The Village at Sydney Creek

Type of visit: Required - 1 Year

At 08:45am, on 07/16/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator Audie Sherberg, announced who he was and the reason for the visit. Administrator, Administrator in Training, Maintenance Technician, and LPA conducted a full tour of the facility. This is a single story facility. Upon entering the main entry there is a lobby accessible to the public and from the main lobby there is key coded approved egress door access to three units (neighborhoods). Neighborhood 1 and 2 connect via doors and a garden area. There is a life enrichment room in the middle of neighborhoods 1 & 2 used for activities, that is also licensed by Community Care Licensing (CCL) as an adult day program (ADP). Neighborhood 3 has its own entry point and patio space. There are a total of 44 resident bedrooms that can be designated single or dual occupancy, but never allow the facility to exceed a census of 84. Each resident bedroom has a private bathroom, there are also public bathrooms located in each neighborhood. Each neighborhood has a common space, dining area, kitchen for serving meals, and laundry space for urgent laundry needs. LPA noted the garden areas in each neighborhood have seating and shade, and are accessible freely to residents and visitors. Doors leading to the outdoor spaces in each neighborhood have approved egress devices that are activated in the evening for added resident safety and deactivated during the day for free access. The lobby contains seating and a self contained fireplace. LPA noted a carbon monoxide detector located next to the fireplace that is working. The west side of the lobby leads to a concierge desk, administrative offices, public restrooms and a snack bar. There are also two conference rooms. (Continued on LIC809-C) The hallway leading away from the lobby toward neighborhood 3 gives access to the main kitchen where all meals are prepared and delivered to the neighborhoods, the medication room, a salon, a wellness center, the main laundry room, staff break room and two additional public bathrooms. Residents do not have access to these areas independently. LPA noted that the facility has no obstructions in hallways, doorways or exits. The facility has wired smoke detectors in each resident room and hallway leading to resident rooms that were tested by Alpha Fire and Alarm on 2/20/2026 and the sprinkler system was tested on the same day by the same company. LPA observed fire extinguishers throughout the facility in the green compression range, scheduled to be serviced tomorrow, 7/17/2026. LPA noted an emergency chair in neighborhood 3 should the facility need to evacuate down stairs located through this neighborhood's courtyard that lead to a side street. LPA tested facility hot water at various resident faucets throughout the facility ranging from 102.9 - 115°F. LPA noted the facility takes daily temperature checks of the hot water at various rooms and is continuing to work with outside companies to correct the hot water temperature, LPA provided ongoing technical assistance for the water temperature issue. While touring the main kitchen LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. The main kitchen faucets are not accessible to residents and deliver hot water above 125°F and are clearly marked. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records. LPA conducted a staff and resident file review. LPA and Administrator conducted a review of the annual care tool modules. There were no deficiencies cited at this time. Exit interview conducted, report signed, and report provided to the Administrator.the state’s words, verbatim · CDSS document, Jul 16, 2026

The state marks this report as 9 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Licensee does not ensure that facility faucets used by residents deliver hot water.

