued during this inspection. An exit interview was conducted, and a copy of this report was provided to Jung Hee Kim, Administrator.the state’s words, verbatim · CDSS document, Jan 22, 2026

Allegation investigated: Staff does not ensure facility is free of pests.

On 12/30/25, LPA Gonzalez conducted an unannounced complaint investigation visit for the allegation listed above. LPA met with Chansook Koo, receptionist, and explained the purpose of the visit. LPA was granted access to the facility. Administrator, Steve Cho, joined LPA for the visit shortly after. The investigation consisted of the following: On 12/30/25, LPA Gonzalez collected the following documents: staff roster, resident roster, and service invoices from OK Exterminators dated 11/07/25 and 12/12/25. LPA conducted interviews with staff #1-#5 (S1-S5), and residents #1-#6 (R1-R6). Additionally, LPA Gonzalez and Chansook Koo conducted a tour of the entire facility, and inspected resident rooms, kitchen and common areas. Continued on LIC9099-C Unsubstantiated The investigation revealed the following: Allegation: Staff does not ensure facility is free of pests. It is being alleged that live German cockroaches were observed on facility’s kitchen floor. On 12/30/25, LPA Gonzalez conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff denied the allegation. 5 out 5 staff said pest control services are provided monthly. On 12/30/25, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate with the allegation. During a records review conducted on 12/30/25, LPA reviewed pest control service invoices from OK Exterminators dated 11/07/25 and 12/12/25. Documentation reflected that general pest control services were performed on the referenced dates. On 12/30/25, LPA and Chansook Koo conducted a tour of the facility and inspected rooms #113 and #114 on the first floor, rooms #228 and #229 on the second floor, rooms #301 and #306 on the third floor, as well as the kitchen and common areas. LPA observed the inspected areas to be clean and free of pests. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of this report was provided to Steve Cho.the state’s words, verbatim · CDSS document, Dec 30, 2025 · control 11-AS-20251226141305

Allegation investigated: Resident sustained unexplained injuries while in care.

