Sunrise of Cupertino

Type of visit: Required - 1 Year

On 9/15/2026, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Tina Bagheri, Executive Director and explained the purpose of the visit. LPA Calandra toured the physical plant. This is a multi-story building with 90 bedrooms and bathrooms, common spaces, a kitchen, dining room, and offices. No accessible bodies of water or hazards observed. The facility was maintained at a comfortable temperature. All bedrooms had the required furniture and sufficient lighting. All bathrooms had grab bars and anti-skid flooring. The facility's hot water temperature was measured within the required 105-120 degrees Fahrenheit. The facility's smoke alarms and carbon monoxide detectors were observed to be in working condition. All of the facility's fire extinguishers were observed to be fully charged and last checked/serviced on 8/3/2026. The facility's first aid kit was observed to have all of the required items. The facility had the required 7 days of non perishables and 2 days of perishables on hand. No food was expired. All sharp objects, soap, detergent, and poisons were observed to be locked and in-accessible to persons in care. LPA reviewed 6 staff files and 5 resident files. All were observed to be complete. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. This facility does not handle cash resources for residents. No deficiencies cited during today's visit. An exit interview was conducted and a copy of the report provided to the facility representative.the state’s words, verbatim · CDSS document, Sep 15, 2026

Type of visit: Case Management - Incident

On 4/30/2026, LPA Grace Donato conducted an unannounced Case Management - Incident visit. LPA met with Executive Director Tina Bagheri and explained the purpose of the visit. On 4/28/2026, CCLD received a report regarding a resident (R1) eloping from facility. R1 left facility around 6pm on 4/24/2026. R1 was located at a nearby business area at approximately 7:47pm. R1 was checked and was at baseline and no injury sustained. Based on interview with ED, the delayed egress sounded the alarm when R1 went out the door. The area where R1 went out has another exit door heading out on the street. There's also a stair case going down to the parking area. When the alarm sounded off staff went and checked and headed down the stair case to the parking area. Other staff members checked video surveillance and found out the R1 went to another exit door heading to the street. Facility did the protocol and searched for R1 involving police and available care staff. LPA observed 2 doors to exit from memory care area, both have alarms. After the incident, facility conducted an in-service training on 4/26 and 4/27 regarding Elopement Response Protocol to staff. No deficiency is cited today. Report is reviewed and copy is provided.the state’s words, verbatim · CDSS document, Apr 30, 2026

Allegation investigated: Facility is in disrepair Resident room is malodorous. Facility staff do not ensure residents are served food of good quality. Facility staff do not respond to residents’ call button in a timely manner. Facility staff are not distributing mail to residents. Facility do not provide residents with transportation. Facility does not provide information about council meetings in a timely manner.