At 9:30am, on 5/27/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to investigate the allegation of this complaint and deliver final findings. LPA met with Administrator Audie Sherberg, announced who he was and the reason for the visit. On the allegation, licensee does not ensure that facility faucets deliver hot water; it was alleged that the facility hot water has been out for about three days and this is not the first time the facility has been without hot water. It was also alleged that due to the lack of hot water residents have not received showers and the dishware is not being cleaned properly. (Continued on LIC9099-C) Substantiated Staff interviews revealed that on 5/11/2026 the Administrator notified the Maintenance Director of the hot water issue, the Maintenance Director called the boiler company they use and scheduled them at their earliest availability for 5/14/2026. On 5/14/2026, the boiler company arrived at the facility, conducted maintenance and replaced some parts including a tempering valve that mixes hot and cold water to ensure water delivered to the faucets for resident use does not exceed 120°F. Interviews revealed that the tempering valve was believed to be the issue as it was corroded and could not be adjusted. The boiler company replaced the tempering valve and checked the temperature at various resident bathroom faucets in all three neighborhoods, observing the temperature ranging between 109 – 111°F at these tested faucets. California Title 22 regulation, for residential care facilities for the elderly, requires hot water delivered to faucets used by residents to be no less than 105°F and no more than 120°F. On 5/21/2026 the Vice President of Operations reported to the Maintenance Director that there was an issue again with the water delivered to the resident used faucets not being hot enough. The Maintenance Director contacted the boiler company and was instructed on a temporary fix. The boiler company placed an order for another tempering valve, stating the replacement installed on 5/14/2026 may be faulty. After applying the temporary fix the Maintenance Director tested hot water temperatures observing them to range between 109 – 114°F at various resident bathroom faucets in all three neighborhoods. During today’s visit LPA, Administrator, and Administrator in Training toured the facility. LPA measured the hot water temperature in all three neighborhoods at resident bathroom faucets in rooms closest and furthest from the boiler room. Resident room 114 at 9:52am reached 100.6°F, resident room 111 at 9:52am reached 92.3°F, resident room 101 at 10:14am to reach 111.2°F; room #108 at 10:25am reached 95.2°F, after running the water for five minutes 97.7°F, and at ten minutes 102.7°F. Room 205 at 11:05am reached 87.8°F at the sink and 88.7°F at the shower; room 202 at 11:15am reached 106.2°F at the sink and shower; room 206 at 11:31am reached 110.8°F at the sink; room 215 at 11:37am at 82.0°F, after running for six minutes 105.0°F at the sink and shower and did not surpass 105.0°F at the shower. Room 314 at 12:04am reached 106.3°F and room 309 at 12:19am after running for ten minutes reached 102.0°F. LPA also measured additional hot water temperatures in various resident rooms throughout the three neighborhoods finding them measuring inconsistently between 87.8 to 111.2°F. After taking all the above readings LPA returned to resident room 111 at 12:28pm to retest the water at the bathroom faucet and recorded it reaching 99.5°F. (Continued on LIC9099-C) Staff stated that the hot water issue has been ongoing for approximately two – three weeks. Recently a solution has been implemented that when med-techs are notified by care staff that the water is not getting hot enough for showers, the med-techs then turn the hot water on in resident rooms at the end of each hallway, and after running the water for approximately 10-15 minutes it gets warm enough for showers. They state this is just a temporary solution and does not work for all showers. Staff also stated they can provide bed baths to residents but were not guided on where to access water warm enough to provide the bed baths. The Maintenance Director stated that on 5/24/2026 a plumbing company was called out due to a shower valve that could not be shut off, while the plumber was there another shower valve with a similar issue was reported by staff. The plumber stated that the issue with both the shower valves in resident rooms were not functioning properly and were mixing cold water back into the hot water line adding to the primary hot water issue. Some of the shower valves have been replaced but as of today’s visit not all the shower valves have been tested ensuring they work properly. Additionally, the Administrator and Maintenance Director stated the boiler company returned yesterday 5/26/2026 to make temporary adjustments to the hot water system until a replacement tempering valve arrives which is on back order and may take four to six weeks to arrive. A similar complaint was received in June 2025. Although the facility shows it is taking measures to fix the issue at the time of the complaints, there is evidence that shows it is recurring and impacts resident care. As of today’s visit, the hot water system is still not delivering consistent hot water within regulation temperatures to all resident rooms. Regarding the water delivered to the kitchen and dishware sanitization, the water delivered to the faucets in the main kitchen, located outside the resident neighborhoods, bypasses the tempering valve allowing for water delivery hotter than 120°F. The faucets in the kitchen are labeled, as required by regulation, indicating they deliver hotter water. Per California Title 22 regulation, for residential care facilities for the elderly, the facility must ensure disinfection of dishes and utensils by one of two means; either by maintaining hot water at a minimum temperature of 170°F at the final rinse cycle of diswashing machines, or by an alternative comparable method such as the addition of a sanitation agent to the final rinse water. This facility uses a sanitizing agent called Aqua Pure, containing sodium hypochlorite, during the sanitization process of washing dishes and utensils. (Continued on LIC9099-C) Based on observation, all interviews conducted, and documents obtained, at this time the above allegation was found to be substantiated, there is a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted, deficiencies cited on LIC809-D page, report signed, appeal rights and report provided to the Licensee.the state’s words, verbatim · CDSS document, May 27, 2026 · control 29-AS-20260522111709

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 24, 2026

Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on observation, interview and record review, the licensee did not ensure the facility boiler system and shower valves are in good repair and delivering consistent hot water to resident faucets which poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 27, 2026

Plan of correction: Administrator states they will create a written plan adressing further planned fixes to the hot water system, how residents will recieve care including showers/bathing, and ongoing communication and email plan to LPA by 5/28/2026 and the facility will fix the hot water system by 6/24/2026.

Allegation investigated: Resident ingested a hazardous substance while in care due to staff neglect.

