The Gardens at Park Balboa

Allegation investigated: . Staff neglect led to resident developing pressure injuries while in care.

Licensing Program Analyst (LPA) Christine Yee conducted a subsequent complaint visit to deliver findings for the above allegation. LPA Yee met with Jonathan McFall, Marketing Director since Dion Gallarza, Executive Director had scheduled training and was not on-site. The reason for today's visit was explained. On 11/07/2025, from 12:00 pm to 3:15 pm, Licensing Program Analyst (LPA) Christine Yee conducted an unannounced initial complaint visit. LPA met with Executive Director Dion Gallarza and Wellness Director, Laura Diaz; toured the physical plant and obtained documentation on residents. On the allegation: Staff neglect led to resident developing pressure injuries while in care. On 11/06/2025, the Department received a complaint, alleging that due to staff neglect, Resident #1 (R1) developed a stage 3 sacral pressure injury. Continued on LIC9099-C Substantiated Page 2. The Department conducted the following interviews: on 11/19/2025 at approximately 11:30 am, interviewed the Executive Director; on 11/19/2025 at approximately 1:00 pm interviewed R1; on 12/4/2025 at approximately 12:00 pm interviewed staff; on 12/4/2025 at approximately 1:00 pm to 1:20 pm interviewed residents; on 12/9/2025 at approximately 2:30 pm, interviewed Family #1 (F1); on 12/29/2025 from approximately 2:00 pm to 2:30pm interviewed staff. The Department reviewed medical records for R1 from North Hills Rehab Center and from Kaiser Permanente. Records indicate that R1 had a left sacrum-pressure injury stage 3 on admission to the hospital dated 10/31/2025. Records state the pressure injury appears “over bony prominence, full thickness tissue loss, subcutaneous fat visible.” Record states R1 is diabetic and incontinent. R1 was admitted to the facility on 10/10/2025. R1’s Preplacement Appraisal Form (LIC 603) dated 10/2/2025 and Service Care Plan dated 10/4/2025 state resident needs assistance with showers/bathing, and does not claim that R1 is incontinent at time of admission. On the following dates R1 had falls: 10/14/2025, 10/20/2025, 10/21/2025, 10/22/2025, and 10/31/2025, all of which were reported via an Unusual Incident report to CCL. R1 refused transport for all falls, except the final one on 10/31/2025. Executive Director and Staff interviewed stated they were not aware of any pressure injuries, stated R1 was fairly independent, but staff assisted R1 with bathing and medication management. Health Services Director stated they do not perform any skin checks prior to admission unless the resident has a history of skin breakdown. Health Services Director stated they were aware of the regulations on pressure injuries, but erroneously believed Stage 1 and 2 can be monitored within the facility, while Stage 3 is allowed with home health wound care only. Staff stated they often saw R1 sitting on either R1’s bed or couch, stated R1 was not very mobile and was very stubborn, refused medical evaluation following multiple falls, and wanted to refuse medical evaluation on 10/31/2025. Staff interviewed confirmed their duties include showering and changing residents, and noted R1 often refused showers. All staff interviewed stated they assisted R1 with diaper changes, and some stated they had only given R1 one shower, while others denied ever providing R1 Continued on LIC9099-C Page 3 a shower. Staff denied seeing any wounds on R1’s buttocks and/or sacrum. Some staff denied a pressure injury was ever mentioned to them, but during interview Staff 1 admitted that F1 had “asked about a pressure injury” but does not remember what was said about it. When R1 was interviewed, they had no complaints about the care or staff. R1 stated they were not aware of the pressure injuries, and did not have any pain. R1 stated they could dress and toilet themselves, and stated the only time staff would have seen their body is during shower assistance. R1 stated they got themselves in and out of bed on their own, they liked to be up and moving around, and did not stay in bed or a chair often. Review of shower schedule shows that R1 was scheduled for PM showers for Tuesday and Saturday. The facility had no records to show if any showers were refused. Based on the timeline, there would have been 6 showers given from 10/10/2025 through 10/31/2025 if the schedule was adhered to. F1 stated approximately one week prior to R1 being admitted to the hospital on 10/31/2025, F1 observed what F1 determined to be a stage 2 pressure injury on R1 buttocks area. F1 described it as being “smaller than a dime.” F1 did not advise any staff, as F1 was going to directly request wound care through Kaiser. Approximately two to three days after F1 discovered the pressure injury, a caregiver (name unknown) told F1 that R1 had “a little sore on [R1’s] butt,” and R1 was admitted to the hospital “two to three days” after that. F1 stated they had professional medical training as a Registered Nurse and Nurse Practitioner. When asked to elaborate on the interaction with the caregiver, F1 stated they would often find R1’s adult diaper soiled and F1 would change and clean R1, as well as assist with showering R1 sometimes. F1 notified a caregiver that R1 was “dirty” and needed a shower after F1 found R1 “dirty” with feces. As F1 and the caregiver were showering R1, the caregiver made the comment about the “sore on [R1’s] butt.” F1 took R1 to their primary care physician on 10/30/2025 and discussed needing wound care. F1 indicated R1 did not have any sores when they arrived at the facility. Other residents interviewed, who had been at the facility for multiple years, stated they had no complaints or concerns with their care and living arrangements. Continued on LIC9099-C Page 4. The investigation provided sufficient evidence to substantiate neglect/lack of care. Per R1’s family, they observed a pressure injury on R1’s sacrum about one week prior to R1’s hospitalization (on 10/31/2025), and F1 advised a caregiver had also observed the pressure injury and commented about it. One staff interviewed confirmed F1 asked them about a pressure injury, but all staff denied observing or having knowledge of one. Per Kaiser Permanente Hospital medical records, R1 was admitted to the hospital on 10/31/2025 with a stage 3 community acquired pressure injury (CAPI) on R1’s sacrum. Based on interviews and record review, there is a preponderance of evidence to support that the above allegation occurred, therefore, the allegation is SUBSTANTIATED. Deficiency cited under Health and Safety Code, Chapter 3.2 Residential Care for the Elderly, Article 3 Immediate civil penalties of $500 was assessed on today's visit. Jonathan McFall was also informed that additional civil penalties may also be assessed based on Health and Safety Code 1569.49(e) or (f). Exit interview was conducted, APPEALS RIGHTS was discussed and a copy was provided. Page 2A The Department conducted the following interviews: on 11/19/2025 at approximately 11:30 am, interviewed the Executive Director; on 11/19/2025 at approximately 1:00 pm interviewed R1; on 12/4/2025 at approximately 12:00 pm interviewed staff; on 12/4/2025 at approximately 1:00 pm to 1:20 pm interviewed residents; on 12/9/2025 at approximately 2:30 pm, interviewed Family #1 (F1); on 12/29/2025 from approximately 2:00 pm to 2:30pm interviewed staff. The Department reviewed medical records for R1 from North Hills Rehab Center and from Kaiser Permanente. R1 stated they had no issues with the care at the facility and were treated well. R1 stated they transfer in and out of bed independently and walk on their own, usually with a walker. R1 stated they fell from bed and staff was there to assist them “right away.” On the following dates R1 had falls: 10/14/2025, 10/20/2025, 10/21/2025, 10/22/2025, and 10/31/2025, all of which were reported via an Unusual Incident report to CCL. 9-1-1 was called for each fall, but R1 refused transport for all falls, except the final one on 10/31/2025. R1’s medical records from 10/31/2025 show R1 was diagnosed with a closed head injury, accidental fall, left elbow laceration, right elbow laceration, and left lower leg laceration. The medical records state R1 fell from bed with a head injury and has had recurrent falls over the past three to four weeks associated with progressive weakness, functional decline, and worsening cognition including memory loss and urinary incontinence. An MRI showed R1 had an acute lacunar infarct (ischemic stroke). Medical records state the first responders reported R1’s “bed was pretty high,” and one staff interviewed confirmed R1’s bed was high. Interviews from Health Service Director and staff confirm R1 had several falls within their approximate three-week stay in the facility. Health Service Director stated R1 was active and independent with transfers and walking, with the assistance of a walker, and wore a fall pendant. Health Service Director stated they had been working with F1 regarding the falls, and R1 had a doctor’s appointment just prior to the 10/31/2025 hospitalization. F1 was trying to determine why R1 was falling so much and wanted to discuss R1’s medications with the doctor. F1 also removed R1’s dog from the facility in case R1 was tripping over the dog. Staff interviewed also believed the dog could have been a factor in the falls. Staff interviewed stated they mentioned to F1 that a hospital bed would be beneficial, but one was not yet obtained. F1 stated they were aware R1 was deteriorating quickly and it was a “battle “ to keep R1 from falling. F1 confirmed they spoke Continued on LIC9099-C Page 3A with the Health Services Director regarding the falls about two to three days before the 10/31/2025 hospitalization. F1 stated they discussed about R1 potentially needing a higher level of care, but nothing was decided upon. F1 confirmed R1 had a history of falls six to eight months prior to moving in. On 10/30/2025, F1 took R1 to their primary care physician to discuss medication management, physical therapy, and wound care, but those were not yet put into place by 10/31/2025. F1 also stated R1 tried to be independent but was also sure they could do things they could not handle, and was a “good liar” so as not to be a “burden.” F1 stated R1 initially refused to use their walker but began to use it more, although they also started refusing to go down for meals, which could be due to getting weaker. Overall, although R1 had experienced multiple falls during a three-week period residing at the facility, measures had been taken to try to address the reasons for R1’s falls, R1 was reassessed by their doctor, and discussions had begun about a potential higher level of care. Based on all interviews conducted and documents obtained, at this time the above allegations were found to be unsubstantiated, meaning that the allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview was conducted, copy of report and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 28, 2026 · control 29-AS-20251106161044