On February 23, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced complaint visit to deliver the findings for the above allegations. LPA met with Executive Director, Tina Tayabeh and explained the purpose of the visit. Regarding the allegation, facility is in disrepair and resident room is malodorous, according to the reporting party, on December 14, 2025, Resident 1's (R1's) sink and toilet became backed up and although the maintenance worker came to inspect the issue, he has not returned and the unresolved toilet backup has caused a strong odor in R1's room. During the complaint investigation, LPA observed R1's room. R1's room was observed to be odor-free and both the toilet and sink was observed to be in good working condition. According to R1 during the visit, the toilet and sink was fine and working. Regarding the allegation, facility staff do not ensure residents are served food of good quality, according to the reporting party, there has been a decline in the quality of food over the past several months, noting that residents are frequently served sandwiches multiple times a day. (Continue to 9099C) Unsubstantiated During the investigation, LPA interviewed the Cullinary Director, observed the kitchen/food, and reviewed the food menu for the month. According to the Cullinary Director and the food menu reviewed, there is a monthly food menus posted around the facility, along with the daily menu. Sandwiches get served everyday as an alternative option for residents who do not want to eat the main dish being cooked. Based on observation, LPA visited the facility on 12/26/25 and observed quiche with potatoes and steamed vegetables as the main dish on the menu for lunch. LPA observed the kitchen staff baking quiche, steaming vegetables and LPA observed ingredients for sandwiches. Regarding the allegation, facility staff do not respond to residents’ call button in a timely manner, according to the reporting party, staff do not respond to call bells in a timely manner, often taking 30 minutes or longer to assist residents. During the investigation, LPA interviewed staff, residents and reviewed call button response log. According to staff and residents interviewed, although response times vary due to overrall resident needs and the time of day, staff do respond to the call button requests. Based on call button response log reviewed, the average response time for staff to respond to a resident's call button is 5-10 minutes. Regarding allegation, facility staff are not distributing mail to residents, according to the reporting party, residents have not received any mail for the past two years. During the investigation, LPA interviewed staff, residents, and observed the mailing system. Based on observations, LPA observed a locked drawer next to the receptionist desk which maintains all residents' mail. According to the administrator, she denied this allegation and indicated that the front desk handles the mail when it comes in. The administrator and the receptionist indicated when mail gets delivered to the facility, the receptionists sorts it out and puts it in the accorded resident's slot in a locked drawer. According to staff and residents interviewed, residents receive their mail directly from the front desk and the residents who require assistance receiving their mail either has a family collect it for them or a team member will deliver it to the resident's room depending on what the resident requests. In addition, staff indicated, if residents don't retrieve their mail for a while, the front desk will call the resident or their responsible party to remind them that there is mail to be picked up. For memory care residents, the responsible party picks up the residents mail and for some of the independent residents, they will authorize someone else to pick up their mail if they are unable to. Staff will also deliver mail and packages if residents wish to have it delivered to their room. (Continue to 9099C) Regarding allegation, facility do not provide residents with transportation, according to the reporting party, there have been multiple occasions when R1 was not provided transportation to his/her medical appointments, despite the facility having a van designated for resident transport. During the investigation, LPA interviewed staff, reviewed the residency agreement, and reviewed the transportation log at the front desk. Based on residency agreement, the facility will make available to residents or otherwise assure the provision of scheduled transportation to health facilities, appointments, agencies, shopping, etc. According to staff interviewed, transportation is scheduled through a transportation log that is at the front from. All residents with or without their own personal cars can request transportation ahead of time and staff will try to accommodate the residents. If the facility drivers are unavailable that day/time because they are transporting other residents for their scheduled outing, the facility will accommodate the residents by paying for their taxi, uber, etc. Regarding the allegation, facility does not provide information about council meetings in a timely manner, according to the reporting party, announcements for resident and family council meetings are not posted in a timely manner. Notices are often posted only the day before the meetings, which results in low attendance among residents. During the investigation, LPA interviewed staff and observed the resident activity calendar for the month of December, along with previous months. Based on the activity calendar, LPA observed the resident council meeting on the activities calendar. LPA observed the date and time of the resident council meeting on the activities calendar. According to staff interviewed, resident council meetings are typically held on the third Tuesday or Wedneday of each month, however residents are aware of when the resident council meeting is because it is on the monthly activities calendar, in addition to daily activity calendar that is both projected on the facility television screens and hard copies are printed out and put in the front lobby. Therefore, based on interviews conducted, documents reviewed, and information collected, the department has determined that although the above allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED. Report is reviewed with the Executive Director and a copy is provided.the state’s words, verbatim · CDSS document, Feb 23, 2026 · control 26-AS-20251216152356