On November 2, 2025, the department conducted a follow-up complaint visit to the facility and was greeted by the Administrator. The department explained that the purpose of this visit is to deliver findings regarding the complaint allegation mentioned above. The investigation included the following: On 07/23/2025, the department reviewed and obtained the following documents for Resident #1 (R1): Resident Roster (dated 09/16/24), Staff Roster (dated 01/10/25), ID/Emergency Information (dated 01/26/24), Admission Agreement (dated 01/26/24), Appraisal & Needs Service Plan (dated 09/18/24), Physician's Report (dated 03/22/24), Unusual Incident/Injury Report (dated 09/21/24), Medication Administration Records (dated 02/19/24 - 09/19/24), Consent for Emergency Medical Treatment (dated 11/26/24), Copy of the Death Report (dated 09/21/24), and Legal Services Documents (dated 10/16/24). On 04/15/2025, at 2:26 PM, the department interviewed Med Tech (MT1). On 04/15/2025, at approximately 2:59 p.m., the department interviewed the Staff member (S1). On 04/15/25, at approximately 2:06 PM, the department interviewed Resident (R2). The department attempted to interview the staff members (S2), but they were unable to answer the interview questions. Substantiated It is alleged that Resident (R1) sustained multiple rib fractures, including a clavicle fracture, along with a bruise on the lower back and buttocks. The department obtained and reviewed Cedars-Sinai Medical Center Hospital records for R1 dated 09/21/2024. The department found on 09/21/2024, the facility's Med Tech (MT1) checked R1's vital signs in the a.m. (actual time not found on record) and found R1 was in an altered mental state. The facility then contacted R1's primary physician and called 911. At approximately 8:06 a.m., the Emergency Medical Services (EMS) arrived, and R1 was transported to Cedars-Sinai Medical Center. The department found R1 was in an altered mental state due to R1 not eating and refusing medication for two days. The Cedars-Sinai Medical Records review indicated that the facility informed the hospital that R1 had no history of falls; however, a review of the Home Health records indicated R1 had a secondary diagnosis of repeated falls. Additionally, R1 complained of low back pain and left arm pain prior to the 09/21/2024 hospitalization. On 04/15/2025, at approximately 2:26 pm, the department interviewed Med Tech (MT1), who stated that when R1 experienced an unwitnessed fall, staff did not document unwitnessed falls with Unusual Incident Reports, nor did the staff seek medical attention to rule out invisible injuries after unwitnessed falls. Based on reviews and interviews, the preponderance of evidence standard has been met; therefore, the above allegation is substantiated. Per the California Code of Regulations (Title 22, Division 6, Chapter 8), the deficiency noted above was observed, and a citation was issued (ref. LIC 9099D). At the time of the complaint visit, an immediate civil penalty of $500 was issued, and the licensee was informed that an enhanced civil penalty determination is pending reference to Health & Safety Code § 1569.49. An exit interview was conducted and plans of correction were developed and reviewed. A copy of this report and appeal rights were discussed with Administrator Steve Cho and a hard copy left with Kay Hwang. The department attempted to interview the staff members (S2), but they were unable to answer the interview questions. On 07/23/2025, LPA interviewed three staff members (S1-S3), five residents (#2-6, R2-R6). LPA was unable to interview R1 because R1 passed away on 09/21/2024. Allegation: Questionable Death. On 01/27/2025, at approximately 2:58 PM, the department reviewed records from Cedars-Sinai Medical Center regarding the care timeline dated 09/21/2024. According to the Cedars-Sinai Medical Records, R1 was transported from Sunny Hill Assisted Living Facility to Cedars-Sinai Medical Center Emergency Department on 09/21/2024, for altered mental status, with conditions including sepsis, shock, and a urinary tract infection (UTI). The department examined the Cedars-Sinai Medical Records and the death certificate provided by the Special Investigator Assistant (SIA). R1 was diagnosed with severe sepsis and acute UTI. The death certificate listed cardiopulmonary arrest, acute hypoxic respiratory failure, acute kidney failure, and pneumonia as causes of death. On 04/15/25, at approximately 2:26 pm, the department interviewed Med Tech (MT1), who stated that on September 18, 2024, R1 refused food and medications and complained of pain. The department reviewed the Cedars-Sinai Medical Record, which showed that the hospital Social Worker (SW) called Sunny Hills Assisted Living and spoke with a staff member (S2), who stated that R1 had refused all medication and food for the past two days. The SW noted that there were no concerns of suspected abuse or neglect based on R1’s mental state and physical mobility. On 04/15/2025, at 2:26 PM, the department interviewed Med Tech (MT1), who reported that on 09/18 and 19/2024, R1 refused to eat, refused medications, and did not allow MT1 to check R1’s vital signs. The department reviewed the emergency room case for R1, date 09/ 21/2024. R1 passed away on 09/21/2024, at 3:43 PM. A family member was contacted twice to inform them of the critical situation and prognosis. R1 was appropriately assigned a Do Not Attempt Resuscitation (DNAR) status. Subsequently, R1 experienced respiratory and cardiac arrest and died. The department's review of R1’s death certificate indicated that the causes of death were cardiopulmonary arrest, acute hypoxic respiratory failure, acute kidney failure, and pneumonia. Regarding the allegation, “Questionable Death,” based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have occurred or be valid, there is not a preponderance of evidence to prove whether the alleged violation did or did not occur; as a result, the allegation is Unsubstantiated. Allegation: Staff did not notify the resident's representatives about the resident's change in conditions. The complaint alleges that the facility failed to contact the responsible party regarding the resident's change in condition. On 07/23/2025, LPA Richard interviewed Staff #1 (S1), who denied the allegation and reported that when R1 was admitted to the facility on 01/26, 2024, the staff attempted to call the phone number listed in the admission record for R1, but there was no answer. R1 personally signed the admission agreement. The S1 mentioned that they also called the phone number from a previous admission agreement, but again, no one answered. It was noted that R1 has not received any visitors except on one occasion. A couple of times, someone came with another person to speak with R1; that was the last time anyone saw them. For the past eight months, R1 has had that many visitors. On the same date, LPA interviewed three staff members (S1-S3), all of whom denied the allegation. Staff member S3 mentioned that during one attempt to contact the responsible party, the person who answered was very upset and told S3, "Do not call this number anymore; it is up to you now." Additionally, LPA interviewed five residents (R2-R6), with the help of an interpreter, all of whom stated that the facility does contact their families. LPA also reviewed the admission agreement dated 01/26/2024, which indicated that R1 was the only person who signed the agreement. There was no responsible party signature on file. LPA was unable to interview Resident #1 due to R1 passing on 09/21/2024 at Cedar Sinai Hospital. Based on interviews and observations, there is insufficient evidence to support the allegation: Staff did not notify the resident's authorized representatives of the resident's change in condition. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated. Allegation: Staff did not seek medical attention for the residents in a timely manner. The complaint claims that staff failed to seek medical attention for residents in a timely manner. On 07/23/2025, LPA Richard interviewed Staff member #1 (S1), who reported that on 09/21/2024, the caregiver contacted Med Tech (MT) to check the vitals of resident R1. After assessing R1's vitals, Med Tech discovered that R1 was exhibiting an altered mental status. The (MT) immediately notified R1's primary care physician and family. When there was no response, the facility called for Emergency Medical Services (EMS). As a result, R1 was transported to Cedars-Sinai Medical Center. On 07/23/2025, the Licensing Program Analyst (LPA) interviewed three staff members, Staff #1-3 (S1-S3). All three denied the allegations, affirming that staff members never neglected residents and always provided necessary medical attention. They stated that in the event of a Medical Emergency, they would call 911. The (MT) and (S1) reported that on 09/21/2024, staff promptly assisted Resident #1 (R1), who was then transported to Cedars-Sinai Hospital's ICU at approximately 8:06 AM, where R1 was admitted. There were no instances in which the facility failed to seek timely medical attention for a resident. On 07/ 23/2025, the LPA interviewed five residents, Residents #2-6: (R2-R6). All five residents stated that the facility usually calls 911 for them, or the Nurse comes to assist them when needed. Based on interviews and observations, there is insufficient evidence to support the allegation: Staff did not seek attention for the residents in a timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated. Allegation: Staff locked the residents in their rooms. The complaint alleges that every time they visit R1, there is no way to exit the third floor because all the stairway doors are locked, and the elevator requires a key to operate. LPA interviewed S1, who stated that the elevator door is locked. However, if a visitor signs in, we will provide them with a code to open it. Additionally, a staff member is always present on the third floor to open the door for residents who wish to enter. LPA interviewed staff #1-3 (S1-S3), who stated that the residents do not need a key because the rooms are locked from the inside. The residents could open their doors from the inside, but when they are outside, they need assistance when returning to their rooms. S3 also stated that since R1 was admitted to the facility, R1 has only had one visitor following R1's admission to the facility. On 07/23/25, the LPA interviewed five residents (R2-R6), who all showed the LPA the key they had to open their rooms from the outside. On 07/23/25, the LPA inspected and observed that the third-floor rooms are locked from the inside, allowing residents to leave their rooms at any time. Based on interviews and observations, there is insufficient evidence to support the allegation: Staff did not seek attention for the residents in a timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated. No deficiencies were cited. Exit interview conducted. A copy of the report was given to Kay Hwang.the state’s words, verbatim · CDSS document, Nov 2, 2025 · control 11-AS-20250114113540