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.312(a) · Plan of correction due date: Aug 31, 2026

§1569.312 Basic services requirements: Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement was not met evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above when due to a lack of care and supervision by facility staff, R1 developed a stage 3 pressure injury, which posed an immediate health and safety risk to residents in care. Immediate civil penalties of $500 was assessed.the state’s words, verbatim · CDSS document, Aug 28, 2026

Plan of correction: Licensee will submit a written plan on how the facility will ensure appropriate care and supervision to meet the needs of residents. Submit a copy of the plan to CCL by 8/31/26

Allegation investigated: . Staff do not provide adequate food service

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Laura Diaz, Health Services Director until 1:30pm, when she had to leave for the day. The remainder of the visit was conducted with Theresa Danielis, Business Office. Dion Gallarza, Executive Director was off today. The reason for today's visit was provided. On today's visit, LPA Yee conducted an interview with Laura Diaz and Theresa Danielis at 1:25pm, Staff #1 at 1:40pm and Resident #1 at 2:51pm. Per information received during the investigation, one or two residents have small complaints such as the food is not hot enough or that the food service is slow. Per explanation provided for these complaints is that continued on LIC9099-C Unsubstantiated Page 2. the food is hot but not as hot as they like and residents like to come down to the dining room, about 15-30 minutes before the dining room opens and wait for their food order to be taken and complain about the long wait. Per investigation into the allegation that Staff do not provide adequate food service, the investigation revealed that on 5/26/26, Resident #1 had ordered a patty melt with American cheese to go, during lunch. Staff #2 had taken the order and Staff #3 handled the order. When Resident #1 opened the box to check the order, they observed that the staff had screwed up the order. Inside the box was a tuna melt with white cheese. Resident #1 got angry and upset and called the kitchen staff incompetent, idiots and stupid. Staff offered to re-do the order but the resident stated that they like tuna anyway and left the dining room. Per Resident #1 they screw up the orders all the time. They ask for a hot dog without the bun and it comes with a bun, They eat the hot dog and left the bun. They ask for iceberg lettuce, avocado, beets and they get purple lettuce, cucumbers and things they don't like. They want what they ordered. This incident was addressed internally with Dion Gallarza, Executive Director. Per Staff, Resident #1 complains about everything and they do their best to accommodate the resident. Per Staff #1, the order was read incorrectly and mistakes happen. Per interview with Resident #1, they did not file this complaint and never intended it to rise to the level of a complaint. Based on the information received on today's visit, there is insufficient evidence to support the allegation that Staff do not provide adequate food service, therefore the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was providedthe state’s words, verbatim · CDSS document, May 29, 2026 · control 29-AS-20260526150210

Allegation investigated: . Staff do not maintain facility in good repair 2. Staff do not provide resident with laundry service 3. Staff do not maintain facility sanitary 4. Staff inappropriately spoke to resident 5. Staff do not provide resident with comfortable accommodations