Type of visit: Required - 1 Year

On 09/04/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with the executive director Tina Bagheri Teyebeh and explained the purpose of today's visit. There are currently 57 residents in assisted living and 34 in memory care. This is a multilevel facility at 3 floors for assisted living and 2 floor for memory care. The facility is licensed for 60 years and over. 20 may be bedridden. Delayed egress, secured perimeter approved. Hopsice waiver for 20 residents. There are 16 residents under hospice during today's visit. The physical plant was toured inside and outside of the facility to ensure the safety of the clients. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked and secured in the kitchen. Perishable and non-perishable food supplies are observed as in place. Dietary plans and modified diets are observed to be in place. Kitchen grade fire extinguisher is observed as in place and with an inspection date of 08/15/2025. Menu is posted by elevators and available via touch screen monitor in the dining room. There are 3 med rooms within the facility. LPA reviewed resident medications at random and observed them as current and stored correctly. LPA observed that there are multiple fire extinguishers in place on each floor with an inspection date of 08/15/2025 smoke detectors, carbon monoxide detectors are observed in place through out the facility. Central heating and air conditioning is in place. Laundry areas are also observed as fully operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 08/28/2025 which was an earthquake drill per records reviewed. Continued on next page... Page 2 Water temperatures were taken in random locations such as room 214 at 114F, Room 140 at 115F, Room 200 at 115F, Room 107 at 117F. Cleaning supplies are observed to be inaccessible to residents in care stored in janitorial room adjacent to the laundry area. Resident rooms are observed at random. LPA observed resident rooms 351, 347, 354, 118, and 143. All are observed as clean, free of odors, and contained all the required furniture per regulatory recommendations. Resident linen supplies are observed as in place. Facility does have a pendant and pull chords in place. Memory care primarily have pull chords, pendants are an option, and assisted living have pendants. LPA reviewed five staff files and six resident files during today's inspection. All files are observed as current. Staff are actively conducting training via relias and internal training systems for Sunrise is observed as current. Administrator certificate is current expiring 09/17/2026. No citations issued. Report is reviewed with administrator and a copy is provided on this day.the state’s words, verbatim · CDSS document, Sep 4, 2025

Allegation investigated: Facility staff did not properly assist resident with hygiene needs Facility staff did not allow resident to wear their own clothing of choice

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to deliver the finding for the above allegations. LPA met with Executive Director, Tina Bagheri. On 01/31/2025, the Department received a complaint regarding the above allegations. On 02/04/2025, the initial complaint investigation was conducted. Documents were obtained for this investigation to include resident (R1)’s physician’s report, pre-appraisal, and needs and services plan. It was alleged that the staff did not properly assist resident (R1) with hygiene needs as it was stated that the staff did not encourage the resident to change into clean clothing. Page 1 of 3. Unfounded It was also alleged that the staff did not allow R1 to wear their own clothing of choice because the staff chooses it for him/her, including undergarments as it was stated that the staff are only giving R1 pull ups options instead of underwear. 6 staff members were interviewed. Based on staff interview, it was stated that when R1 first transitioned into the memory care unit the staff were made aware by R1’s family that R1 had tendencies to shuffle his/her clean and dirty clothes and reuse dirty clothes. During R1’s transition into memory care, the facility’s approach with R1 was orienting him/her to the new environment before implementing hands on care, as R1 was previously not receiving any hands-on care. It was stated that staff continued to supervise, monitor, provide stand-by assistance, and provide R1 with verbal cues and reminders when necessary. Staff stated that when they observed R1 was reusing his/her dirty clothing, the staff would verbally prompt R1 to change his/her clothes. It was stated that R1 had a certain clothing item that he/she liked to wear and if he/she saw it in the dirty pile, R1 would take it and wear it. The facility staff informed R1’s family (authorized representative) of their concerns. Staff stated that when they tried to verbally redirect R1 from reusing dirty clothing, R1 would get verbally aggressive with staff and ask staff to leave him/her alone as he/she was “not a kid”. After discussing the concern with R1’s authorized representative, the facility staff and R1's authorized representative agreed to separate R1’s clothes in storage bins and place a lock on the dirty clothing bin to prevent R1 from getting into his/her dirty clothes. Staff stated since implementation of the clean/dirty storage bins, it has helped reduce R1 reusing dirty clothing. 5 out of 5 staff members stated that the staff are trained to provide residents who are unable to fully decide for themselves 2 options of outfits to choose from. Page 2 of 3. 5 out of 5 staff members stated that staff pick 2 outfit options for R1 to choose from. It was stated that R1 is able to decipher whether he/she likes the outfits, and staff would continue to show options until R1 agrees to it. 5 out of 5 staff members stated that R1 has the option of using either pull ups or underwear. It was stated that R1 has the option of choosing which option he/she wants to wear, however, is encouraged to wear pull ups for precautionary measures. On 02/04/2025, R1 was interviewed. Based on interview, R1 stated that he/she can wear the clothes that he/she wants and is able to change his/her own undergarments. On 02/04/2025, LPA Chang observed that R1’s closet was unlocked and accessible to R1. LPA observed a locked box of laundry in R1’s bedroom. LPA observed R1’s clothing was clean. On 05/20/2025, LPA Kabariti observed R1’s clothing looked clean with no observation of obvious stains and foul odor. LPA observed R1’s closet contained 2 large storage bins with 1 of the bins labeled “dirty clothes”. R1’s closet observed with a few blouses that were hung. Based on record review, R1 requires dressing assistance. It’s indicated that R1 tends to reuse clothing. The facility plans to assist resident with putting away dirty clothes at the end of each day into the laundry basket/hamper. R1 also requires physical assistance with bathing and has preferred shower days of 2 times per week. The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unfounded, meaning, the allegations are false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Tina Bagheri and a copy of the report was provided. Page 3 of 3.the state’s words, verbatim · CDSS document, Jul 22, 2025 · control 26-AS-20250131095320