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Nov 4, 2025

The licensee shall ensure that residents are regularly observed for changes in physical... and... assistance is provided when such observation reveals unmet needs. When changes... are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and... responsible person...This requirement was not met as evidence by: Based on interviews and record review, the licensee did not ensure R1 receive assistance after fall(s) and complaints of low back pain. This posed an immediate health risk to resident.the state’s words, verbatim · CDSS document, Nov 2, 2025

Plan of correction: The facility wll provide a written plan outlining how it will address falls and train staff on how to handle a resident's fall, whether witnessed or unwitnessed. The plan will include training dates and should be emailed to Antonine.Richard@dss.ca.gov by the POC due date.

Allegation investigated: Staff does not ensure resident receives sufficient continence care resulting in resident being left in multiple soaked diapers.

On 10/27/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to deliver amended report for the allegation mentioned above. LPA met with Chansook Koo, Receptionist, and the purpose of the visit was explained. LPA was granted entrance to the facility. ** **This report supersedes the report created and delivered on 09/11/25. This report is to clarify findings. On 09/11/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted a subsequent unannounced complaint visit to further investigate the allegations mentioned above. LPA met with Administrator, Steve Cho, and the purpose of the visit was explained. LPA was granted entrance to the facility. The investigation consisted of the following: On 07/28/25, LPA requested the staff and resident rosters. Continued on LIC9099-C Substantiated LPA reviewed service records for resident #1 (R1) and requested copies of the following documents: Facesheet, Physician’s Report, Service and Care Plan, Resident notes (dated 07/14/25-07/19/25), Unusual Incident/Injury Report (dated: 07/21/25), and 2-Hour Rounds Check Policy Form. Additionally, LPA conducted interviews with staff #1-#5 (S1-S5), witness #1 (W1), attempted to interview witness #2 (W2), residents #2-#4 (R2-R4) and attempted to interview R1. On 09/11/25, LPA Gonzalez conducted interviews with residents #5-#6 (R5-R6), and S1. The investigation revealed the following: Allegation: Staff does not ensure resident receives sufficient continence care resulting in resident being left in multiple soaked diapers. It is being alleged that a resident came into the emergency department wearing 3 diapers that were all soaked through. On 07/28/25, between 10:20 AM and 12:00 PM, LPA conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff stated that they did not know if the above allegation happened. 5 out of 5 staff said they do not put more than one diaper on a resident. Interview conducted with S1 revealed that after conducting their own investigation, they became aware of two staff admitting to putting more than one diaper on a resident, and that they have taken the necessary disciplinary action. On 07/28/25, between 1:05 PM and 2:00 PM, LPA conducted interviews with R2-R4 and attempted to interview R1 but was unable to as R1 is in the hospital. On 09/11/25, between 1:00 PM and 1:45 PM, LPA conducted interviews with R5-R6. Of those interviewed, 5 out of 5 residents said don’t use diapers. 5 out of 5 residents said they don’t know if staff puts multiple diapers on any resident. Based on record reviewed, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. Title 22, Division 6 Chapter 8 are being cited on the attached LIC9099-D. An exit interview was conducted, and a copy of the report along with appeal rights was provided to Chansook Koo.the state’s words, verbatim · CDSS document, Oct 27, 2025 · control 11-AS-20250721104317