At 9:30am, on 5/27/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to further investigate the allegation of this complaint and deliver final findings. LPA met with Administrator Audie Sherberg, announced who he was and the reason for the visit. During a visit conducted on 5/6/2026 LPA conducted interviews, collected relevant documentation and toured the interior and exterior of the facility. On the allegation, resident ingested a hazardous substance while in care due to staff neglect; it was alleged that Resident #1 (R1) ingested rat poison while in care at the facility. (Continued on LIC9099-C) Unsubstantiated An incident report submitted by the facility to Community Care Licensing (CCL) on 5/4/2026 states that on 5/3/2026 at approximately 6:00pm staff observed R1 walking in the garden area with a rodent bait station in hand. The bait station was open and contained rodent control bait pellet packets. R1 had removed the packets and they appeared torn and wet. Staff washed R1’s hands, Poison Control was contacted by staff, and they advised staff to send R1 to the hospital for evaluation. The pellet packaging indicated the pellets were bromethalin. R1 was observed at the hospital, treated for possible ingestion of bromethalin, and returned to the facility the next morning. The report also states that on 5/4/2026 the Administrator had the maintenance department remove all remaining bait stations in the courtyards accessible to residents and that the pest control company would visit the community to inventory and double check that all bait stations were removed. Staff interviews confirmed the events that happened on 5/3/2026 according to the incident report and they are not sure if R1 ingested the bromethalin but did notice at least one of the packets appeared torn open, not like a rodent would chew it open but torn open, and the packet appeared wet at the tear. Staff stated emergency responders took the packets with them. Interviews and hospital discharge documents stated that there is no widely available test to determine if there is bromethalin in a human’s system and it was not determined if R1 had ingested bromethalin. Hospital discharge documents also state R1 was treated with oral medication as a precaution. Additionally, staff stated that when they notified the Administrator about the incident they were instructed to activate the approved egress devices on all doors leading to the courtyards to keep residents from accessing any additional bait stations in the courtyard without staff being alerted. Staff state that the egress devices are usually deactivated to allow residents to wander the courtyard freely since there are additional egress devices on the perimeter gate of the courtyard, and staff are expected to conduct regular checks every 30 minutes on the residents in the courtyard. R1 was found during one of the 30-minute checks, but staff state that the checks sometimes are not conducted on time with up to an hour passing between checks. Interviews revealed that R1 enjoys gardening and spends a lot of time in the facility courtyard; it can be difficult to redirect R1 from the gardening tasks they are doing in the courtyard; and R1 sometimes gets frustrated when they do try. Staff stated in the past R1 has removed the in-ground utility box covers in the courtyard that give access to electronic irrigation valves. (Continued on LIC9099-C) Interviews also revealed that three days prior to the incident on 5/3/2026, on 4/30/2026, R1 was found by staff sitting on a bench in the courtyard with an open faux rock bait station and approximately ten packets of bait laid neatly out on a rag on the bench next to R1. These packets did not appear to be open. Staff brought R1 into the dining/living room area of neighborhood two and notified a medication technician (med-tech). The med-tech observed R1 and had R1 wash their hands. The med-tech told staff to monitor R1 for any changes in condition, they removed the pellet packets from the station and disposed of them. The med-tech instructed the staff to return the empty bait station back to it’s place in the courtyard and as the staff was headed outside the facility nurse came into the dining/living room area. It was communicated to the nurse that R1 had the bait station but no one ever mentioned to the nurse that R1 had opened the station and had access to the bromethalin pellet packets. Interviews also revealed that this incident on 4/30/2026 was not communicated to the Administrator until the incident on 5/3/2026. Review of R1’s medical assessment (LIC602A) dated 7/29/2025 states the safety of R1 and other residents is at risk if R1 is given access to personal care and hygiene items, but R1 and other residents are not at risk if R1 is given access to poisonous substances. R1 opening the bait stations posed a risk to not only themselves but also other residents. R1’s preadmission appraisal dated 8/23/2025 and service plan dated 9/9/2025 do not mention any risks or non-risks to R1 regarding poisonous substances. The Administrator stated that they were hired in June of 2025 and approximately seven months prior to the incident on 5/3/2026, they became aware of rodent bait boxes throughout the outside of the facility including in the courtyards accessible to residents through each neighborhood. At that time they were black boxes without a key lock that the Administrator felt were easy to break open, they had the pest control company switch the black boxes out for the bait stations that R1 had during both incidents. These rodent bait stations are shaped to look like a light grey rock and are opened with a key mechanism. The exterior of the faux rock bait stations state “Caution! Bromethalin 0.01%.” The Administrator states the pest control company says these stations are child and pet resistant. It is still undetermined how R1 opened the locked bait station. A pest control service invoice dated 5/4/2026 states eight external bait stations (EBSs) were collected from the facility that had been in the neighborhood courtyards and four remain on the front of the property. The front of the property is inaccessible to residents in the neighborhoods. (Continued on LIC9099-C) Based on all interviews conducted and documents obtained, the allegation above could not be proven, that the resident ingested the hazardous substance. Therefore, at this time the allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. During today’s visit LPA conducted a case management visit addressing a continued concern of hazardous/poisonous substances accessible to residents in care and addressing the need for staff to better communicate during incidents like the one that occurred on 4/30/2026. Technical Assistance is also issued for Observation of the Resident. Exit interview conducted, report signed, and report provided to the Administrator.the state’s words, verbatim · CDSS document, May 27, 2026 · control 29-AS-20260504152017

