Villa Redondo Care Home

Type of visit: Case Management - Other

On 09/01/26 at approximately 9:00 AM, Licensing Program Analyst (LPA) Jose Anguiano conducted a visit for the purpose of delivering amended reports and collecting the required signatures. LPA met with Assistant Administrator Jesus Chavez. No deficiencies were cited during today’s visit, and a copy of the reports was provided to the Administrator.the state’s words, verbatim · CDSS document, Sep 1, 2026

Allegation investigated: Staff did not allow resident to get their personal belongings

On 08/14/2026 around 8:00AM, Licensing Program Analyst (LPA) Jose Anguiano conducted a subsequent unannounced visit to deliver findings. LPA met with the Assistant Administrator Jesus Chavez. LPA Anguiano explained the purpose of this visit is to deliver findings. The investigation consisted of the following: On 11/25/2025, 07/23/2026, and 08/04/2026 The Department conducted interviews with former Administrator Maria Bravo (A1), Assistant Administrator/Jesus Chavez (S1), and Jared Mikos/Director of Operations (S2), Skill nursing representative (W1), staff members (S3–S6), and residents (R1-R9). On 11/25/2025 The department obtained and reviewed resident (R1) Wellness Program Daily Logs dates ranging from 03/30/24 to 06/12/24, Nurse Facility Skin Integrity Report dated 03/08/24. Staff & Resident rosters dated 11/25/25, R1’s Physician's Report 10/05/022. Please see report continuation on (LIC9099-C) Unsubstantiated The Department conducted additional interviews with eight residents (R2, R3, R4, R6, R7, R8, and R9) and found 7 of 8 residents interviewed did not support the allegation. The department found 1 out of 9 residents (R5) interviewed had no knowledge of any resident being unable to retrieve their personal belongings. On 11/25/2025 and 08/04/26, the Department obtained Resident Personal Property and Valuables form dated 04/14/2021. The department found this R1 crossed out the form and declined to have personal belongings inventoried. Villa Redondo Care Facility records show that on 05/13/2024, staff contacted R1 and requested that R1 arrange for pickup of the belongings. R1 refused and ended the call. Follow-up calls on 05/17/2024 at 3:21 PM and 05/30/2024 at 11:33 AM went to voicemail. On 06/12/2024 at 2:28 PM, staff spoke with R1, who refused to provide a delivery address, used profanity, told the facility to keep the items, and declined staff’s offer to pack and deliver the belongings. Based on the evidence gathered, interviews conducted, and records reviewed, although the allegation “Staff did not allow resident to get their personal belongings” may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this complaint Report was provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 31, 2026 · control 11-AS-20251120153104

Allegation investigated: Illegal eviction

This is an amended report, this report supersedes the original report delivered, the findings have not changed. On 08/14/2026 around 8:00AM, Licensing Program Analyst (LPA) Jose Anguiano conducted a subsequent unannounced visit to deliver findings. LPA met with the Assistant Administrator Jesus Chavez. LPA Anguiano explained the purpose of the visit is to deliver complaint findings. The investigation consisted of the following: On 11/25/2025, 07/23/26, and 08/04/26 The Department conducted interviews with former Administrator Maria Bravo (A1), Assistant Administrator/Jesus Chavez (S1), and Jared Mikos/Director of Operations (S2), Skill nursing representative (W1), staff members (S3–S6), and residents (R1-R9). On 11/25/2025 The department obtained and reviewed resident (R1) Wellness Program Daily Logs dates ranging from 03/30/24 to 06/12/24, Nurse Facility Skin Integrity Report dated 03/08/24. Staff & Resident rosters dated 11/25/25, R1’s Physician's Report 10/05/022. Please see report continuation on (LIC9099-C) Substantiated On 07/14/26 The Department collected and reviewed additional records for R1: Medical records print date 07/24/26, R1’s Needs and Service Plan 06/29/23, R1’s Admission Agreement 04/15/21, R1’s Unusual Incident Reports for dates 03/30/24, 04/01/24 and 05/13/22. On 07/22/26 The Department collected and reviewed Admission record for Bell Convalescent Hospital dated 05/07/24.The investigation revealed the following: Regarding the allegation, “Staff did not allow resident to return to the facility” it is alleged that following R1’s hospitalization and treatment for a foot infection, facility staff did not allow R1 to return to the facility. Interviews conducted revealed the following: On 11/25/2025 and 08/04/26, The Department conducted an interview with Assistant Administrator Jesus Chavez (S1) who stated being new to the facility and not familiar with R1’s case. S1 was not working for the facility during the time R1 resided at the facility. S1 stated procedurally, the facility Wellness Director assesses a resident who is sent out to the hospital. The department conducted interviews with 4 staff (S3-S6) and found 4 out of 4 staff interviewed disagreed with the allegations. The department conducted interviews with nine residents (R1-R9) and 1 of 9 residents disagreed with the allegation (R1) agreed with the allegation. The department found 6 out of 9 (R3, R4, R6, R7, R8, R9) residents disagreed with the allegation. The department found 2 of 9 residents (R2, R5) interviewed were not knowledgeable of occurrences related to the allegation. The department conducted a review of facility documentation and R1’s medical records. The department found the following: Narrative Charting daily logs show that on 03/30/2024 (R1) was admitted to Long Beach Memorial Hospital for a left foot infection. An additional Daily Log entry dated 05/07/2024, completed by the former Wellness Director, shows that R1 was reassessed and documented to have MRSA a prohibited health condition. The same 05/07/2024 facility record further shows that the facility was unable to accommodate R1 due to treatment needed for MRSA and R1 was informed of this determination. The records reviewed did not establish that the facility refused R1’s return for reasons unrelated to his documented medical condition and care needs. Based on the evidence gathered, interviews conducted, and records reviewed, although the allegation “Staff did not allow resident to return to the facility” may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this complaint report was provided to the Administrator. On 07/14/26 The Department collected and reviewed additional records for R1: Medical records print date 07/24/26, R1’s Needs and Service Plan 06/29/23, R1’s Admission Agreement 04/15/21, R1’s Unusual Incident Reports for dates 03/30/24, 04/01/24 and 05/13/22. On 07/22/26 The Department collected and reviewed Admission record for Bell Convalescent Hospital dated 05/07/24. Regarding the allegation, ‘Illegal Eviction,’ it is alleged that facility staff did not allow R1 to return to the facility and failed to provide the required written eviction notice or follow proper eviction procedures. On 11/25/2025 The department conducted an interview with (R1) and stated being informed by Former Administrator Maria Bravo (A1) that returning to the facility would not be allowed due to R1 “not being able to get out of bed,” which R1 stated was “untrue”. R1 reported no written 30 day eviction notice was not provided. R1 explained that foot became infected, the doctor sent R1 to the ER, and surgery followed. When ready to return, R1 was informed by the facility former Wellness Director that R1 would not be allowed re entry based on R1’s MRSA diagnosis. The department obtained and reviewed the facility Narrative Charting daily logs and found that on 05/07/2024, staff the former Wellness Director (S8) documented a discussion with R1 regarding the facility inability to accommodate R1 and informed R1 would not be returning to the facility. Additional Daily Log dated 05/13/2024 at 10:20 AM, indicate Former Administrator (A1) contacted R1 and again informed verbally that the facility would not accept R1 back. The facility was unable to provide a copy of a 30-Day eviction notice to R1 or confirm that a written eviction notice was provide to R1. The department conducted a review if facility records was unable to find a written eviction notice, indicating required specific facts (date, place, witnesses, circumstances). The department was unable to confirm 30-Day eviction notice was served or mailed to R1 or R1’s person responsible or that proper eviction procedures were followed. The department found the R1 was communicated verbally by A1 and S8 without providing the required written notice or following regulatory eviction procedures. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegations are found to be SUBSTANTIATED. This is a violation of California Code of Regulations, Title 22, Division 6, Chapter 8. A citation is being issued on the attached (LIC-9099D). An exit interview, a copy of this report and appeal rights were provided to the Administrator. On 07/22/26 The Department collected and reviewed Admission record for Bell Convalescent Hospital dated 05/07/24. Regarding the allegation, ‘Illegal Eviction,’ it is alleged that facility staff did not allow R1 to return to the facility and failed to provide the required written eviction notice or follow proper eviction procedures. On 11/25/2025 The department conducted an interview with (R1) and stated being informed by Former Administrator Maria Bravo (A1) that returning to the facility would not be allowed due to R1 “not being able to get out of bed,” which R1 stated was “untrue”. R1 reported no written 30 day eviction notice was not provided. R1 explained that foot became infected, the doctor sent R1 to the ER, and surgery followed. When ready to return, R1 was informed by the facility former Wellness Director that R1 would not be allowed re entry based on R1’s MRSA diagnosis. The department obtained and reviewed the facility Narrative Charting daily logs and found that on 05/07/2024, staff the former Wellness Director (S8) documented a discussion with R1 regarding the facility inability to accommodate R1 and informed R1 would not be returning to the facility. Additional Daily Log dated 05/13/2024 at 10:20 AM, indicate Former Administrator (A1) contacted R1 and again informed verbally that the facility would not accept R1 back. The facility was unable to provide a copy of a 30-Day eviction notice to R1 or confirm that a written eviction notice was provide to R1. The department conducted a review if facility records was unable to find a written eviction notice, indicating required specific facts (date, place, witnesses, circumstances). The department was unable to confirm 30-Day eviction notice was served or mailed to R1 or R1’s person responsible or that proper eviction procedures were followed. The department found the R1 was communicated verbally by A1 and S8 without providing the required written notice or following regulatory eviction procedures. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegations are found to be SUBSTANTIATED. This is a violation of California Code of Regulations, Title 22, Division 6, Chapter 8. A citation is being issued on the attached (LIC-9099D). An exit interview, a copy of this report and appeal rights were provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 14, 2026 · control 11-AS-20251120153104

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(c) · Plan of correction due date: Aug 26, 2026

Eviction Procedures (c) The licensee shall, in addition to serving the required thirty (30) day notice, sixty (60) day notice, or seeking approval from the Department and serving a three (3) day notice on the resident, notify or mail a copy of the notice to quit to the resident's responsible person. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility failed to provide R1 the required written eviction notice, failed to provide or mail a copy to R1’s responsible person, and did not seek Department approval to serve a three-day notice. This violation posed a potential personal rights risk to R1.the state’s words, verbatim · CDSS document, Aug 14, 2026

Plan of correction: Licensee agreed to develop and submit a written prevention plan describing how the facility will ensure future evictions comply with Section 87224 The written plan shall be submitted to CCLD by the POC due date to Jose.Anguiano@dss.ca.gov.