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Sep 18, 2025

87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This regulation is not met as evidenced by: Based on interview with S1 revealed that two staff members admitted to putting multiple diapers on a resident which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 27, 2025

Plan of correction: Administrator will provide an in service training for all staff on personal rights for the residents. Administrator agreed to submit in service training log to LPA Gonzalez via email by POC due date 09/18/25.

Allegation investigated: Resident is being physically abused while in care. Facility staff are not properly supervising residents who are a fall risk.

** This report serves as an amendment to add additional information to the report created on 07/02/25. It does not supersede the complaint investigation report created 07/02/25. **On 09/11/25 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint investigation visit for the allegations listed above. LPA met with Administrator, Steve Cho, and explained that the purpose of this visit is to provide an amended copy of the LIC9099 report, and was granted entrance to the facility. On 07/02/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit to investigate the allegations mentioned above. LPA met with Administrator, Steve Cho, and the purpose of the visit was explained. LPA was granted entrance to the facility. Continued on LIC9099-C Unsubstantiated The investigation consisted of the following: On 07/02/25, LPA requested the staff and resident rosters. LPA reviewed service records for resident #1 (R1) and requested copies of the following documents: Physician’s Report, Advance Health Care Directive Form, Admission Agreement, Medication List dated 07/01/25, Resident Care Assessment Form, Appraisal Needs and Services Plan, Preplacement Appraisal Information, Personal Care Program Form, and 2-Hour Rounds Check Policy Form. Additionally, LPA conducted interviews with staff #1-#5 (S1-S5), witness #1 (W1), and residents #2-#5 (R2-R5) and attempted to interview R1. Furthermore, LPA and Steve Cho conducted a tour of the facility. On 09/11/25, LPA Gonzalez received the following documents for R1: Medication Administration Record (MAR) for the months of July and August 2025, and staff notes. The investigation revealed the following: Allegation: Resident is being physically abused while in care. It is being that a resident is being abused on a regular basis and has been observed with multiple bruises and scars on their body. On 07/02/25, between 11:00 AM and 12:15 PM, LPA Gonzalez interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that body checks are conducted daily and any bruising or change in condition is communicated to both the primary care physician and families and are then monitored. 5 out of 5 staff interviewed stated that they treat residents with dignity and respect. On 07/02/25, between 01:35 PM and 2:18 PM, LPA Gonzalez interviewed R2-R5 and attempted to interview R1 but was unable to because the resident was asleep in their room and did not wish to be interviewed. Based on interviews conducted, 4 out of 5 residents denied the allegation. 4 out of 5 residents stated that staff have not physically abused them while in care. 4 out of 5 residents stated that they have not observed staff physically abusing a resident while in care. 4 out of 5 residents stated that staff treat them with dignity and respect. On 09/11/25, LPA conducted a review of records and revealed the following: Physician’s Report (dated: 07/08/25) stated that R1’s ambulatory status is bedridden based upon both physical and mental conditions. Continued on LIC9099-C Report also stated that R1 has a history of skin condition or breakdown due to thin skin related to age. A review of the MAR for the months of July, and August 2025 noted that certain prescribed medications may contribute to increased bruising. There was no incident reports reporting any physical abuse, scars or bruising. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. Allegation: Facility staff are not properly supervising residents who are a fall risk. It is being alleged that a resident has been observed with multiple bruises and scars on their body, and that staff claim the injuries are due to the resident falling out of their bed. It is also being alleged that a resident is often left alone in their room. On 07/02/25, between 11:00 AM and 12:15 PM, LPA Gonzalez interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that they supervise and monitor residents who are considered a fall risk. 5 out of 5 staff stated that they check on the residents frequently and as needed depending on the residents’ needs. S1 stated that all residents are checked every two hours and as needed. S1 stated that when a resident is considered a fall risk after assessment, they recommend to the family or the party responsible for their special care service called the Personal Care Program, which is offered for an additional fee. If the family denies that extra coverage, then staff will continue to follow their 2-hour Rounds Check Policy which ensures that the residents are checked on every 2 hours when they are in their rooms. On 07/02/25, between 01:35 PM and 2:18 PM, LPA Gonzalez interviewed R2-R5 and attempted to interview R1 but was unable to because the resident was asleep in their room and did not wish to be interviewed. Based on interviews conducted, 4 out of 5 residents denied the allegation. 4 out of 5 residents stated that staff does supervise residents who are a fall risk. 4 out of 5 residents stated that they do not know if a resident has fallen down the stairs. 4 out of 5 residents stated that they are not left alone in their room for a long period of time. 4 out of 5 residents stated that staff treat them with dignity and respect. Continued on LIC9099-C On 09/11/25, LPA Gonzalez conducted a review of records and observed that there were no incident reports reporting any physical abuse, scars or bruising. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Administrator, Steve Cho.the state’s words, verbatim · CDSS document, Sep 11, 2025 · control 11-AS-20250623123311

Allegation investigated: Facility staff do not ensure resident is provided adequite supervision resulting in resident having multiple falls while in care.