Type of visit: Case Management - Other

At 9:30am, on 5/27/2026, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct a case management-other visit to the facility. LPA met with Administrator Audie Sherberg, announced who he was and the reason for the visit. During today's visit LPA, Administrator, and Administrator in Training conducted a tour of the facility checking the overall safety and wellbeing of the residents in care. During today’s visit LPA also delivered final findings to complaint control number 29-AS-20260504152017. The complaint included incident’s that occurred on 4/30/2026 and 5/3/2026 where Resident #1 (R1) accessed rodent poison from rodent bait stations located in the courtyard accessible to residents in care. On 4/3/2025, the staff who found R1 with the bait station open and touching the packets communicated the issue to the med-tech, who only advised R1 to wash their hands and be monitored. Shortly after, the med-tech and staff crossed paths with the facility nurse and communicated R1 had the bait station rock but did not communicate it was open or R1 had access to the packets. Additionally, none of this information was communicated to the Administrator until the second incident on 5/3/2026. Facility staff did not appropriately communicate important updates about R1 to facility management, who would have taken different actions had they been notified. R1 opening the bait stations posed a risk to not only themselves but also other residents. (Continued on LIC809-C) During the investigation LPA noted an incident documented in R1’s Notes/Incidents dated 2/13/2026 that states a med-tech was passing medications and they placed R1’s hearing aids on the dining room table next to R1. The med-tech briefly turned away to assist another resident. Upon turning back to R1 they noticed that one hearing aid was missing and R1 had the other hearing aid in one hand and a cup of water in the other. The med-tech could not find the hearing aid and staff felt R1 may have ingested it. Staff notified R1’s primary care physician (PCP) at the time of the incident, the PCP instructed staff on what to observe, and the PCP visited the resident later the same day. Additionally, on 5/8/2026 the facility self-reported to Community Care Licensing (CCL) an incident that occurred on 5/7/2026 that staff observed Resident #2 (R2) exit another residents room when R2 complained to staff that they had a burning sensation in their mouth. Staff observed the corners of R2’s mouth to be red and a small amount of blood on their tongue. Staff assisted R2 to rinse out their mouth and when staff went to the room R2 was observed leaving they found an unattended hygiene cart. On the cart accessible to residents was Aveeno daily moisturizing lotion and Symmetry foaming hand sanitizer, Aveeno body wash, no-rinse hair & skin cleaning spray, Lubriderm lotion, and toothpaste. Staff called 911 and Poison Control. Emergency responders and Poison Control indicated R2 did not need to be seen at the hospital but instructed staff to monitor R2 for changes in condition and to call 911 should R2 experience changes in condition. This unattended hygiene cart was accessible to all residents in neighborhood #1 posing a threat. During the tour conducted on todays visit LPA observed and photographed in unlocked cabinets in the kitchen area of neighborhoods #2 and #3 unlocked first aid kits with aspirin, ibuprofen, and other medications accessible to residents in care. Additionally in neighborhood #3 in a plastic three drawer bin on the kitchen counter two pairs of office scissors, antiperspirant spray, and spray body cleaner. During the facilities annual inspection conducted on 6/18/2025 a citation was issued for hazardous and poisonous items being accessible to residents in care. Although interviews revealed some efforts have been made to make hazardous and poisonous substances inaccessible to residents in care, there is a continued pattern of inadequate supervision and failure to consistently implement effective safeguards. (Continued on LIC809-C) Exit interview, deficiency cited on LIC809-D page, a civil penalty of $250 for a repeat violation within twelve months is being assessed on the attached LIC421FC, report signed, report and appeal rights provided to the Administrator.the state’s words, verbatim · CDSS document, May 27, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Jun 12, 2026

(a)...the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances,... and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: Based on interview and record review, the licensee did not ensure hazardous and poisonous items were inaccessible to residents which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 27, 2026

Plan of correction: During today's visit staff removed hazardous items found during tour, the administrator purchased locking hygiene carts after the incident with R2, the bait stations were previously removed. Additionally Administrator states a maintenance director was hired 5/25/2026... who will conduct regular checks of the facility. The Administrator will also conduct staff training at their next all staff meeting scheduled for 6/10/2026 and will email LPA training documents and signed staff roster on or before 6/12/2026.

Allegation investigated: Licensee does not ensure that facility faucets used by residents for personal care deliver hot water. Staff do not ensure that resident's needs are met. Staff do not ensure that the facility is sanitized.

On 6/19/2025 at 09:43am Licensing Program Analyst (LPA) Haner-Tomasko arrived unannounced at the facility to further investigate the allegations to this complaint. LPA met with Administrator Liza Hix and explained the purpose of the visit. During the visit, from 1:30pm to 3:40pm LPA interviewed staff, clients, administrator, Vice President of Operations, and obtained relevant documents. On the allegation: Licensee does not ensure that facility faucets used by residents for personal care deliver hot water. It was alleged that off and on for several years the facility has had a problem with the faucets delivering hot water and now it is happening more frequently, resulting in residents needing to take cold showers. LPA noted the facility has a boiler room off the main kitchen. (Continued on LIC9099-C) Unsubstantiated There are two boilers that supply a large hot water tank and from there the hot water is delivered to the kitchen and through mixers to all other areas of the facility. LPA interviews revealed on 5/1/2025 a plumber repaired a leak in one of the boilers, there was not a hot water issue at this time, the plumber recommended the boiler be replaced but they do not work on boilers. Vice President of Operations Lisa Hulse contacted Wick Boiler Service, Inc to schedule a maintenance visit on 6/2/2025 and they recommended rebuilding the boilers at that visit. On 6/16/2025 Administrator Liza Hix was notified by staff there was no hot water at around 8:00am, she contacted Wick Boilers via text message at 8:21am and they arrived at the facility the same day at around 11:00am. LPA observed during the previous visit to the facility for this complaint on 6/18/2025 a boiler company was working on the boilers. LPA interviews with staff revealed there have been a couple of occasions over the last year or two where the water was not hot enough to shower residents, the issue was resolved within a couple of hours, and staff were instructed to schedule the showers later in their shift. LPA interviews revealed the showers were completed by staff and residents have not had to take cold showers. As of 6/19/2025 the boilers have been fixed and the facility is working to ensure the hot water temperature is within regulation. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. On the allegation: Staff do not ensure that resident's needs are met. It was alleged that the facility is understaffed, resulting in residents not receiving incontinence care regularly and residents who go out to the secured patio are alone and fall frequently. LPA interviews with staff revealed 6 of 7 staff feel the facility is staffed to meet the residents needs, there are occasional call offs, and the facility covers the staff call offs. LPA interviews also revealed the staff are not aware of any incontinence issues not being met and they are expected to check the incontinent residents ever 1-2 hours or more often for residents who need. LPA interviews revealed that staff are expected to check the secured patio every 30 minutes – 1 hour and the majority of staff interviewed believe this is being done. LPA noted during file review that three residents have fallen in the secure patio area in the last three months, the facility called 911 and submitted incident reports to Licensing. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. On the allegation: Staff do not ensure that the facility is sanitized. It was alleged that due to the faucets not delivering hot water the kitchen could not be sanitized. LPA interviews with kitchen staff revealed the kitchen wash all kitchen utensils and dishware in a dish sanitizer that utilizes a disinfectant agent and when the sanitizer is not functioning, they have a backup sink with three basins and sanitizing chemical to perform the “three sink sanitization method.” LPA interviews showed that during this week’s hot water issues the kitchen staff were able to follow sanitizing protocols or wait for the hot water supply to be restored between maintenance. LPA observed the kitchen to be clean, organized and free of debris. Based on all interviews conducted and documents obtained, at this time the above allegation was found to be unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted, no citation was given at this time and report was provided.the state’s words, verbatim · CDSS document, Jun 19, 2025 · control 29-AS-20250616114812