Allegation investigated: Staff did not ensure the resident attended their religious services on time.

**This report supersedes the report delivered on 06/02/2026 to include additional information to the findings.** On 07/13/2026 at 9:10 am, the Department arrived at the facility to conduct an subsequent visit to deliver the findings for the allegation listed above. During today’s visit, the Department met with Wesam "Sam" Kachouri (Administrator) and explained the purpose of the visit. The investigation consisted of the following: On 06/02/2026, the Department conducted interviews between the hours of 9:35 am - 11:28 am with the Administrator (A1), Staff (S1-S5), and Residents (R1-R6). The Department also requested and obtained copies of the staff roster (dated 05/15/2026), resident roster (received on 06/02/2026), and R1’s documents including the Admission Agreement (dated 08/08/2025), LIC 602 Medical Assessment (dated 08/25/2025), LIC 603 Preplacement Appraisal Information (not dated), LIC 613C-2 Personal Rights (dated 08/25/2025), Personal Rights Policy (GP02) (dated 06/01/2025), Resident Sign-In/Sign-Out Policy (GP08) (dated 12/13/2024), and Resident Sign-In/Out Log (March 2026 – May 2026). Unsubstantiated The investigation revealed the following: Allegation: Staff did not ensure the resident attended their religious services on time. It was alleged that on the morning of the incident, a staff member refused to allow R1’s family member to sign R1 out at the agreed upon time of 9:00am, as previously approved by facility management. The family member reported being unable to sign R1 out until 9:30am, resulting in a late arrival to church, and stated they were on the phone with R1 during the delay. On 06/02/2026 between 9:35 am - 9:55 am, the Department interviewed A1. A1 denied the allegation and stated R1’s family member may sign R1 out at any time based on R1’s personal rights. A1 stated that staff may ask visitors to briefly wait if the lobby floor is wet due to mopping to prevent fall risk, but clarified that the lobby is unlocked at 9:00 am and visitors may enter earlier with staff assistance. A1 stated the facility does not restrict resident departure for religious services and that residents may leave freely at any time. A1 confirmed that staff can disengage the door lock for early visitors using the video call system and that advance arrangements are accommodated but not required. A1 stated that any temporary waiting would be due to immediate safety concerns and not due to a facility policy or routine practice. On 06/02/2026, between 9:01am -11:28am, the Department interviewed 5 staff in regards the allegation. 4 out of 5 staff denied the allegation, stating that no staff refused or delayed the sign-out and explained that the lobby is typically closed until 9:30am due to housekeeping mopping the floors, requiring residents to be escorted downstairs during that time to prevent fall risk. Staff reported that R1’s family member arrived early at approximately 8:35am before staff were present in the lobby, and 1 staff stated that similar situations have occurred once or twice before on Sundays. Staff consistently stated that residents may leave whenever they choose and that the facility does not restrict religious attendance. 1 out of 5 staff was unaware of the allegation, stating they were not on duty and could not provide information on what had occurred. On 06/02/2026 between the hours of 9:28am - 10:53am, the Department interviewed 6 residents in regards the allegation. 6 out of 6 residents denied the allegation, stating they had not experienced staff refusing or delaying sign outs and had not witnessed staff preventing a resident’s family member from signing them out at an agreed upon time. Residents reported that staff allow them to leave when requested, that staff respect their rights, and that any waiting is due to staff assisting other residents or normal delays. R1 stated that they usually leave on time and that any delays are rare and related to staff assisting multiple residents, not refusal. No residents reported being aware of or observing the alleged incident. On 06/02/2026 between 1:00 pm - 2:15 pm, the Department conducted a records review. The Admission Agreement states visiting hours are 9:00 am - 7:00 pm daily and that arrangements can be made for special visits at any time. The LIC 613C-2 Personal Rights document states residents may receive visitors privately and without prior notice during reasonable hours. The Personal Rights Policy (GP02) states residents have the right to attend religious services inside or outside the facility and the right to leave the facility at any time. The Resident Sign-In/Sign-Out Policy (GP08) requires residents to sign out when leaving but does not impose time restrictions, require prior approval, or permit staff to delay departure. None of the reviewed policies authorize staff to delay resident departure for religious services or require visitors to wait due to housekeeping activities. The Department reviewed the Resident Sign-In/Out Log for March 2026 - May 2026. The log reflects that R1 routinely leaves the facility with her authorized representative for various outings including beach trips, shopping, meals, medical appointments, and religious services. The log demonstrates that R1 regularly departs the facility without documented restriction and staff consistently facilitate R1’s ability to leave for community activities in accordance with facility policy and resident personal rights. On 07/02/2026 between the hours of 4 pm – 5 pm, the Department received additional written clarification from Administrator (A1). A1 stated the lobby is unlocked at 9:00 am daily and visitors may enter earlier with staff assistance using the video call system. A1 stated housekeeping normally mops the lobby at approximately 7:30 am and that any later mopping occurs only when housekeeping must respond to urgent cleaning needs elsewhere. A1 stated visitors are not required to wait outside and may be assisted through the lobby safely even when the floor is wet. A1 stated residents are not delayed when leaving for religious services and may depart at any time, including before 9:00 am. Based on information gathered through interviews and record reviews, there is not enough evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted with Wesam "Sam" Kachouri (Administrator) and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 13, 2026 · control 11-AS-20260527154622

Allegation investigated: Staff did not ensure the resident attended their religious services on time.