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct a case management – incident visit. LPA met with Executive Director, Tina Bagheri. This visit is a follow-up on a case management visit conducted on 11/08/2024 regarding sexual abuse by staff (S1) to resident (R1) the night of 11/06/2024. On 11/07/2024, the incident was reported to the Department. During the investigation, it was found that S1 had inappropriately touched R1’s private areas without consent. The incident was witnessed by a staff member who entered the memory care unit and observed the incident. This staff member immediately rushed to grab another staff and returned to the memory care unit where R1 motioned for the two staff to come over. Due to R1’s diagnosis, R1 primarily relied on physical gesture to communicate. R1 was motioning a grabbing motion in R1’s private areas indicating that R1 was inappropriately touched by S1. Law enforcement investigated the case and interviewed R1 who was able to articulate that an incident had occurred based on expression. R1 answered yes to the questions of S1 touching R1’s private areas, if he/she was scared, if he/she requested help, if S1 hit him/her, if S1 took his/her pants off, and if R1 saw S1’s private part. R1 was noticeablely distraught during the interview. Page 1 of 2. R1 had a surveillance camera inside his/her room that was set up by R1’s power of attorney (POA). The surveillance camera from R1’s room showed unusual behavior from S1 the night of the incident. Although R1 and S1 were off camera for part of the surveillance footage clips, R1 could be heard yelling for help. The surveillance footage corroborated with the two staff member/witness statements, when they explained that R1 tried to hand signal being inappropriately touched by S1. On 11/07/2024, S1 was immediately terminated from the facility. On 11/12/2024, S1 was immediately excluded from the Department. A case management visit was conducted at the facility and hand delivered S1’s order for immediate exclusion. On 11/14/2024, S1 was arrested and transported to jail without incident, where S1 remains without bail. A deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Executive Director, Tina Bagheri and a copy of the report and appeal rights were provided. Page 2 of 2.the state’s words, verbatim · CDSS document, May 20, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.58 · Plan of correction due date: May 21, 2025

(a) The department may prohibit any person … from employing, or continuing the employment of, or allowing in a licensed facility, or allowing contact with clients of a licensed facility by, any employee, prospective employee, or person who is not a client who has: (2) Engaged in conduct which is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility, or the people of the State of California. This requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not comply with the section cited above wherein staff (S1) had sexually abused resident (R1) in care which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 20, 2025

Plan of correction: On 11/07/2024, S1 was immediately terminated from the facility. On 11/12/2024, S1 was immediately excluded from the Department (Case management completed). Licensee cleared the deficiency prior to visit.