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and met with Dion Gallarza, Executive Director. The reason for today's visit was provided. On today's visit, LPA Yee conducted an interview with the Executive Director at 10:19am, Staff #1 at 11:51am and Resident #1 at 12:35pm and toured resident's room at 1:07pm. File review was conducted at 1:21pm and copies of documents were obtained. Per interviews conducted today, regarding allegation #1 - Staff do not maintain facility in good repair, the information provided, the toilet in Resident #1's bathroom was not broken and does not need to be replaced. Investigation revealed that Resident #1 likes to hit the toilet handle multiple times when flushing, causing the continued on LIC9099-C Unsubstantiated Page 2. chain that lifts the stopper inside the water tank to tangle up and prevent the handle from working correctly and prevent the rubber stopper from closing completely, causing the water in the tank to run continuously. Once the problem was diagnosed, maintenance shortened the chain to prevent the chain from tangling. Resident #1 also complained that the bathroom sink was not draining correctly and wants the facility to snake the pipes or replace the pipes to allow the water and soap suds to drain immediately. The facility snaked the pipes and the resident also paid someone to snake the pipe. Per information provided, the resident uses a lot of soap due to personal issues with germs. Based on the information provided, there is insufficient evidence to to support the allegation that staff do not maintain facility in good repair, therefore the allegation is unsubstantiated at this time. Investigation into allegation #2 - Staff do not provide resident with laundry service revealed that the facility does Resident #1's laundry every Wednesday. Residents are also told at the time of admission that large comforters and thick blankets are not washed at the facility. Laundry service for those items are available down the street if needed at the residents own expense. Resident can schedule pickup services if needed. Everything else, including small bedding items are washed on-site. Per interview conducted with staff, Resident #1 does not use the laundry hamper. They prefer to put their dirty clothes in a trash bag and expects their clothes to be returned in a new clean bag. Resident #1 also expects their laundry to be done and returned to their room immediately and does not like it when it is not returned immediately. Per Resident #1, the staff don't return their clothes until 5 hours later and they need their clothes. This past Wednesday (5/13/26), staff did better and they returned their clothes quick(3 hours) and wants it to stay that way or returned sooner. Per Resident #1, staff make him wait for his clothes and the laundry lady gets nasty. Per Staff #1, they do about 18 loads of laundry a day and they run behind sometimes. and the resident is constantly asking staff where their clothes are and gets upset and very aggressive, Per Staff #1, Staff #2 was running behind on the laundry this past Wednesday(5/13/26) and Resident #1 was very upset so that they walked the resident's clothing to Staff #2 to get it washed first. Resident #1 has a lot of towels to be washed. Per Staff #1, they accommodate Resident #1 just so that the resident does not get continued on LIC9099-C Page 3. upset. When they return Resident #1's clothing, they have to ring the door bell to be allowed entry and are not allowed to put the clothes on the chair or on the bed. Resident gets upset. Sometimes, Resident#1 will not allow staff into their room and so they just hand the resident their clothes at the door. Resident does not like staff in their room. Based on the information received on today's visit, there is insufficient evidence to support the allegation that Staff do not provide resident with laundry service, therefore the allegation is unsubstantiated at this time. Regarding allegation #3 - that Staff do not maintain facility sanitary, the investigation revealed that Resident #1's room is cleaned also on Wednesday. Per staff, Resident #1 tells them when their room can be cleaned and they have to come back. This interferes with the cleaning schedule. They can accommodate the resident sometimes but not all the time. Per information received, Resident #1 does not allow staff to dust the furniture, bathroom counter or to touch anything in the bedroom. Per staff, Resident #1 allows staff to clean the bathroom and the bedroom floor with water only. Resident does not allow staff to use any cleansers or any form of chemical. Resident #1 does not like the smell. Investigation also reveals that Resident #1 urinates on the bathroom floor and Resident #1 makes the staff clean the bathroom a minimum of 3 times. Each time the floor is cleaned, Resident #1 makes the staff go to the back of the facility to wash the mop. Once the staff has completed the housekeeping, Resident #1 inspects the room and if they see something, staff has to clean it again before they can leave. While staff is cleaning, Resident #1 is standing by the door and watching the whole process. Based on the information obtained during the investigation, there is insufficient evidence to support the allegation that Staff do not maintain facility sanitary, therefore the allegation is unsubstantiated at this time. Investigation into allegation #4 - Staff inappropriately spoke to resident revealed that Resident #1 speaks down to the staff. Staff are treated like the resident's personal servants and staff are told that by Resident #1. It is alleged that Staff #2 shouted at Resident #1 and acts snotty with them. Per interviews conducted with staff, staff do not shout at residents. Staff #2 denies shouting to Executive Director. Per the Executive continued on LIC9099-C Page 4 Director, Staff #2 does speak loudly with everyone and it could be misconstrued as shouting. This was discussed with Staff #2 and staff was advised not to engage with the resident and to allow their supervisor to address any issues directly with the resident. Per interview with Staff #1, they have not observed or heard Staff #2 shout at any resident. Based on the information received on today's visit, there is insufficient evidence to support the allegation that Staff inappropriately spoke to resident, therefore the allegation is unsubstantiated at this time. The investigation into allegation #5 - Staff do not provide resident with comfortable accommodations revealed that Resident #1's bathroom has window louvres and it allegedly does not close tightly. The facility provides shower liners for all residents but not a shower curtain. It is alleged that a draft/wind comes into the bathroom and wraps the liner around the resident during showers because there is no shower curtain. A curtain was requested from the facility and they accommodated the resident and one was provided at the facility's expense. Resident #1 also requested a new toilet so that the handle used to flush the toilet is specifically located in the front of the water tank as opposed to being located to the side of the tank. Per Resident #1, the placement of the handle on the right side of the tank hurts their back. Resident #1 is independent and is completely ambulatory. Per the Executive Director, resident was asked why they don't stand up to flush the toilet when they are done toileting. A discussion was had with the Executive Director and resident was advised that the toilet being requested was more expensive and the resident could purchase one at their own expense and they would install the toilet for them. Resident refused. The Executive Director then told the resident that they would work with them. The Executive Director told the resident that if the facility needed to purchase another toilet for another room, they would purchase the toilet being requested and switch it out with the one in their room. There was no time frame or date promised for making the toilet switch. Resident #1 agreed. Based on the information received, there is insufficient evidence to support the allegation that the Staff do not provide resident with comfortable accommodations therefore the allegation is unsubstantiated at this time. Although the above allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 15, 2026 · control 29-AS-20260505085849

Allegation investigated: . Staff handled resident in a rough manner resulting in injuries. 2. Staff unable to provide assistance to residents in a timely manner.

Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to deliver the findings of the investigation and met with Dion Gallarza, Executive Director. The reason for the visit was provided. On October 24, 2025, LPA Yee conducted an unannounced initial complaint visit to investigate the above allegations and met with Laura Diaz, Health Services Director. Dion Gallarza, Executive Director, was off on the day of the initial visit. The reason for the visit was provided. On the visit conducted on October 24, 2025, LPA Yee conducted interviews with Laura Diaz, Wellness Director at 11:18am, Staff #2 at 12:35pm, Staff #3 at 1:33pm, Staff #1 at 3:06pm, Staff #4 at 2:24pm, Continued on LIC9099-C Unsubstantiated Page 2. Resident #1 at 2:20pm and Resident #2 at 2:43pm and collected copies of documents for Resident #1 and Resident #2. Due to time constraints and the information received, further investigation was needed to make a finding for the above allegations. Exit interview was conducted and a copy of the report was provided. On February 20, 2026, LPA Yee conducted a telephone interview with Dion Gallarza, Executive Director, at 9:48am. Per information received from the investigation regarding the allegation that staff handled resident in a rough manner resulting in injuries, the investigation revealed that Resident #1 was taking Eliquis 2.5 mg, a blood thinner. It was also revealed that Resident #1 has dry skin and likes to scratch their hands and also likes to actively move their hands while talking. Per interviews conducted with staff, everyone denies that staff handle residents in a rough manner. Per Staff, they do not pick up residents by their hands. They are picked up by their arm pits. Resident #1 requires a 2 man assist and is picked up by their arm pits so it is unknown how Resident #1 would have sustained the bruises on their hands. The staff also indicated that the residents’ in Safe Haven don't have behaviors resulting in another resident being hit.. The bruises could have been sustained if Resident #1 waved their hands around while talking and could have hit something. Per information provided, Resident #1 likes to hit the underside of the table with their hands or hit the wall and easily sustained bruises due to the use of blood thinner. Per facility documentation dated October 16, 2025, Resident #1’s responsible party was notified of the bruises observed on the top of the resident’s hands on October 15, 2025. The Responsible party expressed concerns. Per facility documentation, staff from each shift who worked on October 14, 2025, were interviewed by the Executive Director. Staff indicated that Resident#1 had been observed laying their head on their hands and scratching their hands. The facility’s Nurse Practitioner was also called, and pictures of the resident’s hands were sent and the Nurse Practitioner indicated that it would not take much pressure to cause bruising due to the use of blood thinner. Per the Executive Director’s interview with Resident #1, they also indicated that the lady who shaves them was also holding their hands, lifted them up by their shirt and lifted them in the air. The lady who shaves the resident is the responsible party. Based on the information obtained from interviews continued on LIC9099-C Page 3. conducted, there is insufficient evidence to support the allegation that staff handled the resident in a rough manner resulting in injuries, therefore the allegation is unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Per information obtained regarding the allegation that staff unable to provide assistance to residents in a timely manner, the investigation reveals that the facility has 3 shifts. Safe Haven has 2 caregivers and a Medication Technician working the morning and evening shift and one caregiver on the night shift. Assisted Living has 2-3 caregivers in the morning and evening shift and one at night. There is a total of 3 staff for the night shift – one caregiver in Assisted Living, one caregiver in Safe Haven and a Medication Technician. The staff assist and cover each other. Per Laura Diaz, Wellness Director, many of the assisted living residents are independent and don’t need assistance with feeding or to be checked regularly. Residents are observed during mealtimes. Room checks are done for at risk residents based on their needs. The Safe Haven residents do not have any issues or behaviors and are asleep and room checks are conducted every hour. Incontinent residents are changed 2-3 times at night or as needed. Per Laura Diaz, they do not have any staffing issues. Staff respond to calls for assistance within ten minutes. Caregivers assist each other if an assigned caregiver is unable to respond to a resident. Another caregiver will provide coverage. Based on information received during the investigation, there is insufficient evidence to support the allegation that staff unable to provide assistance to residents in a timely manner, therefore the allegation is unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Feb 23, 2026 · control 29-AS-20251021133859

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Quoc Huynh arrived unannounced at 9:28AM to conduct an Annual Continuation visit. The LPA met with the Executive Director (ED) Dion Gallarza and explained the reason for the visit. Entrance interview conducted. At 9:31AM, the LPA and ED conducted a brief health and safety tour of the physical plants areas, and no immediate concerns were observed. RECORDS: Resident records were reviewed at 9:57AM. LPA Huynh reviewed ten (10) files for, but not limited to: admissions agreements, medical assessment, appraisals, and consent forms. Resident records reviewed were in order at this time. The LPA reviewed eleven (11) personnel records for, but not limited to: job application, health assessments, TB results, criminal record statements and clearances, first aid/CPR certification, and appropriate trainings. Staff files reviewed were in compliance with regulation at this time. Three (3) staff did not have a certified first aid/CPR training on file, however, received Relias online module trainings and certified staff are on the premises at all times. The LPA advised the ED to ensure direct care staff receive first aid/CPR certification. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER: The LPA reviewed the facility's Infection Control Plan and Emergency Disaster Plan. LPA noted that the facility is in compliance with regulation with both plans reviewed annually. The facility conducts emergency disaster drills monthly, with the last drill documented on 09/16/2025. Fire alarm system is tested annually with the last inspection on 05/01/2025. Additionally, the commercial kitchen was inspected on 08/30/2025 and fire doors were tested on 09/23/2025 by GFP Guard Fire Protection Services Inc. MEDICATION: Medication review began at 11:30AM. The LPA reviewed medications for five (5) residents. Medications were maintained locked inaccessible to residents in the Medication Room located on the first floor in the Memory Care Unit. Resident medications reviewed were documented and stored in compliance with regulation at this time. No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.the state’s words, verbatim · CDSS document, Oct 2, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Quoc Huynh arrived unannounced at 4:20PM for a required one-year visit. The LPA met with the Executive Director (ED) Dion Gallarza and explained the reason for the visit. Entrance interview conducted. At 4:29PM, the LPA and ED toured the physical plant areas inside and outside to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. The following was observed: RESIDENT ROOMS: The LPA observed ten (10) randomly selected rooms with private restrooms on the first and second floor and no immediate health or safety hazards were observed. Restrooms were clean, with properly installed grab-bars in resident bathrooms and non-skid strips in showers. Resident rooms were furnished with all required furniture within regulation. Water temperature was tested throughout the units and measured between 108.1 degrees F and 118.2 degrees F, which is within the required range per regulation. Report Continued on LIC 809-C COMMON AREAS: The facility is a two-story building with a total of one hundred and six (106) units. On the first floor, there was the kitchen facilities, dining room, laundry room, lobby, two (2) outdoor courtyards, resident units, and the memory care unit. The memory care unit had its own courtyard and dining room with food delivered from the main kitchen. On the second floor, there was an activity room and resident units. The LPA observed common areas to be clean and contain furniture in good condition. There were no obstructions and/or tripping hazards throughout the facility. Required postings were found in the hallways on the first floor. LPA observed emergency evacuation chairs at each stairway in the event of an emergency and elevators are out of order. There were no bodies of water observed during today’s visit. Fire extinguishers were observed throughout the facility, which were last serviced on 09/2025. KITCHEN: The kitchen was located on the 1st floor attached to the dining room. Facility dining room and commercial kitchen were inspected and in compliance with Title 22 regulations. There was a sufficient supply of perishable and non-perishable food. The food appeared to be of good quality and labeled appropriately. Emergency food was stored with dry food items and emergency water was stored in an inoperable commercial refrigerator in the rear of the kitchen. Due to time constraints, LPA Huynh will return at a later date for an Annual Continuation. No deficiency cited. Exit interview conducted. A copy of today’s report was reviewed and provided.the state’s words, verbatim · CDSS document, Sep 22, 2025

Allegation investigated: . Staff did not provide proper mobility assistance to residents in care