Type of visit: Case Management - Annual Continuation

At 09:43am, on 06/19/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to continue the annual facility inspection started on 6/18/2025. LPA met with Administrator Liza Hix, announced who he was and the reason for the visit. LPA conducted staff and resident file reviews. During file review of Resident #1 (R1) LPA noted resident sustained three falls in 2024 and three falls in 2025 with no reappraisal completed reflecting care needs and fall mitigation measures. LPA noted a reappraisal was completed for R1 on 6/18/2025 when LPA started the resident file reviews. A resident assessment was completed for R1 on 12/30/2024 indicates the residents mobility as independent with no reference to fall risk. LPA asked Vice President of Operations Lisa Hulse and Staff #1 (S1) if a reappraisal has been completed reflecting the residents fall risk and change of condition, both stated "no there is not." During file review LPA noted Resident #2 (R2) receiving home health care for a wound on their right calf. In a fax to the physician from facility staff dated 5/9/2025 staff stated "Wound on right calf looks infected." LPA noted a reappraisal completed for R2 on 12/20/2024. When LPA asked Lisa Hulse and S1 if there is a reappraisal reflecting R2's change in condition regarding the wound and Home Health intervention they stated "no there is not." LPA and Administrator conducted a review of the annual care tool. Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC809-D). Exit interview conducted, appeal rights and a copy of this report issued.the state’s words, verbatim · CDSS document, Jun 19, 2025

Type of visit: Required - 1 Year

At 08:35am, on 06/18/2025, Licensing Program Analyst (LPA) Haner-Tomasko arrived at the facility unannounced to conduct the annual facility inspection. LPA met with Administrator Liza Hix, announced who he was and the reason for the visit. Administrator and LPA conducted a full tour of the facility. This facility has a main entry with lobby accessible to the public and from the main lobby there is locked access to three units (neighborhoods). Neighborhood 1 and 2 connect via doors and garden area and neighborhood 3 has its own entry point and patio space. There are a total of 44 resident bedrooms that can be designated single or dual occupancy, but never allow the facility to exceed a census of 84. Each resident bedroom has a private bathroom and there are public bathrooms located in each neighborhood and the main lobby. Each neighborhood has a common space, dining area, kitchen for serving meals, and laundry space for urgent laundry needs. LPA noted the garden areas in each neighborhood have seating and shade, and are accessible freely to residents and visitors. While touring the facility with the Administrator, the LPA noted multiple hazardous items not locked up, accessible to residents, and unattended. At 10:52am while touring the kitchen in neighborhood 2 LPA observed and photographed an aerosol can of Spray Scents deodorizer in the non-lockable cabinet to the right of the refrigerator, accessible to residents in care. At 10:56am, also in neighborhood 2's kitchen LPA observed and photographed 7 bottles of nail polish, a bottle of nail polish remover and an aerosol can of nail dryer in a kitchen cabinet under the bar counter that was missing the lock pieces giving access to residents. (Continued on LIC809-C) At 11:19am while touring neighborhood 3's kitchen, LPA observed and photographed an aerosol can of Zep Freshen Disinfectant Spray in a non-locking cabinet between the refrigerator and oven accessible to residents in care. At 11:27am LPA observed and photographed a spray bottle of glass cleaner on the bathroom counter in bedroom 309, accessible to residents in care. Off the main lobby and inaccessible to unattended residents are offices, conference rooms, access to the licensed adult day program, the main kitchen that prepares and delivers all meals to each neighborhood for serving, the medication room, a salon, wellness room, four public restrooms and a staff room. LPA observed at least 2-days of perishable and at least 7-days of nonperishable foods. The facility has wired smoke detectors inspected on 8/21/2024 by Alpha Fire & Security Alarm. There is a carbon monoxide detector located in each neighborhood and main lobby. LPA observed fire extinguishers throughout the facility, tagged current and in the green compression range, serviced on 06/28/2024. LPA noted the facility boilers for hot water delivery to all facility faucets were being repaired at the time of the visit. LPA conducted a sample medication audit and reviewed the facilities Centrally Stored Medication Records, finding no violations. LPA was not able to complete the annual inspection and may return at a later time to finish. Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC809-D). Exit interview conducted, appeal rights and a copy of this report issued.the state’s words, verbatim · CDSS document, Jun 18, 2025