On 09/11/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted a subsequent unannounced complaint visit to further investigate the allegations mentioned above. LPA met with Administrator, Steve Cho, and the purpose of the visit was explained. LPA was granted entrance to the facility. The investigation consisted of the following: On 07/28/25, LPA requested the staff and resident rosters. LPA reviewed service records for resident #1 (R1) and requested copies of the following documents: Facesheet, Physician’s Report, Service and Care Plan, Resident notes (dated 07/14/25-07/19/25), Unusual Incident/Injury Report (dated: 07/21/25), and 2-Hour Rounds Check Policy Form. Additionally, LPA conducted interviews with staff #1-#5 (S1-S5), witness #1 (W1), attempted to interview witness #2 (W2), residents #2-#4 (R2-R4) and attempted to interview R1. On 09/11/25, LPA Gonzalez conducted interviews with residents #5-#6 (R5-R6), and S1. Unsubstantiated The investigation revealed the following: Allegation: Facility staff do not ensure resident is provided adequate supervision resulting in resident having multiple falls while in care. It is being alleged that a resident has sustained multiple falls at the facility resulting in resident having multiple bruises on their arms, and face. On 07/28/25, between 10:20 AM and 12:00 PM, LPA conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff stated that they provide adequate supervision for residents to prevent any fall and/or injuries. 3 out of 5 staff said they did not know if R1 fell on 07/19/25, and 2 out of 5 staff stated R1 did fall. 3 out of 5 staff stated that R1 does not fall frequently. 5 out of 5 staff stated that residents are checked on every 2 hours and as needed. On 07/28/25, between 1:05 PM and 2:00 PM, LPA conducted interviews with R2-R4 and attempted to interview R1 but was unable to as R1 is in the hospital. On 09/11/25, between 1:00 PM and 1:45 PM, LPA conducted interviews with R5-R6. Of those interviewed, 5 out of 5 residents said they weren’t aware of a resident sustaining multiple falls. 5 out of 5 residents reported feeling safe when being assisted by staff. 5 out of 5 residents said they are satisfied with staff and the services provided to them. On 09/11/25, LPA conducted a review of records and revealed the following: Physician’s Report (dated: 07/09/25) noted that resident is non-ambulatory and will participate in unsafe wandering and will try and get out of bed without reason and/or physical power. An Unusual Incident/Injury Report (dated: 07/21/25) reported that on 07/19/25, at around 05:30 AM, R1 was found on the floor with a laceration on left eye area. R1 was assessed, and first aid was provided. R1’s responsible party was then notified, and staff continued to observe R1 for any change in condition. Then at 08:10 AM, R1 was observed bleeding from nose, and 911 was called and resident was transported to hospital. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of the report along with appeal rights was provided to Administrator, Steve Cho. The investigation revealed the following: Allegation: Staff does not ensure resident receives sufficient continence care resulting in resident being left in multiple soaked diapers. It is being alleged that a resident came into the emergency department wearing 3 diapers that were all soaked through. On 07/28/25, between 10:20 AM and 12:00 PM, LPA conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff stated that they did not know if the above allegation happened. 5 out of 5 staff said they do not put more than one diaper on a resident. Interview conducted with S1 revealed that after conducting their own investigation, they became aware of two staff admitting to putting more than one diaper on a resident, and that they have taken the necessary disciplinary action. On 07/28/25, between 1:05 PM and 2:00 PM, LPA conducted interviews with R2-R4 and attempted to interview R1 but was unable to as R1 is in the hospital. On 09/11/25, between 1:00 PM and 1:45 PM, LPA conducted interviews with R5-R6. Of those interviewed, 5 out of 5 residents said they weren’t aware of a resident sustaining multiple falls. 5 out of 5 residents reported feeling safe when being assisted by staff. 5 out of 5 residents said they are satisfied with staff and the services provided to them. Based on record reviewed, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. Title 22, Division 6 Chapter 8 are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of the report along with appeal rights was provided to Administrator, Steve Cho.the state’s words, verbatim · CDSS document, Sep 11, 2025 · control 11-AS-20250721104317

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Sep 18, 2025

87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This regulation is not met as evidenced by: Based on interview with S1 revealed that two staff members admitted to putting multiple diapers on a resident which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 11, 2025

Plan of correction: Administrator will provide an in service training for all staff on personal rights for the residents. Administrator agreed to submit in service training log to LPA Gonzalez via email by POC due date.