On 06/02/2026 at 8:20am, the Department arrived at the facility to conduct an initial visit to investigate the allegation listed above. During today’s visit, the Department met with Jesse Chavez (Assistant Administrator) and explained the purpose of the visit. The investigation consisted of the following: On 06/02/2026, the Department conducted interviews between the hours of 9:35am - 11:28am with the Administrator (A1), Staff (S1-S5) and Residents (R1-R6). The Department also requested and obtained copies of the staff roster (dated 05/15/2026), resident roster (received on 06/02/2026) and R1's documents such as Admission Agreement (dated 08/08/2025), LIC 602 Medical Assessment for RCFE (dated 08/25/2025), LIC 603 Preplacement Appraisal Information (not dated), LIC 613C-2 Personal Rights In Privately Operated Residential Care Facilities for the Elderly (dated 08/25/2025), Personal Rights Policy (GP02) (dated 06/01/2025), Resident Sign-In / Sign-Out Policy (GP08) (dated 12/13/2024) and Resident Sign In/Out Log (March 2026-May 2026). Unsubstantiated The investigation revealed the following: Allegation: Staff did not ensure the resident attended their religious services on time. It was alleged that on the morning of the incident, a staff member refused to allow R1’s family member to sign R1 out at the agreed upon time of 9:00am, as previously approved by facility management. The family member reported being unable to sign R1 out until 9:30am, resulting in a late arrival to church, and stated they were on the phone with R1 during the delay. On 06/02/2026 between 9:35am - 9:55am, the Department interviewed A1. A1 denied the allegation and stated that R1’s family member may sign R1 out at any time based on R1’s personal rights. A1 stated that staff may ask visitors to wait if the lobby floor is being mopped between 9:00am - 9:30am to prevent fall risk. A1 reported that no incident report was completed and stated the facility has filed multiple SOC 341 forms regarding the family member’s behavior towards R1. On 06/02/2026, between 9:01am -11:28am, the Department interviewed 5 staff in regards the allegation. 4 out of 5 staff denied the allegation, stating that no staff refused or delayed the sign-out and explained that the lobby is typically closed until 9:30am due to housekeeping mopping the floors, requiring residents to be escorted downstairs during that time to prevent fall risk. Staff reported that R1’s family member arrived early at approximately 8:35am before staff were present in the lobby, and 1 staff stated that similar situations have occurred once or twice before on Sundays. Staff consistently stated that residents may leave whenever they choose and that the facility does not restrict religious attendance. 1 out of 5 staff was unaware of the allegation, stating they were not on duty and could not confirm what occurred. On 06/02/2026 between the hours of 9:28am - 10:53am, the Department interviewed 6 residents regarding the allegation. 6 out of 6 residents denied the allegation, stating they had not experienced staff refusing or delaying sign outs and had not witnessed staff preventing a resident’s family member from signing them out at an agreed upon time. Residents reported that staff allow them to leave when requested, that staff respect their rights, and that any waiting is due to staff assisting other residents or normal delays. R1 stated that they usually leave on time and that any delays are rare and related to staff assisting multiple residents, not refusal. No residents reported being aware of or observing the alleged incident. On 06/02/2026 between 1:00pm -2:15pm, the Department conducted a records review and observed the following: According to R1's Admission Agreement (dated on 08/28/2026) on page 8 under section 12. Facility Visiting Policy states: The facility encourages visiting between the resident and family/or friends. (a) facility visiting hours are: Monday through Sunday 9am - 7pm. On page 17, 13. Visiting hours are from 9am to 7pm daily. Visitors are required to use the visitors log to sign in and out. Arrangements can be made for special visits at any time. On page 28 in the Policies Concerning Family Visits the facility encourages visits from family, friends and clergy. Please feel free to visit from 9am - 7pm. If additional visiting times are needed, please contact the facility in advance to make arrangements. Also according to R1's LIC 613C-2 Personal Rights In Privately Operated Residential Care Facilities for the Elderly (signed & dated 08/25/2025 by R1) on page 5 of 8 it states (24) To consent to have relatives and other individuals of the resident's choosing visit during reasonable hours, privately and without prior notice. The facility’s Personal Rights Policy (GP02) (dated 06/01/2025) which states that residents have the right to attend religious services of their choice inside or outside the facility and the right to leave the facility at any time. The policy does not authorize staff to delay or restrict a resident’s ability to depart for religious services. The Resident Sign-In/Sign-Out Policy (GP08) (dated 12/13/2024) requires residents to sign out when leaving but does not impose time restrictions, require prior approval, or permit staff to delay a resident’s departure. The policy does not reference any limitation related to religious outings or scheduled pick up times. Based on the policies reviewed, residents are permitted to leave freely with their authorized representative, and staff are required to support residents’ rights to attend religious services without interference or delay. The Department reviewed the Resident Sign-In/Out Log for March 2026 - May 2026. The log reflects that R1 routinely leaves the facility with her authorized representative for various outings, including frequent trips to the beach, shopping, meals, medical appointments, and other community activities. R1 signed out to the beach on multiple dates including Monday 03/02/2026, Saturday 03/07/2026, Monday 03/09/2026, Thursday 03/12/2026, Friday 03/13/2026, Monday 03/16/2026, Tuesday 03/17/2026 at 9:50 AM, Sunday 05/03/2026, Monday 05/04/2026, Thursday 05/07/2026, Saturday 05/16/2026, Friday 05/22/2026, Sunday 05/24/2026, Saturday 05/30/2026, and Sunday 05/31/2026. R1 also signed out for shopping or meals on Thursday 03/12/2026, Friday 03/13/2026, Wednesday 04/24/2026, Sunday 04/26/2026, Tuesday 04/28/2026, and Tuesday 05/12/2026. Medical appointments were documented on Monday 03/23/2026, Saturday 03/28/2026, Wednesday 04/22/2026, Wednesday 04/29/2026, Thursday 04/30/2026, Friday 05/01/2026, and Saturday 05/16/2026. Additional outings were recorded on Saturday 03/28/2026, Tuesday 03/31/2026, Monday 04/13/2026, Sunday 04/19/2026 (including a 9:08 coffee outing), Friday 04/24/2026, and Tuesday 05/26/2026. The log demonstrates that R1 regularly departs the facility without documented restriction, and staff consistently facilitate R1's ability to leave for community activities, including religious services, in accordance with facility policy and resident personal rights. Based on information gathered through interviews and record reviews, there is not enough evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. Exit interview conducted with Jesse Chavez (Assistant Administrator) and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 2, 2026 · control 11-AS-20260527154622

Allegation investigated: Staff do not allow resident phone usage.

On 05/28/26 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the facility. California Department of Social Services (CDSS) was met by staff one, Jesus Chavez (S1), and the purpose of the visit was explained. S1 and LPA toured the facility. The investigation consisted of the following: On 05/28/26 CDSS requested and reviewed facility documents and toured the facility. Between 09:00AM and 12:00PM, LPA interviewed six (6) out of fifty-six (56) clients and four (4) out of thirty-two (32) staff. The investigation revealed the following: Regarding the allegation “Staff do not allow resident phone usage.”, it is being alleged that a resident was not allowed to use the phone to call their responsible person. Record reviews revealed that the "Use of the facility telephone is made available to residents between the hours of 9AM and 5PM. Use of the telephone outside of these hours is for emergency purposes and for special cases.", which indicates that residents are able to use the facility phone between these hours and are able to use the facility phone in special cases. Report continues, please see LIC9099-C. Unsubstantiated Interviews revealed that five (5) out of six (6) residents (R2 through R6) and all four staff (S1 through S4) have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with Jesus Chavez - Assistant Administrator, and a copy of this report has been provided.the state’s words, verbatim · CDSS document, May 28, 2026 · control 11-AS-20260520105147

Allegation investigated: Staff do not allow resident phone usage.

On 05/28/26 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the facility. California Department of Social Services (CDSS) was met by staff one, Jesus Chavez (S1), and the purpose of the visit was explained. S1 and LPA toured the facility. The investigation consisted of the following: On 05/28/26 CDSS requested and reviewed facility documents and toured the facility. Between 09:00AM and 12:00PM, LPA interviewed six (6) out of fifty-six (56) clients and four (4) out of thirty-two (32) staff. The investigation revealed the following: Regarding the allegation “Staff do not allow resident phone usage.”, it is being alleged that a resident was not allowed to use the phone to call their responsible person. Record reviews revealed that the "Use of the facility telephone is made available to residents between the hours of 9AM and 5PM. Use of the telephone outside of these hours is for emergency purposes and for special cases.", which indicates that residents are able to use the facility phone between these hours and are able to use the facility phone in special cases. Report continues, please see LIC9099-C. Unsubstantiated Interviews revealed that five (5) out of six (6) residents (R2 through R6) and all four staff (S1 through S4) have denied the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with Jesus Chavez - Assistant Administrator, and a copy of this report has been provided.the state’s words, verbatim · CDSS document, May 28, 2026 · control 11-AS-20260520105147

Allegation investigated: Staff did not ensure the resident attended their medical appointments Facility elevator is in disrepair Staff did not provide proper supervision to resident in care Staff did not safeguard the resident’s personal items Staff spoke inappropriately to resident in care Staff did not provide proper medication assistance to residents in care

On 4/30/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Assistant Administrator, Jesus Chavez and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility. The investigation consisted of the following: On 4/30/26 LPA Shirley reviewed copies of the following records: Staff and Resident Roster, Physician Reports, Identification and Emergency Information, Resident Personal Property and Valuables, Admission Agreement, Medication Administration Records, (MARs), Elevator Service Log, Appointment Tracking Sheet, Resident Assessment Form, Individual Service Plan and Unusual Incident/Injury Reports. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff-5 (S1 – S5), and Resident -1 – Resident -5 (R1-R5) R6 is non-verbal. Con'd on 9099-C Unsubstantiated The investigation revealed the following: Allegation: Staff did not ensure the resident attended their medical appointments It is being reported that staff rescheduled R1’s appointments to coincide with staff schedules. LPA Felisa Shirley reviewed R1’s appointment tracking sheet and observed that R1 had 2 appointments in February 2026. Appointments scheduled for 2/5/26 and 2/20/26. The appointment for 2/20/26 was rescheduled for 4/29/26. Staff for Villa Redondo Care Home provided transportation for the appointment on 2/5/26. There were no appointments scheduled in March 2026. R1 had 1 appointment for April 2026 on 4/29/26. Staff for Villa Redondo Care Home provided transportation for the appointment on 4/29/26. R1 returned to the facility on 4/29/26 from doctor’s appointment and a family member arrived to the facility to accompany R1 to another doctor’s appointment. Per interview with S1 on 4/30/26, he does not have information regarding the second appointment on 4/29/26. Per interview with S1, staff ensures that there is staff available to accompany R1 to all doctors appointments when given notice. LPA interviewed staff 1 – staff 5 (S1 – S5). Of those interviewed 5 out of 5 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 5 out of 5 denied the allegation. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not ensure the resident attended their medical appointments,” therefore, the allegation is unsubstantiated. Allegation: Facility elevator is in disrepair It is being reported that facility’s elevator breaks down and is a hazard in case of an emergency. On 4/30/26, LPA Shirley toured this facility and observed that there are 4 sets of stairs and one elevator. LPA Shirley notes that elevator is working today, 4/30/26. LPA Shirley reviewed the service log for the elevator which was last serviced, 4/21/26. LPA notes that the elevator is serviced monthly by Delta Elevator Company, Inc. Per interview on 4/30/26 with S1, the elevator is paused to service the elevator once monthly. Per S1, the staff and residents are notified when the elevators are being serviced and notices are also posted. LPA interviewed staff 1 – staff 5 (S1 – S5). Of those interviewed 5 out of 5 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 5 out of 5 denied the allegation. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Facility elevator is in disrepair,” therefore, the allegation is unsubstantiated. Con'd 9099-C Allegation: Staff did not provide proper supervision to resident in care It is being reported that R1’s roommate R6 has fallen multiple times due to understaffing at this facility. R6 was admitted to this facility on 8/20/21, per Admission Agreement. Since R6’s day of admission, there are 16 Special incident Reports, (SIR’s), which include 3 falls. Per Resident Assessment form dated, 1/9/26, R6 is a fall risk. Resident is under C&V Hospice service. Per Individualized Service Plan dated 1/9/26, resident requires status checks for safety purposes, rail on R6’s bed, and requires full assist/escorting to all meals and events. R6 was transferred to another room on 4/9/26. LPA interviewed staff 1 – staff 5 (S1 – S5). Of those interviewed 5 out of 5 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 5 out of 5 denied the allegation. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not provide proper supervision to resident in care,” therefore, the allegation is unsubstantiated. Allegation: Staff did not safeguard the resident’s personal items It is being reported that after R1’s roommate had visitors, R1’s phone charger was missing. LPA observed that R1’s Residents Personal Property and Valuables form was not filled out however, it was signed by R1. Per interview with S2, R1’s phone and charger were both in the Med Tech room charging. When S2 discovered that the phone was not charging, she replaced the charger. Both phone and charger were given back to R1. LPA interviewed staff 1 – staff 5 (S1 – S5). Of those interviewed 5 out of 5 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 5 out of 5 denied the allegation. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not safeguard the resident’s personal items,” therefore, the allegation is unsubstantiated. Con'd on 9099-C Allegation: Staff spoke inappropriately to resident in care It is being reported that a specific Med Tech was rude and condescending to residents. Per interview with R1 on 4/30/26, she indicated that staff are usually easygoing and that she had never had the experience of a member of staff speaking to her inappropriately. Per interview with S5 on 4/30/26, staff are usually speaking loudly as many of the residents are hard of hearing. S5 stated speaking loudly may be misinterpreted as being rude, however staff are trying to make sure that the residents hear them. LPA interviewed staff 1 – staff 5 (S1 – S5). Of those interviewed 5 out of 5 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 5 out of 5 denied the allegation. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff spoke inappropriately to resident in care,” therefore, the allegation is unsubstantiated. Allegation: Staff did not provide proper medication assistance to residents in care It is being reported that a conversation was overheard that residents were not receiving their prescribed medication. LPA Shirley requested and was provided a copy of the name of residents that are prescribed the medication, Norco. There are 8 residents that are receiving, Norco. On 4/30/26, LPA Shirley reviewed the residents receiving Norco Medication Administration Record, (MAR). Upon review of the MAR’s, LPA Shirley observed that the medication, Hydrocodone for Norco is prescribed as a Pro Re Nata (PRN) which means, “As the Need Arises.” LPA Shirley observed that the medication was administered as needed with the initials of the staff that administered the medication. LPA interviewed staff 1 – staff 5 (S1 – S5). Of those interviewed 5 out of 5 denied the allegation. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 5 out of 5 denied the allegation. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not provide proper medication assistance to residents in care,” therefore, the allegation is unsubstantiated. No deficiencies were cited for these allegations. An exit interview was conducted and a copy of this report was provided to the Assistant Administrator, Jesus Chavez.the state’s words, verbatim · CDSS document, Apr 30, 2026 · control 11-AS-20260421131039