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Dion Gallarza, Executive Director (ED). The reason for today's visit was provided. On today's visit LPA Yee conducted an interview with the Executive Director at 11:04am, Staff #1 at 11:37am, Staff #2 at 12:04pm, Staff # 3 at 12:55pm and Resident #2 at 1:42pm. LPA attempted to interview Resident #1 but resident refused. Facility records were reviewed and copies obtained. Per information obtained during the investigation, regarding the above allegation that staff did not provide proper mobility assistance to residents in care, it was revealed that Staff #2, Staff #4 and Staff #5 were in the breakroom taking their break on 6/8/25. When Staff #2 left the breakroom, Staff #4 made an unkind comment about the way Staff #2 dresses to Staff #5. Staff #5 went and told Staff #2 about the comment Unsubstantiated made by Staff #4. The comment made by Staff #4 upset Staff #2. Staff #2 approached Staff #1, Maintenance Director, and informed them about the comment made by Staff #4. Staff #2 was told by Staff #1 that they would investigate the incident. On the same day, the Maintenance Director had all three staff submit written statements regarding what happened in the breakroom. Staff #5 was counseled on 6/11/25 and Staff #4 was counseled on 6/12/25. Staff #4 and Staff #5 were also required to take online training in Harassment in the Workplace and Violence in the Workplace. Per interviews conducted with the Executive Director and Staff #1, Staff #4 has worked at the facility for about 4 months and they have received staff complaints about Staff #4. Staff #4, who works as a housekeeper, likes to tell staff what they should be doing and what they are doing wrong. Staff #4, likes to boss other staff around and was told by their supervisor that they are to address their concerns with a supervisor, not with the staff. Staff #4 also rubs the other staff the wrong way. The Executive Director, Staff #1 and Staff #3 also indicate that Staff #2 is a very good caregiver. Staff #2 is always happy, has a good attitude, very attentive towards the residents, has a great attitude, friendly, very helpful and enjoys working with the residents. Staff #2 has not received any complaints or write ups. As a result of the breakroom incident and staff being counseled, they believe that Staff #2 is being targeted. Per interview conducted with Staff #2, staff denies ever refusing to assist a resident or leaving any resident with their legs hanging off the bed unless they requested it that way. Staff #2 will also asks residents if they want to go back to their room. Per Staff #2, they love all the residents. Per Staff #2, they may not be able to immediately assist a resident because they are assisting someone else at the time but another staff will cover them. Per Interview conducted with Resident #2, they confirm that Staff #2 is sweet and loves to help the resident. Per Resident #2, Staff #2 likes to sing, dance and is happy. Staff #2 has not refused to assist them. Staff #2 bends over backwards to help the residents. Per Resident #2, they have great caregivers here. Based on the information received during today's investigation, there is insufficient evidence to support the allegation that Staff did not provide proper mobility assistance to residents in care, therefore the allegation is unsubstantiated at this time. Exit interview was conducted.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 29-AS-20250624113912

Allegation investigated: . Questionable Death

Licensing Program Analyst (LPA) Christine Yee conducted another subsequent complaint visit to deliver the findings for the above allegation and met with Dion Gallarza, Executive Director. The reason for today’s visit was provided. On 11/6/24 Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint investigation visit for the above allegation. Upon arrival, LPA met with Executive Director (ED), Dion Gallarza and explained the reason for the visit. Entrance interview conducted. During 11/6/24 visit, LPA Arroyo, along with the ED conducted a plant tour at 9:20am, conducted an interview with the ED starting at 9:25am, conducted a resident file review at 9:45am, and obtained copies of pertinent documents relevant to the investigation. It has been determined further investigation is required Unsubstantiated Page 2. prior to issuing findings. No health and safety concerns noted on today’s visit. Exit interview conducted. No citations issued at this time. A copy of the report was issued On 4/24/25, Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to investigate the above allegation and met with Dion Gallarza, Executive Director. The reason for the visit was explained. On today's visit, LPA Yee conducted another interview with the Executive Director at 10:21am, Resident #2 at 11:15am, Staff #1 at 11:36am, Staff #2 at 11:52am, Staff #3 at 12:19pm, Staff #4 at 1:52pm, conducted a tour of the site of the incident at 1:25pm and obtained additional facility documents throughout the visit. Per interviews and documents reviewed during today's visit, it was again determined that additional investigation is needed before the findings of the above allegation can be made. Per the investigation conducted regarding the allegation of questionable death of Resident #1, the following information was revealed. Resident #1 was admitted to the facility on 6/8/2024. Per review of the Physician’s Report dated 5/22/24, Resident #1 was diagnosed with bipolar disorder, anxiety disorder, polymyalgia rheumatica and had mild cognitive impairment. Per interview with Witness #1, Resident #1 was not on any medications for bipolar disorder or depression when they became a client of theirs. Resident #1 had a known history of depression and was previously prescribed lithium, a mood stabilizer for bipolar disorder but it was discontinued when the resident was hospitalized for lithium toxicity. Lithium was not resumed after the hospitalization. Records reviewed also do not indicate any history of suicidal ideations. At the time of admission, Resident #1 was not on any psychiatric medications. The Physician’s report Page 3. also indicates that Resident #1 is not currently depressed. Per interview conducted with Witness #1, Resident #1 was not on any medications for depression or bipolar disorder when Resident #1 became a client of theirs in February 2024. Witness #1 also indicated that they do not treat mental disorders as it is outside their scope of practice. The family was advised to take Resident #1 to see a mental health professional or to return to the doctor who had prescribed the Lithium initially. On 9/13/24, the resident’s family took Resident #1 to their doctor appointment and on that visit the resident was observed to be very restless and was prescribed Escitalopram 5mg to treat their anxiety. Per facility records, the medication was started on 9/17/24. On the afternoon of 9/29/24, Resident #1 was found lying face down on the ground in a pool of blood by Resident #2. Resident #2 was returning to their room from the back of the building. Resident #2 returned to their room and called the front desk for assistance. Staff #1 was sent to assist Resident #2, but it was unclear whether it was Resident #2 that needed help. Per Staff #1, they went to Resident #2s room, also using the back way and found Resident#1, unresponsive and laying face down in a pool of blood. The front desk was contacted to call 911. Staff #4 called 911 and was asked to turn Resident #1 over and perform CPR. Staff #1 assisted Staff #4 with turning the resident over and chest compressions were administered by Staff #4 until the paramedics arrived to take over. The paramedics pronounced the time of death at 1324 hours. Once the paramedics were done, the police cordoned off the resident’s room and the back area as a crime scene to conduct their investigation. Per their investigation, Page 4. Resident #1 was last seen by Staff #1 at 1200 hours on 9/29/24. The police observed that Resident #1 was laying on their back. Per interview conducted with Staff #1, police were informed that Resident #1 was initially found unresponsive, facing down. Per the police investigation, Resident #1 was found on the ground directly below the second-floor landing. Police also found a sandal belonging to the resident by the railing on the second-floor landing. Based on these observations, it was determined that Resident #1 fell from the second floor and determined that the resident committed suicide. There was no suicide note found. The police also contacted the coroner on the day of the incident. Upon arrival at the scene, the coroner took over the investigation from the police. Upon completion of their investigation, Resident #1 was transported to the LA County morgue due to the circumstances of the death. Resident #1 was examined on 9/30/24 and cause of death was noted as multiple blunt force trauma injuries and the manner of death is suicide. Per police interview conducted with the family, they were given the same information that was given to LPA Yee on 11/5/24 by the family member that was interviewed. The family mentioned that Resident #1 had threatened to do harm to themselves. The family member indicated that they had no reason to take these threats seriously as there was no prior history of suicidal attempts. LPA Yee was not specifically told by family member how Resident #1 was going to hurt themselves. When family was told that Resident #1 fell from the second- floor stairwell landing they suspected that Resident #1 had jumped as they threatened to do. The threats made by Resident #1 to hurt themselves to the Page 5. family was never mentioned to facility staff to allow them the opportunity to seek help for the resident or implement precautionary measures to mitigate any harm to the resident. Per interviews conducted with Staff, they all stated that the resident was observed to be happy. Resident #1 was sociable to staff and residents and was beginning to make friends. Staff did not observe the resident to be depressed or showed any change in condition to raise concerns. Based on LPA Yee’s investigation, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Unless the Department obtains new evidence to change the finding of the investigation, the allegation of questionable death is unsubstantiated at this time. No deficiencies were cited on today's visit Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 28, 2025 · control 29-AS-20241105112517