Allegation investigated: The facility only admits residents based on race.

On 08/21/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent unannounced Complaint Visit to the facility listed above. LPA met with Reception, Chan Sook Koo, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: During the initial visit conducted on 02/22/2024, LPA inspected the facility, interviewed Staff S1-S7, attempted to interview Residents R1-R8, interviewed Resident’s Responsible Party’s Witness W1-W7, and received documents pertinent to the investigation. The following documents were received and reviewed Staff Roster, Resident Roster, an Admission Agreement packet, Anti-Discrimination Policy in-service training logs dated 10/14/2022 and 10/20/2023, Meal Menu (English Version), and advertising brochures. The investigation revealed the following: Unsubstantiated Allegation: The facility only admits residents based on race The allegation alleges that the facility turned away clientele who inquired about moving in and were denied based on race. During record review, LPA received and reviewed an Admission Packet which is given to perspective residents. In the packet is the facility’s Anti-Discrimination Policy that states "It is the policy and practice of Sunny Hills Assisted Living and Memory Care and its agents and employees not to engage in housing discrimination based on a current or prospective resident’s race, color, national, origin, religion, sex, familial status, disability or any other classification protected by applicable federal, state or local law." Additionally in the packet is Personal Rights in Privately Operated Residential Care Facilities for the Elderly that states in number (4) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. LPA additionally received and reviewed the facility’s multilingual brochures. LPA observed the brochure has multiracial photos. During the facility inspection, LPA observed multilingual signs posted throughout the facility, including the menu, activity schedule, and other required postings. LPA received and reviewed staff In-Service training logs dated 10/20/2023 and 10/14/2022, on the topic of the facility’s Non-Discrimination Policy. During interviews with Staff S1-S7, were asked if they have heard of or know of a person inquiring about the facility that was turned away based on race, gender, color, marital status, or national origin, seven (7) out of seven (7) stated no, not that they have knowledge of. Additionally, Staff S1-S7 were asked if they have turned a person away who was inquiring about the facility based on race, gender, color, marital status, or national origin, seven (7) out of seven (7) stated no, they have not turned any inquiring persons away. During an interview with Staff S1, stated when they became the administrator they had multilingual brochures made so they could expand their advertising to all communities. During interviews with Residents R1-R8’s Responsible Party’s Witnesses W1-W7, were asked if they were told the facility is a Korean facility only, seven (7) out of seven (7) stated no, they were not told the facility was a Korean facility. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. LPA did not observe or cite any deficiencies. An exit interview was conducted with Reception, Chan Sook Koo, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 21, 2025 · control 11-AS-20240216142414

Allegation investigated: Resident is being physically abused while in care. Facility staff are not properly supervising residents who are a fall risk.