Allegation investigated: Staff are not following infection control protocol

Licensing Program Analyst (LPA) Rankin conducted a visit to the facility above to conduct a required 10-day visit for a complaint. LPA met with Liza Hix and explained the purpose of the visit. During the investigation, LPA Rankin conducted a tour all 3 memory care neighborhoods. LPA reviewed 8 resident rooms, specifically rooms where dual residents reside or rooms that were found open for residents to wander in and out of. LPA also conducted interviews with the Administrator and the Wellness Coordinator, and obtained documents of, Sydney Creek Policies, Plan for Epidemic Outbreak Mitigation and the Plan of Operation (2012). Unsubstantiated On the allegation: Staff are not following infection control protocol; it was observed by the LPA that in 6 out of the 8 rooms toured there were toothbrushes of residents being stored on the counter. These restrooms are shared between 2 residents only, and in all cases only one of the residents’ toothbrushes were out. All toothbrushes except one were out due to the family/resident requesting and providing an electronic toothbrush requiring charging. The allegation is unsubstantiated due to there are no regulations prohibiting the storage of toothbrushes on countertops. Additionally, this practice was not addressed in the facility's mitigation or infection control plan, so it does not violate their policy. The LPA and Administrator explored various suggestions and alternatives for providing designated storage areas in the restroom for staff and residents to keep toothbrushes in. Although Licensing cannot enforce this requirement, both the LPA and Administrator acknowledge the importance of safeguarding memory care residents from others using their personal hygiene products, within reasonable limits of the facility's ability to manage. The LPA recognizes that some residents may be more independent, and/or their families may prefer their toothbrushes to be kept in a visible location, respecting the individual's personal rights. The facility does have a policy in place that all “Bathrooms shall be checked for cleanliness throughout the day by housekeeping and Direct Care staff” allowing for possible opportunities to move toothbrushes if residents’ agree. Exit interview conducted, copy of report given.the state’s words, verbatim · CDSS document, Sep 3, 2024 · control 29-AS-20240828153748

Type of visit: Case Management - Annual Continuation

On 8/28/24 at 10:46 am, Licensing Program Analyst (LPA) Rankin made an unannounced Case Management Annual Continuation visit to the facility above. LPA met with Liza Hix, Administrator, and explained the purpose of the visit. Physical plant/Outdoor space were toured for a second time due to the size of the facility. The facility has two separate garden areas with nice walkways for residents to enjoy. The garden fountain is in compliance. Items noted as potential fall hazards were addressed and fixed to ensure client safety when walking the garden paths. Facility is in compliance with fire clearance. Emergency Disaster Preparedness plan is current, and forms were posted. The facility provides disaster drills quarterly. The fire extinguishers were charged. The dual smoke and carbon monoxide detectors are present and hard wired throughout the facility and were in inspected this year by an outside company. Facility has an evacuation stair chair in Neighborhood 3 for the evacuation gate. The Storage/Laundry Room have sufficient amounts of personal hygiene products which are provided by the licensee and all cleaning products, toxins are stored and locked away inaccessible to residents in care. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked separately in cupboards. The facility has a license for 84 Non-Ambulatory which 84 may be bedridden. The facility does have delayed egress. The facility does have hospice and home health visits to the facility for residents in care. Staff files: All required training is scheduled and trainer is up to date on requirements. Staff records were checked for expired or missing certificates and clearances: LPA conducted a file review of 6 staff for criminal record clearances/associations/and current First Aid. Records were complete. Exit interview conducted, and the report printed and given to administrator.the state’s words, verbatim · CDSS document, Aug 28, 2024

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

Type of visit: Required - 1 Year

On 7/30/24 at 9:03 am, Licensing Program Analyst (LPA) Rankin made an unannounced Annual/Required visit to the facility above. LPA met with Liza Hix, Administrator, and explained the purpose of the visit. Physical Plan tour was done, and the following was noted: LPA observed the license posted, Complaint Poster, Bill of Rights and Right to Residential Council, non-discrimination statement, and resident rights. The facility conducted Emergency Disaster Drills quarterly as required. The facility maintains a comfortable temperature. The smoke detectors are hard wired and carbon monoxide detectors are placed in each neighborhood, this is reviewed annually by an outside service. Fire extinguishers are located throughout the facility, they were inspected in 04/2024 and are charged in the green. Living rooms, dining rooms, and activity room furniture were checked and in good condition. The common rooms are clean, safe and sanitary. The courtyards of the facility have outdoor furniture, with shaded area for residents. The kitchen area was sufficiently stocked with two-day perishable and seven-day non-perishables. The menu was posted for review. Snacks and beverages are available for residents in the facility when they want. Foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Continued on 809-C Resident rooms are adequately supplied with sheets, pillowcase, mattress pad, and blankets which are in good condition. There is at least one chair, night stand, and sufficient lighting for each resident. There is enough linen available to change weekly or more, if needed. Activity Room has sufficient activities for residents to stay active. Planned activities are offered to residents in care. There is staff hired to coordinate the activities and an activity calendar was available and reviewed. The bathrooms were checked for cleanliness and proper operation. Secured grab bars were noted, sufficient supplies for hand washing was observed. Resident records were reviewed for requirements and legibility: LPA reviewed 5 residents’ files for Medical Assessments, Needs and Service plans, Signed Admission Agreements and Pre-appraisals. There were no issues with resident files reviewed. Medications are centrally stored in a locked medication room. Medications labels from pharmacy are correctly labeled and not tampered with, and a check for expiration dates was done. Updated training is schedule and LPA will follow up and review a sampling of medication on final inspection. Exit interview conducted, and the report printed and given to administrators.the state’s words, verbatim · CDSS document, Jul 30, 2024

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

Allegation investigated: Staff prevent resident from having visitors. Staff do not allow resident to send mail. Staff prevent resident from making/receiving confidential phone calls. Staff do not maintain the facility in clean and sanitary condition.