Allegation investigated: Resident developed multiple pressure injuries while in care resulting in hospitalization. Resident became extremely dehydrated while in care.

On 12/11/25, the department conducted a subsequent visit to further investigate the above allegations and deliver findings. The department met with Director of Operations, Jared Mikos, and explained the reason for the visit. The department was granted access into the facility. The department was later met by Assistant Administrator, Jesus Chavez. The investigation consisted of the following: On 05/16/24, the department requested a copy of the staff roster, resident roster. The department reviewed service records for residents #1-#7 (R1-R7), and collected copies of the following documents for R1: Admission Record, Admission Agreement, Preplacement Appraisal Information, Resident Assessment Form, Individualized Service Plan, Physician’s Report, Identification and Emergency Information, Consent/Release Forms, Personal Rights, Facility Resident Notes, Outside Agency Documentation. Continued on LIC9099-C Unsubstantiated Alamitos Belmont Rehabilitation Hospital Order Summary Report (dated: 06/30/2023), Alamitos Belmont Health Care Discharge Summary (dated: 07/07/2023), medical records from Alamitos Belmont Rehabilitation Hospital (dated: 07/07/25), medical records from St. Mary Medical Center-Long Beach, and Home Health Notes from Mission Home Health of Irvine. Additionally, the department conducted a tour of the facility. On 05/29/24, the department conducted interviews with staff #1-#2 (S1-S2). On 06/10/24, the department obtained medical records from Los Alamitos Medical Center (dated: 04/24/24 and 05/10/24). On 06/20/24, the department conducted interviews with residents #2-#4 (R2-R4) and staff #3-#5 (S3-S5). Furthermore, on 12/11/25, the department conducted interviews with staff #6-#7 (S6-S7) and residents #5-#8 (R5-R8). The investigation revealed the following: Allegation: Resident developed multiple pressure injuries while in care resulting in hospitalization. It is being alleged that R1 developed multiple pressure injuries while at the facility. During the course of the investigation, the department conducted interviews with S1-S7. Of those interviewed, 4 out 7 staff interviewed acknowledged that R1 developed multiple pressure injuries while in care. An interview conducted with S3 revealed that R1 did not have any pressure injuries when they initially arrived at this facility, and that R1’s pressure wounds got worse in just a few days because they were bed bound. During the course of the investigation, the department conducted interviews with R2-R8. The department was unable to interview R1 as they were no longer at the facility. Of those interviewed, 5 out of 7 residents could not corroborate with the allegation, and 2 out of 7 residents did not provide an answer. 7 out of 7 residents reported that staff check on them frequently. The department’s review of R1’s Admission Agreement confirms that R1 was admitted and moved into the facility on 07/07/23. The department reviewed Resident Assessment Form (dated: 07/07/23) for R1 and it revealed the following: R1 had no healing wounds or bedsores and had no skin breakdown. R1 is non-ambulatory due to physical impairment and requires an assistive/adaptive devise. R1 had no history of falls. R1 requires one-person transfer assistance. R1 requires status checks routinely, approximately every hour, due to recent hospitalization, change in status, confusion, illness, history of falls, medication change, etc. The department reviewed R1’s Physician’s Report (dated: 07/03/23) and noted the following: R1 is non-ambulatory due to both physical and mental condition and has no history of skin breakdown or condition. Continued on LIC9099-C The department reviewed facility notes (dated: 03/03/24 – 04/29/24) and noted the following: On 03/03/24, R1 was observed with a wound, and home health was called for R1 to receive wound care but there was no answer. On 03/05/24, there was no noted wound on left side of R1’s left foot, and there was some redness noted from R1 constantly leaning on left side. It further notes that R1’s foot is being elevated to prevent further redness or sore forming. On 04/18/24, R1 complained of stomach pain, 911 was called and R1 was sent transported to Long Beach Memorial Hospital. On 04/21/24, R1 returned from the hospital and was observed to have multiple bedsores on lower and upper extremities. It was noted that on 04/23/24, R1’s family was visiting and they noticed that R1’s right foot was swollen. R1’s family requested for R1 to be sent out to the hospital. R1 was taken to Los Alamitos Medical Center. Notes reveal that R1 returned from the hospital on 04/25/24 and will continue receiving care from Mission Home Health. It further notes that R1’s foot appears to be swollen. 04/29/24 staff observed that swelling on R1’s foot had reduced, and it appeared to be no injury to their foot. The department reviewed medical records from Los Alamitos Medical Center (dated: 04/24/24) and noted the following: On 04/24/24, R1 was admitted for swelling of their right foot. Records note that R1 had a stage 1 mild ulcer to the right heel, with no additional pressure ulcers noted at the time. R1 was discharged on 04/25/24 with a diagnosis of swelling of right foot, decubitus ulcer of right heel, stage 1. On 05/03/24, staff spoke with Mission Home Health regarding R1’s pain on their lower back and, also noted that R1 seemed to be in severe pain during changing. On 05/06/241, staff observed R1 had redness on their lower back with some bleeding. A&D was put on R1’s lower back, and Home Health was notified. On 05/10/24, R1 was sent out to Los Alamitos Hospital due to skin tear on their lower back. The department reviewed medical records from Los Alamitos Medical Center (dated: 05/10/24) and noted the following: R1 was admitted on 05/10/24 for pressure ulcers that have progressively worsened. R1 had wounds to their back, right heel, and left leg. Per XR Chest, R1 had Sepsis fever, and on 05/12/24, an infectious disease consult was conducted due to a Urinary Tract Infection (UTI) and sacral decubiti infected sores. R1 had multiple decubitus ulcers with foul smell. R1 was discharged on 05/24/24. The department reviewed Unusual Incident/Injury Report (UIR) (dated: 04/19/24 and 05/16/24). UIR dated 04/19/24 reports that on 04/18/24, R1 complained of severe stomach pain and was transferred to Long Beach Memorial Hospital. UIR notes that R1 returned to the facility from the hospital with bed sores, and no medication changes. It further notes that Mission Home Health will be doing wound care. Continued on LIC9099-C UIR dated 05/16/24 reports that on 05/10/24 R1 was sent to Los Alamitos Medical Center due to pain and suspected infection of wound. It reports that R1 has been receiving wound care from Mission Home Health and that R1’s wound appeared to be worsening. The department reviewed home heath notes from Mission Home Health and they noted the following: Services for R1 began on 07/12/23. On 07/13/23, Mission Home Health conducted a visit with R1 for an initial evaluation and assessment. On 07/21/23, a follow-up visit was conducted and noted that R1 appeared stable in bed. R1 denied any pain or discomfort. Appetite was ok. No significant changes were reported by facility Med-Tech. Taught patient and caregiver on infection control, safety/fall precautions and preventions, and advised to contact doctor for any emergency and/or medical concerns and changes. On 07/26/23, a follow up visit was conducted and no skin breakdown were noted at the time. On 08/08/23, Mission Home Health conducted an evaluation with R1. A new stage 1 pressure ulcer to left heel was noted. Mission Home Health spoke with doctor’s office, and treatment order was obtained. It was noted that R1’s skin was intact throughout, wound care was provided, and caregiver was instructed on repositioning, and pressure offloading. Home Health continued visits on 08/11/23, 08/14/23, 08/24/23, 08/26/23, 08/31/23, and 09/07/23 for stage 1 pressure injury of left heel, which was noted to have worsened during the visit on 09/08/23, 10/05023, and 10/12/23. R1’s left heel got better, then was exasperated. On 10/19/23, Home Health nurse found reddening of lateral malleoli of left ankle and small wound of lateral left foot, which indicated pressure wound. On 10/24/23, stage 1 pressure injury on left ankle noted. On 10/26/23, stage 1 pressure injury noted on 08/08/23 healed. Per Mission Healthcare Home Health notes, it indicated services for R1 momentarily ended on 11/08/23. Services restarted on 03/08/24. Home Health visited from 03/08/24, 03/09/24, 03/19/24, 03/20/24, 04/16/24, and 04/19/24, where it was noted that R1 had no open wounds. Visits restarted on 04/24/24 noting a ruptured blister on edge of let foot and a traumatic superficial wound to right, mid-forearm, no pressure injuries were noted. Visits continued on 04/30/24, 05/04/24 and 05/05/24, noting the following: traumatic superficial wound to right arm had healed, bruise on lateral ankle, scattered bruises on arms, and a ruptured blister on mid edge of left foot. Wound care services ended on 05/08/24. Based on the information gathered, interviews conducted, and records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. Continued on LIC9099-C Allegation: Resident became extremely dehydrated while in care. It is being alleged that R1 was extremely dehydrated and malnourished, when they went to the hospital, which led to hypoglycemia. On 05/16/24, the department observed water available in the main lobby, and a water dispenser in the second floor. The department reviewed R1’s Physician’s Report (dated: 07/03/23) and noted the following: R1 is non-ambulatory, with a primary diagnosis of: Alzheimer's Disease, and a secondary diagnosis of: Atrial Fibrillation, Type 2 Diabetes mellitus, Hypertensive, Diabetic Chronic Kidney Disease. On page 3 of the medical records, it notes that R1 has Acute Kidney Injury (AKI) and dehydration. The department reviewed medical records from Los Alamitos Medical Center (dated: 04/24/24) and noted the following: On 04/24/24, R1 was admitted for swelling of their right foot. R1 was discharged on 04/25/24. The department reviewed medical records from Los Alamitos Medical Center (dated: 05/10/24) and noted the following: R1 was admitted on 05/10/24 for pressure ulcers that had worsened. Additionally, records noted that R1 was malnourished and severely dehydrated. R1 was discharged on 05/24/24 with a diagnosis of leg ulcer, heel ulcer, pressure ulcer, Acute Kidney Injury (AKI), Uremia, Rhabdomyolysis, Hypotension, Hypothermia, and Hypoglycemia. Dehydration was not noted on the discharge notes. A review of the facility’s incident reports (March, April, May 2024) did not show an incident involving R1 being hospitalized for dehydration. A review of R1’s Medication Administration Record (MAR) (for the months of March, April, May 2024) noted that R1 was taking Bumetanide 1 MG tablet two times a day, Calcitriol 0.25 MCG capsule three times a week, Hydralazine 25 MG table twice a day with food. A review of medical records from Mission Home Health (dated: 07/12/23 – 05/08/24) and noted the following: Services for R1 began on 07/12/23. A review of the Home Health Certification and Plan of Care report from the medical records from Mission Home Health it notes that R1 had Chronic Kidney Disease, Stage 4. During the course of the investigation, the department conducted interviews with S1-S7. Of those interviewed, 5 out of 7 staff could not corroborate with the allegation, and 2 out of 5 staff said they did not know of the allegation. 2 out of 7 staff stated fluids are always available in the main lobby, in the second floor, and staff offer, remind, and encourage residents to drink water and other fluids. S6 said the residents receive water with every meal, as needed, and at any time during the day. S6 said that if the residents have other options such as juice, tea, coffee, and that they can always go to the kitchen and ask for it. Continued on LIC9099-C During the course of the investigation, the department conducted interviews with R2-R8. The department was unable to interview R1 as they were no longer at the facility. Of those interviewed, 7 out of 7 residents could not corroborate with the allegation. 7 out of 7 residents stated there is always water, juice, and coffee available and staff are always asking if they would like something to drink. Based on the information gathered, interviews conducted, and records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with Assistant Administrator, Jesus Chavez, and Director of Operations, Jared Mikos, and a copy of this report, along with appeal rights was provided.the state’s words, verbatim · CDSS document, Dec 11, 2025 · control 11-AS-20240515112718