Allegation investigated: . Facility staff did not assist resident with medical transportation needs 2. Facility staff did not treat resident with dignity and respect 3. Facility overcharged resident

Licensing Program Analyst (LPA), Christine Yee, conducted an unannounced subsequent complaint visit to conduct further investigation and to deliver the findings of the above allegations. LPA Yee met with Dion Galarza, Administrator and the reason for today’s visit was provided. On 5/9/23, Licensing Program Analyst (LPA) Christine Yee conducted an initial unannounced complaint visit to investigate the above allegations and met with Katia Arriaga, Business Manager. Per information received, the Administrator was on vacation. The reason for today's visit was explained. During 5/9/23 visit, LPA Yee conducted an interview with Katia Arriaga, Business Manager, at 1:20pm and Javier Rosales, Chef at 2:52pm. A tour of the dining room was conducted at 3:04pm to observe the table set up. Copies of facility documents were provided at 3:15pm. Continued on LIC9099-C Unsubstantiated Based on information received during the 5/9/23 visit it was determined that additional investigation is needed to make a finding for the above allegation. Exit interview was conducted and a copy of the report was provided. Prior to today’s visit, a telephone interview was conducted with the Executive Director at 2:54pm on 10/24/24. On today’s visit, LPA conducted an interview with Staff #3. Per information received through the interviews conducted regarding allegation #1 - Facility staff did not assist resident with medical transportation needs, Resident #1 made transportation arrangements on the morning of the day of the appointment with Staff #3 to be taken to a scheduled dental appointment at 3:30pm on 4/19/23. Resident #1 was specifically told by Staff #3 that they could be dropped off but they could not be picked up after the appointment since staff gets off at 5pm. Resident was okay with being dropped off per information received during staff interviews. Staff offered to make arrangements for the return trip but the resident indicated that they would take Uber/Lyft and charge it back to the facility. The resident was also mad. Staff #3 specifically advised the resident to check with the office regarding reimbursement since alternate transportation is not reimbursable. Staff #3 transported Resident #1 to their appointment and dropped them off around 3:15 or 3:20pm and reminded again that they would not be picked up. The dental visit was completed at around 4:15pm. Resident #1 called the driver for a ride after 5pm and was told that they were already off work and at home. As a result, Resident #1 alleges that the facility staff did not assist resident to make transportation arrangements. Per investigation conducted, there is insufficient evidence to support the allegation that staff did not assist resident with medical transportation needs, therefore the allegation is unsubstantiated at this time Regarding allegation #2 – staff did not treat the resident with dignity and respect, Resident #1 denies that they were told by staff prior to being dropped off at the dentist that a return ride on the facility van would not be available. Per Resident #1, they were not told until they called the facility to be picked up after the dental visit was concluded. Resident alleges that they were left stranded and they had to make their own arrangement for transportation back to the facility. Per Resident #1, if they had been told in advance, they would have made cheaper arrangements. Per Resident #1, they had to use Lyft and paid $18.96. Per staff interviews conducted, Resident#1 was told that they would not be picked up after the dental appointment due to the lateness of the appointment. The driver goes home at 5pm. Per information received from interviews, there is insufficient evidence to support the allegation that staff did not treat the resident with dignity and respect, therefore the allegation is unsubstantiated at this time. Allegation #3 of this complaint alleges that Staff overcharged Resident. Per Resident #1, they wanted to be reimbursed for the Lyft charges incurred for the dental visit on 4/19/23. On the advice of another resident, Resident #1 deducted the Lyft charges from the May 2023 rent without notifying the office of their intention. As a result of the deduction, the rent was not paid in full. The resident was told that the rent was late and Resident #1 would be charged $250.00 for late fees. Per review of Resident #1's signed Admission Agreement the facility states that Residents will be charged $250 if they pay their rent late. Resident #1 did not want to pay the late charges. Per review of facility reports, it confirms that Resident #1 deducted $18.67 from the May 2023 rent and paid back the $18.67 in June 2023. The facility report does not show that the facility charged the resident $250 for late fees. Since the late fees were not assessed, Resident #1 does not have a claim that they were overcharged, therefore the allegation that the staff overcharged the resident is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 29-AS-20230505143457

Allegation investigated: . Staff assaulted a resident in care.