Licensing Program Analyst (LPA) Erika Miller (Miller) conducted an unannounced complaint visit on March 13, 2024. On June 5, 2024, LPA issued final findings on the allegations above. During the investigation, LPA Miller toured the facility and interviewed staff and residents on March 13, 2024, from 10:15 a.m. to 12:40 p.m. LPA also obtained and reviewed relevant documents. LPA met with Liza Hix, administrator, and explained the purpose of the visit. On the allegation: Staff prevent resident from having visitors. It was alleged that facility staff turned away Resident 1 (R1)’s visitor in January 2024. Administrator stated they never restrict visitors. Administrator stated R1’s family advised that Person 1 (P1), a former caregiver, may try to visit R1 but they have suspicions and asked the facility to keep an eye on P1. On P1’s first visit to the facility, staff overheard P1 say to R1 they will sneak R1 out of the facility. On P1’s second visit, staff observed P1 trying to get R1 to sign checks, which staff reported to the administrator and the family. (Continued on 9099-C) Unsubstantiated Staff also overheard P1 ask R1 to tell an attorney P1 can live in R1’s house. Administrator stated visitors including P1 were never turned away, but staff tried to provide supervision to the visits to ensure R1 was safe. Staff confirmed no one was denied visitors, but they did hang around P1’s visits with R1 to ensure R1 was safe. LPA interviewed R1 who stated they don’t get many visitors, as their family lives far away. R1 stated their boyfriend comes to visit and talks to them on the phone. R1 did not indicate that they are not allowed to have visitors, and is not prevented from communicating with their boyfriend. Other residents interviewed stated they have visitors and they are never turned away. Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. On the allegation: Staff do not allow resident to send mail. Administrator stated residents can mail letters, and they have no reason to not allow residents to send mail. R1 stated no one has brought them stamps or stationary, but they could write a letter and send it to their boyfriend if they wanted to. Other residents interviewed stated they were allowed to send mail. Residents stated they have stamps and have addressed pieces of mail to friends and family. Other residents stated they have given mail to staff and they have mailed it for them with no issues. Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. On the allegation: Staff prevent resident from making/receiving confidential phone calls. Administrator stated each neighborhood has a phone, and residents are allowed to have cell phones and landlines. Administrator stated R1 does not have a cell phone or landline as the family did not request one. R1 stated they get phone calls from their boyfriend. R1 also stated there is a phone in the facility, but they do not call anyone. Other residents stated they can make and receive phone calls freely and no one prevents them from communicating with their friends and family. Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. (Continued on 9099-C) On the allegation: Staff do not maintain the facility in clean and sanitary condition. It was alleged the facility carpet was dirty in R1’s room. LPA toured the facility on March 13, 2024 and observed the facility was clean. LPA observed all carpet in the facility was clean, including in R1’s room. Residents interviewed stated they liked the facility. Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Exit interview conducted, copy of report issued.the state’s words, verbatim · CDSS document, Jun 5, 2024 · control 29-AS-20240307135052

Allegation investigated: Staff does not make dangerous items inaccessible to the residents

During the investigation, LPA toured the facility on April 24, 2024 from 11:00 a.m. to 12:00 p.m. LPA also obtained and reviewed relevant documents. LPA met with Lisa Hulse (Hulse), vice president of operations and explained the purpose of the visit. On April 16, 2024, a witness visited the facility and observed an accessible bathroom cabinet in Neighborhood 1. The witness observed an unlocked cabinet that contained an uncovered toothbrush, toothpaste tube, and an aerosol can. On the second shelf the witness observed 2 electric shavers and an electric curling iron. Witness also observed a full gallon of hand soap on the bathroom counter. Hulse stated that the facility policy requires that items that may pose a danger must be made inaccessible to clients. Hulse stated that she has reminded staff of regulations. (Cont. 9099 C) Unsubstantiated Hulse further stated that hand soap and hand lotion are not poisonous and that an electric razor is not dangerous. Hulse stated this she understands that it is best practice to make the items inaccessible.Hulse will be conducting a staff training to review relevant regulation and to discuss best practices moving forward. At 11:30 a.m. LPA toured each communal bathroom and observed that each bathroom door was locked, and signage was posted that reminded staff that items that could be dangerous to residents must be locked.LPA did not observe any accessible items that could be dangerous to residents. Based on the LPA observation and interview, the allegation is deemed Unsubstantiated at this time. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 24, 2024 · control 29-AS-20240417090505