Type of visit: Required - 1 Year

On 10/27/2025 at 8:24am, Licensing Program Analysts (LPAs) Zina Brown and Lizeth Villegas conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one- year inspection. LPA met with Jared Mikos (Director of Operations) and the purpose of the visit was discussed. Facility is licensed to serve 73 non-ambulatory residents, 7 bedridden residents and an approved hospice waiver for 7 residents. The facility does handle residents cash resources. Currently the facility has 50 residents who reside at the facility. The facility has residents diagnosed with the following: 3 dementia residents 11 receiving home health residents 7 hospice care services residents. The facility is a 3 story building which consist of the following: 1st floor: Lobby, business offices, conference room, salon, laundry, designated smoking area outside, and parking lot 2nd floor: 20 resident rooms, outdoor shaded area, kitchen, and dining room and an emergency evacuation chair is located on the 2nd floor stairwell. 3rd floor: 20 resident rooms, activity room, library, medication and storage room. The facility has a current administrator Jared Mikos certificate # 7008348740 (valid 08/27/2024 - 08/26/2026) The facility annual fees are current. Liability Insurance Policy is with Continuing Care Risk Retention Group, Inc (NAIC #11798) (Policy # PL0002277) is current and valid from 01/01/2025 - 01/01/2026 and as followed occurrence at $1,000,000 and general aggregate at $3,000,000. The facility has a surety bond of $6,000,000 as of April 29, 2014 Between the hours of 9:45am - 11:00am LPA Brown reviewed (5) resident records, (1) Home Health Care Plan and (2) Personal & Incidental Records (P & I's) and (5) Client Medication Administration Records - review conducted by LPA Villegas, who did not observe any discrepancies at the time of visit. Between the hour 10:00am - 10:45am, LPA Villegas toured the facility with Jesus Chavez (Assistant Administrator) & Jared Mikos (Director of Operations and inspected resident bedrooms which had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked, emergency pull cords observed. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Common areas were clean and clear of hazards; doorways were free of obstructions. The water temperature tested at: 116.9°F in the breakroom and 105.8°F in the medication room. First Aid kit was checked and is fully stocked which is located in the medication room and kitchen. Upon document review by LPA, the inspection and drills were conduct: Fire Marshall Inspection on 07/01/2025 Fire Drill & Disaster Drill on 08/05/2025 at 10:00am Fire extinguisher are fully charged are located on each floor of the facility. Carbon monoxide and smoke detector are operational. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the report was provided to Jared Mikos (Director of Operations.the state’s words, verbatim · CDSS document, Oct 27, 2025

Allegation investigated: Staff are not providing residents with medication management. Staff are not abiding by the terms and conditions of Admission Agreement.