On 07/02/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit to investigate the allegations mentioned above. LPA met with Administrator, Steve Cho, and the purpose of the visit was explained. LPA was granted entrance to the facility. The investigation consisted of the following: On 07/02/25, LPA requested the staff and resident rosters. LPA reviewed service records for resident #1 (R1) and requested copies of the following documents: Physician’s Report, Advance Health Care Directive Form, Admission Agreement, Medication List dated 07/01/25, Resident Care Assessment Form, Appraisal Needs and Services Plan, Preplacement Appraisal Information Personal Care Program Form, and 2-Hour Rounds Check Policy Form. Additionally, LPA conducted interviews with staff #1-#5 (S1-S5), witness #1 (W1), and residents #2-#5 (R2-R5) and attempted to interview R1. Furthermore, LPA and Steve Cho conducted a tour of the facility. Continued on LIC9099-C Unsubstantiated The investigation revealed the following: Allegation: Resident is being physically abused while in care. It is being alleged that a resident is being abused on a regular basis and has been observed with multiple bruises and scars on their body. On 07/02/25, between 11:00 AM and 12:15 PM, LPA Gonzalez interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that any bruises and cuts observed on a resident are reported to the med-tech and management, and are then monitored. 5 out of 5 staff interviewed stated that they treat residents with dignity and respect. On 07/02/25, between 01:35 PM and 2:18 PM, LPA Gonzalez interviewed R2-R5. Based on interviews conducted, 4 out of 5 residents denied the allegation. 4 out of 5 residents stated that staff have not physically abused them while in care. 4 out of 5 residents stated that they have not observed staff physically abusing a resident while in care. 4 out of 5 residents stated that staff treat them with dignity and respect. On 07/02/25, between 01:15 PM and 1:35 PM, LPA Gonzalez interviewed W1 and revealed that they appreciate the staff at this facility and all they do for the residents in care. W1 stated that the staff at this facility are very caring and go above and beyond for their family member, and the other residents in care. W1 stated that they understand that with age, the residents can become weak and fragile, and they are more prone to falls. W1 stated that they have no safety concerns for their family member at this facility, and that they have 100% confidence that the staff at this facility will provide the best care possible. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. Continued on LIC9099-C Allegation: Facility staff are not properly supervising residents who are a fall risk. It is being alleged that a resident has been observed with multiple bruises and scars on their body, and that staff claim the injuries are due to the resident falling out of their bed. It is also being alleged that a resident is often left alone in their room. On 07/02/25, between 11:00 AM and 12:15 PM, LPA Gonzalez interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that they supervise and monitor residents who are considered a fall risk. 5 out of 5 staff stated that they check on the residents frequently and as needed depending on the residents’ needs. S1 stated that all residents are checked every two hours and as needed. S1 stated that when a resident is considered a fall risk after assessment, they recommend to the family or the party responsible for their special care service, which is called the Personal Care Program, for an additional fee. If the family denies that extra coverage, then we will continue to follow their 2-hour Rounds Check Policy which ensures that the residents are checked on every 2 hours when they are in their rooms. On 07/02/25, between 01:35 PM and 2:18 PM, LPA Gonzalez interviewed R2-R5. Based on interviews conducted, 4 out of 5 residents denied the allegation. 4 out of 5 residents stated that staff does supervise residents who are a fall risk. 4 out of 5 residents stated that they do not know if a resident has fallen down the stairs. 4 out of 5 residents stated that they are not left alone in their room for a long period of time. 4 out of 5 residents stated that staff treat them with dignity and respect. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Administrator, Steve Cho.the state’s words, verbatim · CDSS document, Jul 2, 2025 · control 11-AS-20250623123311

Type of visit: Required - 1 Year

On 1/15/2025, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Steve Cho/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (120) elderly adults ages 60 and above, of which (120) can be non-ambulatory and (35) bedridden on rooms:100-116,228,302-329. The facility has an approved hospice waiver for (10). The facility is a four-story building located on a main street. The basement/first floor consists of a parking garage. The second floor consists of the medicine room, industrial kitchen, front desk, dining room, several community rooms, patio area with shaded seating, and resident rooms for assisted living. The third floor consists of resident rooms for assisted living, and community rooms. The fourth floor consists of the memory care unit, the bedridden unit, and resident bedrooms. LPA Iniguez and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (5) bedrooms and (5) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 105.0°F to 116.2°F, and the room temperature ranged from 76°F to 78°F. The evaluation Report continues on the next page, LIC 809-C, providing further details of the inspection findings. During the visit, LPA Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 12/5/24. A review of (5) residents' service files and (5) staff personnel files was maintained in order. LPA reviewed (5) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance was provided to LPA. Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies during this visit; therefore, no citations were issued. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Steve Cho / Administrator.the state’s words, verbatim · CDSS document, Jan 15, 2025

Allegation investigated: Staff unlawfully evicted a resident.

The investigation consisted of the following: On 11/07/2024, Community Care Licensing Division (CCLD) Staff conducted a complaint investigation at the above facility to address the following allegation. CCLD Staff met with Administrator Steve Cho and explained the purpose of the visit. CCLD Staff conducted resident and staff interviews and reviewed resident record. Regarding the allegation "Staff unlawfully evicted a resident.” Record review revealed that Resident #1 (R1) was admitted into the facility on 06/13/2023. Interview with the Administrator (S1) indicated R1 has not been served an eviction notice. S1 indicated that in 2023, a Funding Source stated it could pay the Assisted Living Waiver (ALW) Rate one month prior to R1’s admission but has yet to pay as of 11/07/2024. In July 2024, S1 asked the Funding Source and R1’s family if they could pay the normal rate as of January 1, 2024 to present. S1 indicated that R1's ALW is still pending and R1 has not been served an eviction. Continue to LIC9099-C. Unsubstantiated Six out of six staff interviews, including S1, indicated there has not been any recent evictions and residents have not complained about being with an eviction. Six out of six resident interviews, including R1, indicated they have not been served an eviction notice. Five out of six residents indicated they are treated with dignity and respect. R1 did not understand the question. Regarding the allegation “Staff unlawfully evicted a resident," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Administrator Steve Cho.the state’s words, verbatim · CDSS document, Nov 7, 2024 · control 11-AS-20241101161633

Allegation investigated: Staff did not ensure that the resident's call assistance button was operable. Staff did not assist resident in a timely manner.