Allegation investigated: Facility is not meeting the medical needs of residents

Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver final findings for the above allegation. LPA Olson interviewed Staff on 1/29/24 and 2/8/24, LPA attempted to interview Residents and requested relevant documents on 1/29/24. During today’s visit, LPA met with Vice President and explained the reason for the visit. On the allegation: Facility is not meeting the medical needs of residents. It was alleged that a resident’s ability to use their hand declined due to a brace not worn and exercises not done, and the resident’s nails were not maintained and dug into the skin of their palm. It was also alleged that a resident has a skin condition that was not properly being addressed by the facility. LPA interviewed LVN who stated most residents see the same doctor who sends their nurse practitioner to the facility once a week. They have their own list of residents to follow up with, as well as the facility’s list of residents we would like them to look into. LVN stated that any fall, change in condition, or medication change are addressed, or if the facility is concerned in any way. Continued on 9099-C Unsubstantiated LPA reviewed multiple residents files. LPA observed the facility faxed the doctor in regards to Resident 1 (R1)’s weight loss and weight gain. LPA observed the facility faxed R1’s doctor on 10/4/23 requesting home health be ordered due to a right hand contracture. The doctor asked for more information so another fax was sent 10/5/23 stating R1 has contracture to the right hand and was seen by home health, a splint was ordered and R1 was wearing it but now the hand is back to where it started 6 months ago because the brace was not being used, so the facility is requesting Physical Therapy (PT)/Occupational Therapy (OT). LPA interviewed staff about R1’s PT/OT for their hands and the brace. Interviews revealed the brace was not used and discontinued due to the resident constantly being in pain and there being a moisture problem. Staff stated there is now a softer device placed in R1's hand and staff state they constantly check it and ensure it's being used. On 1/29/24 LPA Olson observed resident fingernails in Neighborhood 3. LPA observed multiple residents who had fingernails that appeared long, and some that were jagged and could pose a potential danger if used to scratch. LPA spoke with LVN about the policy for nail care. LVN stated the facility has a Podiatrist who sees residents monthly to care for their toenails. The LVN tries to trim residents fingernails when they do rounds and observe they need trimming, but there is no set schedule to trim the nails. LPA showed LVN pictures of 3 residents nails that needed trimming. LVN said they would go and trim those nails. On 2/8/24 LPA observed R1's scalp to be flaky and green/yellow scabs on R1’s scalp. Records reviewed indicated the facility regularly contacted R1’s doctor regarding the skin condition, and an ointment and shampoo was prescribed by the doctor. Records and interviews indicate staff used the ointment as prescribed and R1’s condition occasionally flares up but facility is managing it as best they can with prescription shampoo and PRNs ordered by R1's doctor. LPA attempted to interview residents about their medical care but they were unable to respond to LPA’s questions. Interviews with staff revealed residents medical needs are always reported timely to the medtech or LVN. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of report issued.the state’s words, verbatim · CDSS document, Feb 8, 2024 · control 29-AS-20240125085421

Allegation investigated: Facility does not have enough staff to meet residents’ needs.

Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver final findings for the above allegation. LPA Chavez interviewed Administrator on 12/28/22 and 12/30/22, requested and reviewed documents on 12/28/22. LPA Olson interviewed Staff on 2/8/24 and requested relevant documents. During today’s visit, LPA met with Vice President and explained the reason for the visit. On the allegation: Facility does not have enough staff to meet residents’ needs. It was alleged that on 12/17/22 there was one employee in Neighborhood 2, which has approximately 15 residents. Administrator states in Neighborhood 1 there are 20 residents and 3 staff on AM and PM shifts, 1-3 staff on the NOC shift; Neighborhood 2 has 16 residents, 3 staff on AM and PM, and 1-3 staff on NOC; and Neighborhood 3 has 15 residents,1 concierge, 2 staff on AM and PM shift and 1-3 staff on NOC. LPA observed the schedule for 12/17/22 and observed 8 total staff scheduled for AM and 7 total staff scheduled for PM. Continued on 9099-C Unsubstantiated LPA Chavez interviewed Administrator on 12/28/22 who stated Life Enrichment staff conduct activities throughout the day, help feed residents and do outings but don’t give baths/showers. Administrator stateed that MedTechs are available if residents refuse a shower more then once and if the resident continues to refuse the facilities LVN may step in to assist. Administrator states the facilities have Concierge staff that are available, if needed to help with feeding and bathing but must be supervised. LPA Chavez toured the facility on 12/28/22 and observed 3 caregivers in each Neighborhood. LPA observed residents appeared neat with no malordors. On 1/29/24, LPA Olson toured Neighborhood 2 and 3. LPA Olson observed 3 staff in each neighborhood and residents’ appearance did not indicate a severe lack of staff. On 2/8/24 LPA Olson interviewed Staff regarding sufficient staff and if residents needs are being met. Interviews revealed sometimes there are only two staff scheduled in each Neighborhood but never just one. Most staff interviewed worked here in December 2022 and remember it being lighter then normal and less staff than usual, but no staff remembered situations where resident's needs weren't met. Staff interviewed stated sometimes after 8pm there is only one staff in the neighborhood but most residents are in bed and it's not a problem. Staff indicated it is possible to meet all the needs of residents with two staff but they prefer and all stated it's easier when there are 3 or more staff. All staff interviewed stated residents needs are always met and there is always someone they can call to help if needed. If the Neighborhood is short staffed residents may not get a shower during that shift but it is always made up the next day. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of report issued.the state’s words, verbatim · CDSS document, Feb 8, 2024 · control 29-AS-20221221173142