On 10/1/25, at 9:30am, Licensing Program Analyst (LPA) Perry Scott conducted an initial complaint visit to the facility and was greeted by Jesus Chavez, Assistant Administrator. LPA explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff and residents, and deliver findings for the allegations mentioned above. The investigation consisted of the following: The department investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R7). The department received the following facility documents: Resident Roster (Date: No Date), Staff Roster (Dated:10/01/2025), Physician Report (Dated: 2/17/2025, 02/19/2025, 03/12/2025,), ID/Emergency Information (Dated: 03/19/2021, 04/12/2024, 02/01/2021), Admissions Agreement (Dated: 03/25/2021), Resident Assessment (Dated: 08/08/25, 04/12/2024, 02/19/2025), Activity Calendar (September 2025, October 2025), and Medication Administration Record (Dated: 8/1-8/312025) from the facility. Report Continued on LIC9099-C Unsubstantiated The investigation revealed the following: Allegation #1- Staff are not providing residents with medication management. The details of the complaint alleged that the facility has a centralized location to give residents their medication but if a resident forgets or oversleeps, then a dosage is missed. On 10/1/2025, from 9:30am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R7) regarding the allegation. 4 of 4 staff denied the allegation that Staff are not providing residents with medication management. All staff (S1-S4) stated that the facility has a centralized location to give residents their medication, which is on the third floor in the medication room. They stated that those who are not able to come to the medication room to get their medication, it is taken to them by the medication technician, so it is not missed. They state further that they utilize Medication Administration Records (MAR) to chart medications given to residents and any missed or refused doses are written in the MAR and reported to their primary physician and family. The department interviewed residents (R1-R7) about the allegation and 7 of 7 residents that were interviewed stated that they have not missed any medications due to the location in which they receive their medication. Additionally, they stated their medication has not been mismanaged by the staff. The department reviewed a random sample of Medication Administration Records (Dated: 8/1/2025-9/30/2025) and did not observe any irregularities or deficiencies in the medication management of the residents’ records. Based on observation, interviews, and records reviewed, there is insufficient evidence to support the allegation that Staff are not providing residents with medication management. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. Allegation #2- Staff are not abiding by the terms and conditions of Admission Agreement. The details of the complaint alleged that the facility is not providing activities for the residents (such as trips to the beach) or providing the residents with cable in their room per their admission agreement. On 10/1/2025, from 9:30am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R7) regarding the allegation. Report Continued on LIC9099-C 4 of 4 staff denied the allegation that Staff are not abiding by the terms and conditions of Admission Agreement. All staff (S1-S4) stated that the residents are provided with daily activities to take part in at the facility and that each resident has access to cable in their room and it is a part of the basic services provided in the admissions agreement. Staff further state that activities provided by the facility include bingo, exercises, board games, trivia, outings to the park/beach, shopping trips, and arts and crafts just to name a few. Staff also stated that the admissions agreement states that the facility has a planned activity program but does not list which activities because the list changes often. The department interviewed residents (R1-R7) about the allegation and 7 of 7 residents that were interviewed stated that the facility does have a planned activity calendar and offers these activities daily. They further state that they are satisfied with the activities provided by the facility and enjoy them. The department reviewed the Admissions Agreement (Dated: 03/25/2021) and the Activity Calendar (September 2025, October 2025) and observed that each day the facility provides activities such as exercises, board games, walks to the beach, arts & crafts, trivia games, and religious discussions throughout the month of October 2025. Most of these activities were provided in the prior months, though some activities were due to change. The department also reviewed the admissions agreement, and cable is provided to all residents as part of the basic services provided by the facility. Additionally, the admissions agreement states that a planned activity program including arrangement for utilization of transportation to local community resources such as senior centers, parks, shopping malls, and other recreational venues will be offered to the residents. Based on observations, interviews, and records reviewed, there is insufficient evidence to support the allegation that Staff are not abiding by the terms and conditions of Admission Agreement. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No citations were issued. An exit interview was conducted with Jesus Chavez, Assistant Administrator, and a hard copy of this Complaint Investigation Report was provided.the state’s words, verbatim · CDSS document, Oct 1, 2025 · control 11-AS-20250923101252

Allegation investigated: Staff do not respond to residents' calls for assistance in a timely manner. Staff do not ensure residents’ incontinence needs are being met. Staff do not ensure residents' showering needs are being met. Staff do not ensure facility remains free of bad odors. Staff are mismanaging residents' medication .

On 08/06/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit to investigate the above-mentioned allegations. LPA met with Assistant Administrator, Jesus Chavez, and explained the purpose of the visit. LPA was granted access to the facility. The investigation consisted of the following: On 07/24/25, LPA reviewed resident files and requested and reviewed the following documents: staff roster, resident roster, call light logs for 06/01/25 through 07/24/25, shower skin monitoring forms for various residents, and residents shower schedule. LPA conducted interviews with staff #1-#6 (S1-S6), and residents #1-#3 (R1-R3). Additionally, LPA and Assistant Administrator, Jesus Chavez toured the facility, and inspected resident rooms, bathrooms, and common areas. On 07/25/25, LPA received Medication Administration Record (MAR) for the months of June and July 2025 R1-R3 and R8, conducted interviews with residents #4-#7 (R4-R7) and attempted to interview residents #8-#9 (R8-R9). Furthermore, on 08/06/25, LPA Gonzalez and Assistant Administrator, Jesus Chavez, inspected resident bedrooms #208 and #319. Unsubstantiated The investigation revealed the following: Regarding the allegation “Staff do not respond to residents' calls for assistance in a timely manner,” it is alleged that staff is taking a long time to respond to a resident’s call light request. On 07/24/25, between 12:10 PM and 1:45 PM, LPA Gonzalez conducted interviews with S1-S6. Of those interviewed, 6 out of 6 staff denied the allegation. 5 out of 6 staff stated that they respond to a residents call light request within 5 minutes. On 07/24/25, between 1:55 PM and 3:30 PM, LPA conducted interviews with R1-R3, and on 07/25/25 between 1:30 PM and 2:45 PM, LPA conducted interviews with R4-R7 and attempted to interview R8-R9. Of those interviewed, 6 out of 7 residents said staff responds to their call light request in a timely manner. 7 out of 7 residents stated that there is enough staff to meet their needs. On 08/06/25, LPA Gonzalez reviewed the Personnel Roster (Dated: 07/01/2025) and observed that there is sufficient staff to meet the needs of the residents. Additionally, on 08/06/25, LPA Gonzalez inspected resident bedrooms #208 and #319 and observed call buttons to be in operable condition. ¬LPA Gonzalez observed Assistant Administrator, Jesus Chavez pull the call light cord and found that the facility staff responded in less than four minutes. Based on record review, interviews, and observations, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Regarding the allegation “Staff do not ensure residents’ incontinence needs are being met,” it is alleged that residents are left in soiled briefs for extended periods of time. On 07/24/25, between 12:10 PM and 1:45 PM, LPA Gonzalez conducted interviews with S1-S6. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff stated that no residents is left in the same briefs for 24 hours or longer. 5 out of 6 staff stated that residents briefs are changed every 2 hours. Continued on LIC9099-C On 07/24/25, between 1:55 PM and 3:30 PM, LPA conducted interviews with R1-R3, and on 07/25/25 between 1:30 PM and 2:45 PM, LPA conducted interviews with R4-R8 and attempted to interview R8-R9. Of those interviewed, 5 out of 7 residents stated that they have not been left in soiled briefs for an extended period of time, and 2 out of 7 residents stated that they don’t require toileting assistance. 5 out of 7 residents stated that staff has not left a resident in the same briefs for 24 hours or longer, and 2 out of 7 residents stated that they didn’t know if a resident has been left in the same briefs for 24 hours or longer. Based on record review, interviews, and observations, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Regarding the allegation, “Staff do not ensure residents' showering needs are being met,” it is alleged that there are several residents who haven’t been showered in a month or longer. On 07/24/25, between 12:10 PM and 1:45 PM, LPA Gonzalez conducted interviews with S1-S6. Of those interviewed, 6 out of 6 staff stated that resident’s bathing needs are being met. S2 stated that the residents get two showers a week and the days vary depending on their schedule, hospice residents get one from staff and two from the hospice agency, and that they just check on their independent residents and make sure they are showering and ask them if they need assistance. S1 stated that if a resident refuses, staff will attempt three times and then document it on their skin monitoring form. The staff will sign that form after 3 attempts and so will the resident. On 07/24/25, between 1:55 PM and 3:30 PM, LPA conducted interviews with R1-R3, and on 07/25/25 between 1:30 PM and 2:45 PM, LPA conducted interviews with R4-R7 and attempted to interview R8-R9. Of those interviewed, 4 out of 7 residents said their bathing needs are being met, and 3 out 7 residents said they don’t require any bathing assistance. 4 out of 7 residents stated they get at least 2 showers a week, and 3 out of 7 residents said they don’t require any bathing assistance. 4 out of 7 residents said no resident has gone 24 hours or more without bathing, and 3 out of 7 residents said they didn’t know if a resident has gone 24 hours or more without bathing. 6 out of 7 residents said they are satisfied with the services provided to them. On 08/05/25 LPA conducted a review of the shower schedule and observed documentation indicating showers are done twice a week, LPA also observed documented refusals from residents on the facility’s skin monitoring forms. Based on record review, interviews, and observations, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Regarding the allegation, “Staff do not ensure facility remains free of bad odors,” it is alleged that a resident’s room has a very bad odor. On 07/24/25, between 12:10 PM and 1:45 PM, LPA Gonzalez conducted interviews with S1-S6. Of those interviewed, 5 out of 6 staff stated that a resident messes with their catheter and it causes urine to spill and get on the floor. 6 out of 6 staff said that housekeeping deep cleans resident’s room once a week, and as needed. 4 out of 6 staff denied that a resident’s room has a bad odor, and 2 out 6 staff said it does have a bad odor. On 07/24/25, between 1:55 PM and 3:30 PM, LPA conducted interviews with R1-R3, and on 07/25/25 between 1:30 PM and 2:45 PM, LPA conducted interviews with R4-R7 and attempted to interview R8-R9. Of those interviewed, 1 resident stated they have had accidents with their catheter which caused urine to spill on the floor, and that staff does a very good job at keeping their room clean. 6 out of 7 residents said they don’t know if a resident’s room has bad odor. 7 out of 7 residents stated that housekeeping cleans their room at least once a week. Based on record review, interviews, and observations, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Continued on LIC9099-C Regarding the allegation, “Staff are mismanaging residents' medication,” it is alleged that residents are missing their medications due to staff not ordering refills timely. On 07/24/25, between 12:10 PM and 1:45 PM, LPA Gonzalez conducted interviews with S1-S6. Of those interviewed, 4 out of 6 staff denied the allegation, and 2 out of 6 staff said they did not know if residents are missing their medications due to staff not ordering refills timely. 5 out of 6 staff said that staff administers the resident’s medication on time and as prescribed, and 1 out of 6 staff said they did not know if staff administers the resident’s medication on time and as prescribed. S2 stated that a resident has asked staff for their PRN medication, but sometimes they are out of it. often. S2 stated that it’s an issue because that certain medication is controlled, and requires for the resident to be seen by their doctor before they prescribe a refill. S2 stated that staff will call the doctor a week before the medication runs out, but the doctor won’t come until a week later to see the resident, which will cause a delay in the resident receiving the medication. On 07/24/25, between 1:55 PM and 3:30 PM, LPA conducted interviews with R1-R3, and on 07/25/25 between 1:30 PM and 2:45 PM, LPA conducted interviews with R4-R7 and attempted to interview R8-R9. Of those interviewed, 7 out 7 residents said they receive their medications on time and as prescribed by their physician. 7 out of 7 residents said they have not missed any medication due to the medication not being available. LPA Gonzalez conducted a record review of the MARs for the months of June and July 2025 for R1-R3 and R8 and did not observe any discrepancies or mismanaging of residents’ medication. Based on observation, interviews conducted, and a review of records, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited during this investigation. An exit interview was conducted with Assistant Administrator, Jesus Chavez, and a copy of this report and appeal rights was provided.the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 11-AS-20250718154112

Allegation investigated: Staff left residents in a soiled diaper for a long period of time. Staff did not ensure that residents are fed. Staff verbally abused a resident in care. Staff threw resident's personal belongings. Staff made false reports about a resident in care. Staff prevented the resident from having a visitor while in care.