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced subsequent complaint visit to conduct further investigateion and to deliver the findings of the above allegations and met with Dion Galarza, Administrator. The reason for today's visit was explained. During the initial visit conducted on 3/3/23, LPA Yee reviewed and obtained copies of facility records related to the complaint throughout the visit, interviewed the Administrator from 10:00am-10:33am, staff #4 at 10:39am-10:48am. Staff #1 is no longer employed by the facility, Staff #2 and Staff #3 were unable to be interviewed since it was their day off. Per review of the facility records and interviews conducted, further investigation is needed to make a finding for the above allegations. Exit interview was conducted and a copy of the report was provided. On today's visit, LPA Yee collected additional facility documents and attempted to interview Staff #2 but Substantiated was advised that the Staff #2 was on vacation and was unavailable to be interviewed again. Per interview conducted with the Executive Director, regarding allegation #1 - staff assaulted a resident in care, on the night of 5/27/22 he received a call from Staff #2 advising him that they observed Staff #1 grab Resident #1 by the right arm and shoved them to the ground. Resident #1 hit their head and sustain a cut above the left eye. The Executive Director came to the facility. Emergency services were contacted and they came out to assess Resident #1 and rendered first aid. The paramedics determined that Resident #1 did not need to be taken to the hospital. Per information provided, Resident #1's physician was notified of the incident and attempts were made to notify the resident's responsible party. A message to call the Administrator was left on the responsible party's voice mail but no return call was received. Per the Administrator, he did not leave a detailed message of the incident for the responsible party since it was bad news. The police was also contacted and they came out to investigate and left a ticket for the incident. The Executive Director spoke with Staff #1. Per information provided, Resident #1 was in their room and wanted to go out. Staff #1 was trying to re-direct the resident who was arguing with them and next thing Staff #1 remembers is that the resident was on the floor. Staff #1 does not know what happened. Per Staff #1, they were turning the resident around and they fell. Staff #1 was suspended and escorted out of the facility. On 6/2/22, Staff #1 was terminated in person. Staff #1 was determined not to be safe around residents. Management took the appropriate steps to mitigate any further abuse of Resident #1 or any other resident, intentionally or unintentionally by Staff #1, Based on the information received there is sufficient evidence to support the allegation that staff assaulted a resident in care, therefore the allegation is substantiated at this time. Deficiencies were cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Immediate civil penalties of $500 was assessed. Exit interview was conducted, Appeals Rights discussed and a copy was provided. was advised that the Staff #2 was on vacation and was unavailable to be interviewed again. Per information received regarding Allegation #2 - Resident's responsible party was not notified of an incident, the Executive Director and facility staff stated that they made attempts to reach Resident #1's responsible party and left a generic voice mail message to call the facility regarding this incident and their calls were not returned by the responsible party. Per the Executive Director, he does not like to leave bad news on a voice mail and prefers to notify family personally. According to information received, the responsible party does a lot of traveling and is not always available or is out of town for business and is very difficult to get a hold of. However, the responsible party denies receiving any calls regarding this incident. Based on the information received, there is insufficient evidence to support the allegation that the resident's responsible party was not notified of an incident, therefore the allegation is unsubstantiated. Exit interview was conducted and copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 29-AS-20230228172613

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Oct 31, 2024

Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by- Resident #1 was shoved by their caregiver which caused the resident to sustain a cut over the left eye. Immediate civil penalties were assessedthe state’s words, verbatim · CDSS document, Oct 30, 2024

Plan of correction: Licensee will provide an action plan to ensure that staff will not abuse or get physical with the residents when they have a behavior or are difficult by10/31/24. Licensee will also ensure that staff are provided with regular personal rights training by November 6, 2024

Allegation investigated: . Staff did not safeguard resident's personal belongings.

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Dion Gallarza, Executive Director. The reason for today's visit was explained. On today's visit, LPA Yee conducted an interview with the Executive Director at 10:44am, Resident #2 at 11:18am and Resident #3 at 12:29pm. Prior to today's visit, LPA Yee interviewed Resident #1 via telephone on 10/28/24 at 1:30pm. The Department received a complaint on 10/24/24 alleging that Staff did not safeguard residents' personal belongings. Per interviews conducted, Resdient #2 took Resident #1's black gel pillow that was left in the dining room. Per interviews conducted, upon inquiry of the residents present in the dining room, Resident #3 advised Resident #1 that Resident #2 was seen with the missing pillow next to them. Resident #2 was Continued on LIC9099-c Unsubstantiated asked by Resident #1 about the pillow and Resident #2 admitted seeing the pillow. Per Resident #2, who has mild cognitive impairment and has memory lapses, they admitted seeing the pillow and must have picked up the pillow because they believed it was theirs. Per Resident #2, stealing is not in their character, Resident #2 told Resident #1 that the pillow was in their room. When they went to Resident #2's room, the pillow was not in the room. Resident #2 stated that maybe they left their room door unlocked and someone came in and took it. Per Resident #1, the Executive Director was told about the missing pillow and they were advised that he would look into it. Resident #1 did not hear back from the Executive Director and so Resident #1 contacted the Department to see if someone would speak with Resident #2 so they would return their pillow. Per Resident #1, they did not say that staff did not safeguard their pillow. Per interview with the Executive Director, Resident #1 approached him on 10/25/24 regarding the lost pillow. Per the Executive Director, they searched Resident #2's room and the pillow was no where to be found. Resident #2 has no idea what happened to the pillow due to the memory lapses. Per the Executive Director, he is constantly reminding the residents not to leave their personal belongings in the dining room or in the common areas. Staff aren't able to keep an eye on their belongings all the time and they need to remember to pick up their personal belongings. Per the Administrator, they will continue to look for the lost pillow. Based on the information received on today's visit, there is insufficient evidence to support the allegation that the staff did not safeguard the resident's personal belongings, therefore the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 29-AS-20241024130944

Allegation investigated: Unlawful eviction

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced initial 10-day complaint visit to investigate the above allegation. Upon arrival at 12:30pm LPA Mosley was greeted by front desk staff who called the Executive Director to inform them of the visit. The LPA met with The Executive Director (ED), Dion Gallarza and explained the reason for the visit. On 10/18/2024, the Department received a complaint regarding the following allegation, Unlawful eviction. LPA toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations. Report Continued on LIC9099C... Unsubstantiated Report Continued from LIC9099... On the allegation, unlawful eviction, it is the concern of the Reporting Party (RP) that facility issued an unlawful eviction to Resident #1 (R1). To investigate this complaint, LPA conducted in person interviews with the Administrator and R1 between 12:45 pm – 1:30 pm. LPA also obtained pertinent documents to the investigation and reviewed facility records. Interviews with R1 revealed that they were involved in an online scheme depleting all financial funds in June of 2024, which has been reporting to local law enforcement. R1 has contacted other agencies to try and obtain funds but has been unsuccessful. R1 states that their Social Security benefits have been temporarily suspended while the investigation is ongoing leaving R1 unable to pay rent. R1 stated they have not made payments to the facility since June 2024 and have not attempted to arrange a payment plan with the facility. Interview with the Executive Director (ED) confirm the statements. Interviews with the ED revealed that the facility has tried to work with R1 in assisting R1 with payment arrangements but R1 has not complied with any arrangements discussed. The facility has made multiple attempts to assist R1 including but not limited to accompanying at the Social Security office but all attempts for assistance have been denied by R1. Records reviewed and obtained revealed that the R1 has not made payments since June 2024 with a total balance of $12,624 as to date. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of unlawful eviction is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 23, 2024 · control 29-AS-20241018133624