Allegation investigated: Facility lack of supervision resident left the facility unassisted.

On 01/02/2025, at 8:45 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a complaint investigation visit. LPA met with Executive Director (ED), Tina Bagheri, and disclosed the purpose of the visit. Regarding the allegation “Facility lack of supervision resident left the facility unassisted”, Reporting Party (RP) stated “ The resident R1 is Bruce Newborn was found at a gas station near the facility by a staff member who was getting gas for their vehicle. R1 is not supposed to leave the facility alone and has wandering behavior. R1 has Mild Cognetive Behavior. The Physicians report states resident is not to leave facility alone. Staff saw resident buying chewing tabacco and then reported it to the facility and took resident back to facility.” Continued on LIC9099-C Unfounded Based on the records review conducted on 01/02/2025, LPA reviewed the resident’s roster and didn’t see resident (R1) living at the facility as R1's name was not listed on the resident roster. LPA checked both Assisted Living and Memory care resident’s rosters. Based on the staff (ED) interview conducted on 01/02/2025, ED stated that the facility doesn’t know the Resident (R1) and they have never lived at the facility. ED stated that they never had any AWOL incidents since the facility opened in October 2023. ED stated they always check Assisted Living Resident’s Physicians report to make sure if the residents can leave the facility on their own or not. Facility’s care managers and front desk have this information to monitor. Based on observations, interview conducted with the Executive Director, and records reviewed, the department has determined that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, the allegation is UNFOUNDED. No deficiencies were cited under the California Code of Regulations, Title 22. An exit interview was conducted. A copy of this report was discussed and left with the Executive Director, Tina Bagheri, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Jan 2, 2025 · control 26-AS-20241224094612

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Christine Dolores and Santino Fortes arrived at the facility unannounced to conduct a case management – other visit. LPA met with Executive Director, Tina Bagheri. The purpose of the visit is to hand deliver an immediate exclusion letter for an individual (S1) who the Department determined engaged in conduct inimical as a staff in the facility. The letter was handed to the Executive Director. The Executive Director states S1 was immediately terminated after the incident on 11/07/2024. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Tina Bagheri and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 12, 2024

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Christine Dolores and Santino Fortes arrived unannounced to conduct the case management - incident visit. LPA met with Executive Director Tina Bagheri. The purpose of the visit was to follow-up on a SOC341 the Department received on 11/07/2024 for an incident that occurred on 11/06/2024 regarding alleged sexual abuse. During visit, 2 staff members were interviewed. Documents were obtained to include resident (R1)'s physician's report, service plan, face sheet, the detectives case number, staff schedule, staff roster, 3 staff member's job application, and 2 staff member's declaration statement. This case management will be pending additional investigation. This report was reviewed with Executive Director, Tina Bagheri and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 8, 2024