This report serves to clarify investigation findings and is created to supersede the LIC 9099 and LIC 9099-C reports created on 3/21/25. Although this report supersedes the previous report, the complaint investigation findings remain the same. On 05/28/2025, LPA conducted a subsequent complaint visit LPA Richard met with Assistant Administrator Jesus Chavez and explained the purpose of the visit. On 03/21/2025, at 1:45 pm, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA met with Administrator Maria Bravo and explained the purpose of the visit. The investigation consisted of the following: On 12/03/24, LPA Richard obtained a copy of the following documents: the facility roster, resident roster, Physician Report, Resident face sheet, Admission agreement, Long Beach Police Department Report Receipt, and interviewed residents and staff members. On 12/03/24, between 10:30 am and 12:00 pm, LPA conducted interviews with residents #1-7(R1-R7), and between 12:00 pm – 2:00 pm, LPA Richard conducted interviews with staff #1-6 (S1-S6). Unsubstantiated Allegation #1: Staff left residents in soiled diapers for a long time. This complaint alleges that residents go hours without being changed and remain in soiled and dirty diapers. On 12/03/2024, between 10:30 am -12:30 pm, LPA Richard interviewed seven (7) residents #1-7 (R1-R7). 6 out of 7of denied the allegation and stated that they are changed every one to two hours daily. LPA interviewed six staff #1-6 (S1-S6). 6 out of 6 denied the allegation and stated that all the residents are being changed every 2 hours, sometimes sooner if an accident happened before or after the time to change passed. LPA interviewed Administrator #1 (A1), who stated that the residents are checked every 1 - 2 hours. Record review of changing schedule (dated 11/01/24 to 11/30/24), has a schedule of all the name of residents who wears a diaper on when to be changed. LPA Richard attempted to interview R1, who declined to answer any of the questions asked. Regarding the allegation: Staff leave residents soiled for an extended period, based on interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Allegation #2: Staff did not ensure that residents were fed. This complaint alleges that staff did not ensure residents were being fed and not being woken up to eat. LPA interviewed Administrator #1 (A1), Maria Bravo, about the allegation. A1 stated that meals are served on the third floor at 8 am, 11:30 am, and 4:30 pm like clockwork. If a resident does not come to eat in the dining room, the staff would go and knock on the resident's door and ask if the residents want to have breakfast brought to the room. The Administrator stated that the staff serves a well-balanced meal with a variety of food options to choose from each day. On 12/03/2024, between 10:30 am - 12:30 pm, LPA Richard interviewed seven residents #1-7 (R1-R7). 6 out of 7 denied the allegation and stated that the facility would go to their room and knock on the door to make sure they had breakfast, lunch, and dinner in the dining room. They also stated that they did not have any problem with the food. Report continued LIC9099-C On 12/03/2024, between 12:30 pm and 2:00 Pm, LPA Richard interviewed six (6) staff #1-6 (S1-S6) 6 out of 6 stated that they make sure the residents eat every day, if the residents did not want to eat the staff would talk to them to found out if they wanted to eat something else. LPA reviewed the facility menu for the week and observed a variety of food options listed on the menu. LPA Richard attempted to interview R1, who declined to answer questions when asked. Regarding the allegation, Staff did not ensure that residents were fed, Based on interviews and records review, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Allegation #3: Staff verbally abused the resident in care. This complaint alleges that the facility staff verbally abused residents due to retaliation if they reported the abuse. On 12/03/2024, between 12:00 pm and 2:00 pm, LPA interviewed Administrator #1 (A1) about the allegation. A1 denied that the staff ever verbally abused the clients. (A1) stated that they respect all the clients, and they go out of their way to help their clients because they want the clients to feel comfortable and have the freedom if they were in their own homes. On 12/03/24, between 10:30 am -12:00 pm, LPA interviewed seven (7) residents (R1-R7), 6 out of 7 stated that since they have been living there, the staff had never verbally abused them. On 12/03/24, between 12:00 pm – and 2:00 pm, LPA interviewed six (6) staff (S1-S6), 6 out of 6 denied the allegation and stated that they had never witnessed other staff verbally abuse the clients, on the contrary, the residents were the ones who verbally abused and threatened the staff. The staff also stated that they have received training regarding clients’ rights. LPA attempted to interview R1, who declined to answer any of the questions asked. Regarding the allegation, Staff verbally abused a resident in care. Based on interviews, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Report continued LIC9099-C Allegation #4: Staff threw the resident's personal belongings. This complaint alleges that staff entered the resident's room and threw the resident's clothes and shoes on the floor. The department interviewed Administrator #1(A1), who stated that the staff never entered the resident's room and threw their clothes and shoes on the floor because the staff knows the residents have rights, and the staff needs permission from the resident to even throw away expired food inside the refrigerator. On 12/ 03/24, between 10:30 am -12:00 pm, LPA interviewed seven (7) residents #1-7 (R1-R7). 5 out of 7 stated that the staff never threw their clothes on the floor. The staff always asked them if they could throw away the expired food inside the refrigerator when cleaning the room. On 12/03/24, between 12:00 pm- 2:00 pm, LPA interviewed six (6) staff #S (S1-S6), and 6 out of 6 stated that the resident has the right to say no to us and we cannot throw away their stuff. The staff also stated that they have not received a complaint from the resident in care that the facility staff threw away their stuff. LPA attempted to interview R1, who declined to answer any of the questions asked. Regarding the allegation, Staff threw the president’s personal belongings. Based on interviews, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Allegation #5: Staff made a false report about a resident in care. This complaint alleges that the staff made a false report about a resident, resulting in the facility calling law enforcement and filing false reports to get the client arrested. On 12/03/24, between 12:00 pm – 2:00 pm, LPA interviewed administrator #1 (A1), who stated that the facility did call law enforcement for the resident it was resident, who was choking one of our residents. When police arrived, the victim didn’t want to press battery charges. On 12/03/24, between 12:00 – 2:00 pm, LPA Records reviewed of law enforcement report receipt dated 11/23/24 and confirmed that law enforcement did receive a call from the facility about an altercation. The department interviewed seven (7) residents #1-7 (R1-R7), and 6 out of 7 stated that they didn’t know anything about the staff making false reports about them; all they knew was that the staff always tried to help when there was fighting among the residents. Report Continues, see LIC9099C LPA Richard attempted to interview R1, who declined to answer any of the questions asked. Regarding the allegation, Staff made a false report about a resident in care. Based on interviews, and record reviews, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Allegation #6: Staff prevented the resident from having a visitor in care. This complaint alleges that the staff is not allowing the residents' visitors to visit the residents and stated that the resident is not there. On 12/03/24, between 12:00 pm -2:00 pm, LPA interviewed administrator #1, Maria Bravo (A1), who denied the allegation. A1 stated that all the residents have visitors seven days a week. If the residents share rooms, they cannot have visitors inside the room, unless it’s a private room. On 12/03/24 between 12:00 pm - 2:00 pm, LPA interviewed the facility front desk (S2) and stated that most of the residents have visitors, and they must sign in and out. Sometimes, the family members refuse to sign in and out, but we never deny them entry. On 12/03/24, between 10:30 am -12:00 pm, LPA interviewed seven (7) residents (R1-R7), and 6 out of 7 stated that they do have family members visit them; they all know that if they have a roommate, they cannot have visitors inside their room. On 12/03/24, between 12:00 pm and 2:00 pm, LPA interviewed six (6) staff (S1-S6), all denied the allegation. LPA Richard attempted to interview R1, who declined to answer any questions asked. Records reviewed, dated 09/30/2024, showed that most of the residents had visitors at the facility. During the visit to the facility on 12/03/2024, the department observed several family members visiting the residents; some of them signed in, and some of them refused to sign in. Based on interviews, observations, and records reviewed, there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to the Assistant Administrator Jesus Chavez.the state’s words, verbatim · CDSS document, May 28, 2025 · control 11-AS-20241125214045

Allegation investigated: Facility is refusing to accept resident back from skilled nursing facility. Staff did not safeguard resident's personal belongings.