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Erica Mosley and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at 9:00 a.m. Upon arrival LPAs were greeted by the front desk receptionist and explained the reason for the visit. Marketing Director Jonathan McFall arrived at approx. 9:40 a.m. and The Executive Director (ED) Dion Gallarza arrived during the inspection. LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: At approx 9:47 am, the LPA's began the physical plant tour, the furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. The fire extinguishers were fully charged and were last serviced 09/03/2024. The LPAs observed required postings throughout the common space. The LPAs observed the stairwells and they each had an emergency evacuation chair. Activity Rooms were observed and clean at the time of visit. Fireplaces were observed adequately screened. The LPA’s observed an adequate supply of emergency food and water. The last fire inspection was completed on 10/30/2023 and was found to be in compliance with Fire Code Regulations at the time of inspection. Emergency disaster drills conducted quarterly as per regulation; the last one conducted on 08/12/2024. The LPAs inspected the kitchen/food service area at 9:52 a.m. Knives are stored and inaccessible to residents. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates. Continue on LIC809-C CONTINUE FROM LIC 809 From approx. 10:01 a.m. to 10:45 a.m. The LPAs observed seven (7) randomly selected resident bedrooms, of which two (2) were in memory care and five (5) in assisted living which were furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The LPAs observed a sufficient supply of towels and linens. The resident restrooms appeared clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared in the private rooms. The hot water measured between 107.9 – 119.6 degrees Fahrenheit all within the required range. LPA’s reviewed Resident Records at approx. 10:40 a.m. Ten (10) personnel files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Ten (10) resident files were reviewed for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. Daily vehicle inspection list and California Highway Patrol Inspection report was reviewed for facility vehicles. All records were in order. During record review it was revealed that facility is approved for four (4) hospice residents however, the facility currently has five (5) residents on hospice. ED stated that their plan is to submit a hospice waiver increase. Infection Control / Emergency disaster planning: During today’s visit the LPA’S reviewed the facility’s infection control practices and the facilities emergency disaster plan. The facilities policies and procedures as it pertains to infection control are adequate. CONTINUED FROM LIC 809-C LPA’s conducted a medication review on four (4) randomly selected residents at approx. 02:00 pm, The medications are centrally stored in the medication room located in the memory care unit. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. At approx. 2:24 pm medication review revealed that three (3) out of four (4) PRN medications for Resident #1 (R1) have been administered however a record of each dose has not been document on the resident’s record. Additionally at approximately 3:05 pm medication review reveal that Resident #2 (R2) medication ROSUVASTATIN 20 mg, 1 tablet per day, quantity 79, was started on 07/7/2024, has six (6) tablets left in the bottle. However there is no record of refusal which indicated there are four (4) extra pills. LPAs conducted interviews during the visit. LPAs obtained the following documents - Census, Staff schedule, and updated Limited Liability insurance. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of the report provided.the state’s words, verbatim · CDSS document, Sep 21, 2024

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: . Facility staff failed to provide timely access to resident's records

LIcensing Program Analyst (LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Katia Arriaga, Business Manager. Dion Gallarza was off today. The reason for today's visit was explained. During today's visit, LPA Yee interviewed the Business Manager at 9:40am, the Administrator via telephone at 10:25am and Adam Khalifa, CEO at 10:56am regarding the request for documents for Resident #1. Per complaint received, a formal request to provide a copy of Resident #1's records were faxed over to the facility on 10/6/23 by the legal representatives of Resident #1. Also included with the request were supporting authorization documents: a Declaration of Successor in Interest, a Authorization for Release of Medical Information signed by the next of kin and a copy of Resident #1'a death certificate was faxed over Substantiated to the facility on 10/6/23. Attached to the complaint received, was a fax confirmation that the 8 page fax was successfully sent to the facility at 1:24pm with a connection time of 8.22 minutes. Per complainant, as of the filing date of this complaint, the legal representatives of Resident #1 have not been provided with the requested documents or have not been contacted by the facility to make arrangements to allow for the copying of the requested documents within the required time frame that is not to exceed 2 business days. Per interviews conducted, with Katia Arriaga, Business Manager, the facility received a four page fax from the legal firm hired by the family to represent Resident #1 on 10/6/23. The four pages consisted of the fax cover, a blank page, a one page Declaration that the son was the beneficiary to Resident #1's estate and a copy of an illegible death certificate. The fax did not include a copy of the letter requesting Resident #1's file. The fax was given to the Administrator. Per review of the fax received, the fax cover indicates that the fax consisted of a 8 pages, which includes the fax cover. There is also a note on the fax cover that advises the recipient that if you do not receive the number of pages stated above or if re-transmission is necessary, to please contact the firm at the telephone numbers provided on the letterhead. No telephone call was made to obtain the missing pages not received on 10/6/23. Per the Administrator, contact with the legal representatives was not made until 10/12/23 to request a legible copy of the death certificate and he was advised that the death certificate would still be dark and illegible. The documents were requested to be emailed and was not received until 10/13/23. The documents were then forwarded to the corporate office for handling by the facility's attorney since the documents were related to a pending lawsuit against the facility. Per interview with the facility CEO, the request was not received until 10/13/23 and they are in the process of providing the documents. They did not refuse to provide the documents. LPA Yee and Katia advised the CEO that the request was originally faxed over on 10/6/23 and they had 2 days to make Resident #1's file available for copying. As of this visit, Resident #1's file has not been provided or made available to the legal representatives. Based on the information received from interviews conducted on today's visit, the above allegation is substantiated. Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8 Exit interview was conducted with Katia Arriaga, Appeals Rights discussed and a copy was given.the state’s words, verbatim · CDSS document, Oct 16, 2023 · control 29-AS-20231011072146

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Oct 23, 2023

Additional Personal Rights of Residents in Privately Operated Facilities: In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (19)To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. Facility failed to provide timely access to Resident #1's filesthe state’s words, verbatim · CDSS document, Oct 16, 2023

Plan of correction: The Licensee will immediately contact the contact person noted on the request at the law firm to schedule a time when they may have access to Resident #1's file for copying. Licensee will provide a signed statement to Licensing stating the arrangements that have been made and agreed to by the facility and the legal representative to allow access to Resident #1's files by no later than POC date - 10/23/23,

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced subsequent required Annual Inspection to continue the annual inspection that was initiated on 9/27/23. The complete CARE Inspection Tool was used and the visit was conducted with Dion Gallarza, Administrator. The reason for the return visit was explained. On today's visit the following domains were reviewed: Personnel Records Training, Resident Rec-Incident Reports, Resident Rights Information, Planned Activities, Food Service, Incidental M &D, Disaster Preparedness and Residents with SHN. Due to time constraints, LPA Yee was not able to review the Physical Plant and Environmental Safety Domain. A return visit will have to be conducted to complete the last domain. Facility files, training records, 10 resident files and the Emergency Disaster Plan were also reviewed during today's visit. Per review of the information requested for in each domain reviewed, there were no deficiencies observed. On today's visit, LPA Yee also delivered the Immediate Civil Penalties that were assessed for the deficiency cited as a result of the substantiated findings for complaint #29-AS-20220601142537 on 4/7/23. No deficiencies were cited on today's visit. Exit interview was conducted and a copy of this report was providedthe state’s words, verbatim · CDSS document, Sep 28, 2023