On 06/26/24, at 09:30am, Licensing Program Analyst (LPA) Perry Scott conducted a 10-day complaint visit to the facility and was greeted by Steve Cho, Administrator. LPA explained the purpose of this visit is to gather information about the complaint and deliver findings for the allegations mentioned above. The investigation consisted of the following: LPA investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R8). Resident Roster (Dated 06/19/24), Staff Roster (Dated 06/26/24), ID/Emergency Information (Dated 04/31/24), and Admission Agreement (Dated 04/31/24/Unsigned) for R1 were obtained from the facility. The investigation revealed the following: Allegation #1- Staff did not ensure that the resident's call assistance button was operable. Report continued on LIC9099-C Unsubstantiated The details of the complaint alleged that R1’s call button was faulty and R1 yelled for assistance for hours, but no one came. On 06/26/24, from 10:00am-2:00pm, LPA interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. R1 could not be interviewed because R1 is no longer at the facility and no new contact information was given. 4 of 4 staff denied the allegation that the Staff did not ensure that the resident's call assistance button was operable. All staff (S1-S4) stated that each room and bathroom have a working call button that alerts the front desk when pushed. Additionally, when the button is pushed, a caregiver is paged to go and check on the resident. The staff stated they have no knowledge of anyone complaining that they were not assisted when the call button was pushed. S1 further stated that S1 had no knowledge of R1 calling for assistance and not receiving it. LPA toured the facility and checked two downstairs rooms (Room 102 and 103) and three upstairs rooms (Room 201, 202, and 206) and found the call buttons all worked and that they registered at the front desk computer. LPA noticed that it took the staff less than five minutes to respond to the call alert. LPA interviewed R1-R8 about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff did not ensure that the resident's call assistance button was operable. All residents interviewed stated that their call button works and when they need assistance and push the button for help, they are given the assistance they need. Based on interviews, there is insufficient evidence to support the allegation that the Staff did not ensure that the resident's call assistance button was operable. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation #2- Staff did not assist resident in a timely manner. The details of the complaint alleged that R1 fell on the floor in the middle of the night, called for help, and no one assisted R1 until hours later. 06/26/24, from 10:00am-2:00pm, LPA interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. R1 could not be interviewed because R1 is no longer at the facility and no new contact information was given. 4 of 4 staff denied the allegation that the Staff did not assist resident in a timely manner. All staff (S1-S4) stated that all residents are assisted in a timely manner and had no knowledge of R1 falling. S1 stated that there is no record of R1 falling, and R1 did not fall to S1s knowledge. Report continued on LIC9099-C LPA interviewed R1-R8 about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff did not assist resident in a timely manner. All residents interviewed stated that they have not had any problems with getting assistance in a timely manner from the staff when they need help. Based on interviews, there is insufficient evidence to support the allegation that the Staff did not assist resident in a timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted with Steve Cho, Administrator, and a hard copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 26, 2024 · control 11-AS-20240619150645

Type of visit: Annual/Random

On 01/10/2024 at around 10:50 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with the Administrator Steve Cho. LPA explained the purpose of the visit and was accompanied by the Administrator inside and outside the facility during this inspection. This facility is licensed to serve 120 non-ambulatory residents, of which 35 may be bedridden. This facility is approved for 10 hospice residents. A total of 89 residents currently resides in this facility, of which 12 are bedridden. The facility has a balance of $1,982 in Annual Licensing Fees due on 01/29/2024. The facility is a four-story building located on a main street. The basement/first floor consists of a parking garage. The second floor consists of the medicine room, industrial kitchen, front desk, dining room, several community rooms, patio area with shaded seating, and resident rooms for assisted living. The third floor consists of resident rooms for assisted living, and community rooms. The fourth floor consists of the memory care unit, the bedridden unit, and resident bedrooms. 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 cabinets. 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. Last fire drill was conducted on 12/12/2023. First aid kit is fully stocked with manual. Last annual fire inspection was conducted on 09/01/2023. There are several fire extinguishers around the facility, and they were last services on 09/01/2023. LPA did not observe an evacuation chair at each stairwell. There is a landline resident telephone on the front desk. Several 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. 5 staff records were reviewed, 5 out of 5 staff records had First Aid Certificates, Criminal Record Clearances, Job Applications, Facility Trainings/Drills, and signed Employee Rights. 1 out 5 staff record did not a Health Screening report and Tuberculosis Test. 5 resident records were reviewed and, 5 out of 5 resident records had Admission Agreements, Consent Forms, Emergency Information, Tuberculosis Test, Centrally Stored Medication Destruction Record, and Personal Rights. 3 out 5 resident records did not have an updated Medical Assessment and Appraisal & Needs Service Plan. Deficiencies are being cited based on LPA observation and record review in accordance with the California Code of Regulations, Title 22, see LIC809Ds. A violation regarding evacuation chair, staff records, and resident records. An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator.the state’s words, verbatim · CDSS document, Jan 10, 2024

The state marks this report as 8 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.