Type of visit: Case Management - Annual Continuation

On 9/20/2024 Licensing Program Analysts (LPAs) Simi Rai and Marcela Yanez, conducted an unannounced Annual Continuation inspection from 9/13/2024. LPAs met with Executive Director (ED) Tina Bagheri Tayabeh and stated the purpose of today's visit. During today's visit, LPAs reviewed 10 resident files and 5 at random resident centrally stored medication files and resident medications. During inspection on 9/13/2024, in resident room #1, LPAs observed 3 over-the-counter medications and acetone alcohol in the mirror cabinet in the resident room which was not locked and accessible to the resident R1. Staff S1 stated R1 was on the facility medication management program and facility staff administered medications to R1. Based on review of R1's LIC 602A Physician's Report dated 2/22/2024, R1 is diagnosed with Dementia. During visit, facility staff removed the items and placed them in a locked cabinet in the resident's room. During inspection on 9/13/2024, in resident room #2, LPAs observed 1 bottle of 19 oz Lysol disinfectant spray and 1 bottle of 91% isopropyl alcohol located on top of the bathroom sink which was not locked and accessible to resident R2. Based on review of R1's LIC 602A Physician's Report dated 9/3/2024, R1 is diagnosed with Dementia. During visit, staff S1 removed the item and placed them in a locked cabinet. During inspection on 9/13/2024, in resident room #1, LPAs observed 2 multi-purpose scissors located in the bathroom and in the sitting area in the bedroom. Based on review of R1's LIC 602A Physician's Report dated 2/22/2024, R1 is diagnosed with Dementia. During visit, staff S1 removed the 2 scissors and placed them in a locked cabinet in the resident's room. Continuation on LIC 809-C, Page 1 of 3. Page 2 of 3. During inspection on 9/13/2024, in resident room #3, LPAs observed 1 bottle of Clorox Disinfecting spray, 1 bottle of disinfection bleach, 1 bottle of Lysol Disinfecting spray and 1 bottle of Tide laundry detergent. Staff S1 stated R3 was on the facility medication management program and facility staff administered medications to R3. Based on review of R3's LIC 602A dated 9/28/2023, R3 is not able to administer own prescription medications, R3 is not able to store own medication, R3 is occasionally confused or forgetful. During visit, staff S1 removed 4 bottles of disinfectants and cleaning solutions from R3's room and placed them in a locked cabinet. During inspection on 9/13/2024, in resident room #4, LPAs observed 1 prescribed medication bottle which was filled in May 2024 in the mirror cabinet over the bathroom sink in the bathroom. LPAs observed resident R4 was present in the room during the time of inspection. Staff S1 stated R4 was on the facility medication management program and facility staff administered medications to R4. Based on review of R4's LIC 602A dated 3/18/2024, R4 is not able to administer own prescription medications and is not able to store own medication. During visit, staff S1 removed the prescription medication and personally took the medication into the locked medication room. During today's inspection, LPA Marcela reviewed 5 resident medications and record of centrally stored prescription medications. LPA Marcela observed 2 out of 5 record of centrally stored prescription medications had either the wrong start date written on the record and medications were administered to the resident. LPA Marcela reviewed resident R1's medication, 1 medications had different start dates recorded on Centrally Stored Medication Log and resident's medication bubble pack. Medication N had start date on medication bubble pack was recorded as 8/25/2024 and the start date on the centrally stored medication log was recorded as 8/22/2024. LPA Marcela reviewed resident R2's medication, 1 medication had different start dates recorded on Centrally Stored Medication Log and resident's medication bubble pack. Medication G had start date on medication bubble pack was recorded on 9/9/2024 and the start date on the centrally stored medication log was recorded as 9/10/2024. Page 3 of 3. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. Technical Violation was provided during today's visit. Plan of Correction (POC) for Type A deficiency issued during today's visit will be due on Saturday, September 21st 2024 11:59 P.M. Plan of Correction (POC) for Type B deficiency issued during today's visit will be due on Friday, September 27th 2024 11:59 P.M. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Executive Director,Tina Bagheri Tayebeh and a copy of the report was provided. Appeal Rights were provided.the state’s words, verbatim · CDSS document, Sep 20, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Sep 21, 2024

87705(f)(2)Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.This requirement was not met as evidenced by: Based on observation and record review, LPAs observed OTC medication, alcohol, and toxic substances in resident bedrooms who are diagnosed with dementia and accessible to residents which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 20, 2024

Plan of correction: Executive Director stated to submit a written plan of action understanding regulation and notifing residents and/or responsible party and staff in-service training by POC due date. Executive Director agreed and understood. During visit, staff S1 removed the items and placed them in a locked cabinet.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(f)(1) · Plan of correction due date: Sep 21, 2024

87705(f)The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement was not met as evidenced by: Based on observation and record review, LPAs observed 2 scissors in the bathroom and resident room which was accessible to resident with dementia which poses/posed an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 20, 2024

Plan of correction: Executive Director stated to submit a written plan of action understanding regulation and in-service training by POC due date. Executive Director agreed and understood. During visit, staff S1 removed the items and placed them in a locked cabinet.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Sep 21, 2024

87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement was not met as evidenced by: Based on observation and record review, LPAs observed 4 bottles of disinfectants and cleaning solutions in resident R3's bathroom underneath the bathroom sink which was not locked and accessible to the resident which poses/posed an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 20, 2024

Plan of correction: Executive Director stated to submit a written plan of action understanding regulation and notify resident and/or responsble party and provide in-serice training by POC due date. Executive Director agreed and understood. During visit, staff S1 removed the 4 bottles and placed them in a locked cabinet.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Sep 21, 2024

87465(h)(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Based on observation and record review, LPAs observed medications in 1 residents rooms which were accessible and unlocked to the residents unable to administer own medication which poses/posed an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 20, 2024

Plan of correction: Executive Director stated to submit a written plan of action understanding regulation and provide in-service training to staff by POC due date. Executive Director agreed and understood. During visit, staff S1 removed the medication from the residents room and placed in the medication rooom.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(6) · Plan of correction due date: Sep 27, 2024

87465 (h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year...This requirement is not med as evidenced by: Based on observation and record review, LPA observed 2 out of 5 Centrally Stored Medication Records was not completed accurately which poses/posed a potential Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 20, 2024

Plan of correction: Executive Director stated to submit a written plan of action understanding regulation and schedule in-service training for medication technicians to complete the records of centrally stored prescription medications for residents by POC due date. Executive Director agreed and understood.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Simi Rai and Marcela Yanez conducted an unannounced Required 1 Year visit. LPAs met with Assisted Living Coordinator Lucely Tan and Maintenance Coordinator Gerardo Vallejo and stated the purpose of today's visit. During visit, LPAs toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPAs toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. LPAs observed additional food supply areas and secured areas for cleaning supplies and laundry detergents. LPAs toured the resident bedrooms. Ten out of ten resident bedrooms had available bedding, drawers, and functioning lights. The resident bathrooms had available soap, paper towels, and trash cans with lids. The water temperature in the bathroom sink ranged from 111.2 - 117.5 degrees F. The temperature of refrigerator was measured at 39 degrees F and temperature of freezer was measured at -11 degrees F. LPAs toured the memory care unit on two floors. LPAs inspected all 6 delayed egress exit doors and alarms were functioning and in good repair. The windows in the memory care resident rooms had screens were clean and maintained in good repair and had window guards. Fire extinguishers was observed and inspected on 08/16/2024. The smoke detectors, carbon monoxide detectors and sprinklers were inspected by third party vendor 06/19/2024. The last fire drills was on 06/20/2024 and 08/28/2024. LPAs reviewed facility records for ten staff. LPAs will return another day to complete annual inspection. This report was reviewed with Assisted Living Coordinator Lucely Tan and Maintenance Coordinator Gerardo Vallejo and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 13, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management – incident visit. LPA met with Executive Director, Tina Bagheri. The purpose of the visit is to follow-up on an incident report the Department received on 12/06/2023 regarding resident (R1). On 12/04/2023, it was reported that a staff found R1 with a pair of scissors and minor injury to the body inside his/her apartment. Resident was transported to the hospital for medical attention. R1’s family was informed. Based on interview, the scissors was brought into R1’s apartment located in assisted living during admission. Residents are allowed to have this item based on review of the resident's medical records. If there is any indication these items would pose a risk to the residents, the facility would communicate the concern with family and/or the resident. Prior to the incident R1 did not show any signs of self-harm. After the incident, the staff did a room check and removed all items which could be harmful to the resident and returned all objects that could be harmful to the family member. Based on record review, R1 was diagnosed with a mild cognitive impairment. R1's records did not indicate a risk for self-harm or any inappropriate behavior. After the incident, R1 was provided a private 24/7 companion and is stated to be doing well. The facility conducted a re-assessment and in-service training with staff. Around 4:15PM, LPA and the Executive Director entered R1's apartment. R1 granted permission to LPA to tour R1's apartment. Documents were obtained during visit to include R1's physician's report, preplacement appraisal information, service plan, and in-service training. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Tina Bagheri and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 17, 2024