On 05/15/2025 at 8:30am, LPA initiated a conducted a subsequent complaint visit at this facility to deliver the complaint findings. During today’s visit, LPA met with Maria Bravo (Administrator) and explained the purpose of the visit. The investigation consisted of the following: On 05/08/2025, LPA interviewed the Administrator (A1), Staff #1 – Staff #4 (S1–S4), & Resident #2 (R2). On 05/15/2025, LPA interviewed Resident (R1), Resident #3 (R3) – Resident #7 (R7). On 05/08/2025, LPA reviewed the documents of the resident roster & staff roster (received on 05/08), all of the documents for R1 such as the Admission Agreement (dated 04/01/2025), LIC 601 Identification & Emergency Information (dated 04/01/2025), LIC 602 Physician Report for RCFE (dated 03/08/2025), LIC 603, LIC 613-C Personal Rights (dated 04/01/2024) LIC 621 Client Resident Personal Property (dated 04/01/2024), (13) LIC 624 Unusual Incident/Injury Report (October 2024 – March 2025), Order Summary Report (dated 05/08/2025), Medication Administration Records (April - May 2025 - printed 05/08/2025), Preplacement Appraisal Information (dated 05/8/2025) , & Individualized Service Plan (dated 04/01/2024). Unsubstantiated The investigation revealed the following: Allegation: Facility is refusing to accept resident back from skilled nursing facility. It was alleged R1 was admitted to the hospital on 03/16/2025 and subsequently transferred to a skilled nursing facility (SNF). It is alleged upon discharge from the SNF the facility refused to accept the resident back to the Villa Redondo. On 05/08/2025 between the hours of 2:04pm -2:47pm, LPA interviewed Staff #1(S1) – Staff #4 (S4) regarding the allegation. On 05/15/2025 between the hours of 9:24am – 10:39am, LPA interviewed Staff #5 (S5) – Staff #7 (S7) regarding the allegation. Staff #1 (S1) – Staff #7 (S7) were unaware of the allegation. S1 – S7 interviews indicated general awareness that returning residents must meet reassessment and care level requirements. No staff reported being involved in or aware of any resident being permanently denied re-entry in the past. 7 out of 7 staff denied the allegation of facility not allowing the resident to return to the facility from Skilled Nursing Facility (SNF). On 05/14/2025 at 11:51am, LPA received interviewed with the Administrator (A1) via email (document dated 05/08/2025) regarding the above allegation. On 05/08/2025, according to the Administrator (A1) Maria Bravo, stated the resident’s return was dependent upon progress in physical therapy and the results of a reassessment. Documentation and correspondence confirmed that the resident was scheduled to return on 05/08/2025. On 05/14, Administrator stated R1 returned to the facility on 05/09. On 05/08/2025 between the hours of 2:25pm – 2:28pm, LPA interviewed Resident #2 (R2). On 05/14/2025 between the hours of 9:37am – 10:20am, LPA interviewed Resident #1 (R1), Resident #3 (R3) – Resident # 8 (R8). (1) out of (8) residents interviewed confirmed the allegation; (7) out of (8) residents denied the allegation. On 05/15/2025 at 10:08am, LPA observed R1 has returned to the facility. Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated. Allegation: Staff did not safeguard resident's personal belongings. It is being alleged that upon moving into the facility Resident #1 (R1) states she had a manual blue wheelchair with duct tape that is missing. On 05/14/2025 at 11:51am, LPA received interviewed question answers from the Administrator (A1) via email (document dated 05/08/2025) regarding the above allegation. A1 was unaware of the allegation. On 05/08/2025, according to the Administrator (A1) Maria Bravo, stated the resident refused to complete the LIC 621: Client/Resident Personal Property and Valuables form, thus declining documentation of personal belongings. A1 stated no inventory of the resident’s belongings was documented at the time of departure to the SNF. A1 stated the resident may have confused her wheelchair with another due to similar descriptions. The facility offered an alternative wheelchair, which the resident declined. On 05/08/2025 between the hours of 2:04pm -2:47pm, LPA interviewed Staff #1(S1) – Staff #4 (S4) and on 05/15/2025, between the hours of 9:24am – 10:39am, LPA interviewed Staff #5 (S1)– Staff #7 (S7) regarding the allegation. Staff #1 (S1) – Staff #7 (S7) were unaware of the allegation. S1 – S7 interviews indicated that residents’ personal items are typically left in their rooms and that the room is locked after staff assist the resident’s roommate. On 05/08/2025 between 2:25pm – 2:28pm and 05/14/2025 9:37am - 10:20am, LPA interviewed Residents #1(R1) – Resident #8 (R8). 3 out of 8 residents interviewed confirmed the allegation; 5 out of 8 out residents denied the allegation. On 05/15/2028 between the hours 8:45am – 9:00am, LPA conducted a record review and observed LIC 621 Client/Resident Personal Property and Valuables. Resident #1 (R1) declined to complete the document by listing all their personal belongings. On 05/08/2025, between the hours of 2:25pm – 2:28pm, LPA conducted a tour of the resident room and observe Resident (R1) has a red electric wheelchair located near R1 bed located in her shared room. Based on observation, interviews, and record reviews, there is not enough evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is unsubstantiated. Exit interview conducted with Maria Bravo (Administrator) & copy of the report was provided.the state’s words, verbatim · CDSS document, May 15, 2025 · control 11-AS-20250506153328

Allegation investigated: Staff left residents in a soiled diaper for a long period of time. Staff did not ensure that residents are fed. Staff verbally abused a resident in care. Staff threw resident's personal belongings. Staff made false reports about resident in care. Staff prevented resident from having a visitor while in care.

On 03/21/2025, at 1:45 pm, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA met with Administrator Maria Bravo and explained the purpose of the visit. The investigation consisted of the following: On 12/03/24, LPA Richard obtained a copy of the following documents: the facility roster, resident roster, Physician Report, Resident face sheet, Admission agreement, Long Beach Police Department Report Receipt, and interviewed residents and staff members. On 12/03/24, between 10:30 am, and 12:00 pm, LPA conducted interviews with residents #2-7(R2-R7), and between 12:00 pm – 2:00 pm LPA Richard conducted interviews with staff #1-6 (S1-S6). Report continues, see LIC9099C Unsubstantiated Allegation #1: Staff left residents in soiled diapers for a long time. The investigation revealed the following: Regarding the allegation Staff leave residents soiled for an extended period, it is alleged that residents go hours without being changed and remain in soiled and dirty diapers. On 12/03/2024, between 10:30 am -12:30 pm, LPA Richard interviewed three (3) residents #2-4 (R2-R4) 3 out of 3 denied the allegation and stated that they are changed every one to two hours daily. LPA interviewed six staff #1-6 (S1-S6) 6 out of 6 denied the allegation and stated that all the residents are being changed every 2 hours sometimes sooner if tan accident happened before or after the time to change passed. LPA interviewed administrator#1 (A1) who stated that the residents are checked every 1 - 2 hours. Record review of changing schedule (dated 11/01/24 to 11/30/24), has a schedule of all the name of residents who wears a diaper on when to be changed. LPA Richard was not able to interview R1. Regarding the allegation: Staff leave residents soiled for an extended period, based on interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Report Continues, see LIC9099C Allegation #2: Staff did not ensure that residents were fed. The complainant alleges that staff did not ensure residents were being fed and not being woken up to eat. LPA interviewed administrator #1 (A1) Maria Bravo about the allegation. A1 stated that meals are served on the third floor at 8 am, 11:30 am, and 4:30 pm like clockwork. If a resident does not come to eat in the dining room, the staff would go and knock on the resident's room and ask if the residents want to have the breakfast brought to the room. The Administrator stated that the staff serves a well-balanced meal with a variety of food options to choose from each day. On 12/03/2024, between 10:30 am - 12:30 pm, LPA Richard interviewed six residents #2 (R2-R7) 6 out of 6 denied the allegation and stated that the facility would go to their room and knocked on the door to make sure they had breakfast, lunch and dinner, in the dining room. They also stated that they did not have any problem with the food. On 12/03/2024, between 12:30 pm and 2:00 Pm, LPA Richard interviewed six (6) staff #1-6 (S1-S6) 6 out of 6 stated that they make sure the residents eat every day, if the residents did not want to eat the staff would talk to them to found out if they wanted to eat something else. LPA reviewed the facility menu for the week and observed a variety of food options listed on the menu. LPA was unable to interview R1. Regarding the allegation, Staff did not ensure that residents were fed, Based on interviews and records review, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Report Continues, see LIC9099C Allegation #3: Staff verbally abused resident in care. The complaint alleged that the facility verbally abused residents due to retaliation if they reported the abuse. On, 12/03/2024, between 12:00 pm and 2:00 pm LPA interviewed administrator #1 (A1) about the allegation A1 denied the staff ever verbally abusing the clients. (A1) stated that they respect all the clients, and they go out of their way to help their clients because they want the clients to feel comfortable and have the freedom if they were in their own homes. On 12/03/24, between 10:30 am -12:00 pm, LPA interviewed six (6) residents (R2-R7), 6 out of 6 stated that since they have been living there, the staff had never verbally abused them. On 12/03/24, between 12:00 pm – and 2:00 pm, LPA interviewed six (6) staff (S1-S6), 6 out of 6 denied the allegation and stated that they had never witnessed other staff verbally abuse the clients, on the contrary, the residents were the ones who verbally abused and threatened the staff. The staff also stated that they have taken training regarding clients’ rights. LPA Richard was unable to interview R1. Regarding the allegation, Staff verbally abused a resident in care. Based on interviews, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Report Continues see LIC9099C Allegation #4: Staff threw resident’s personal belongings. It is being alleged that staff entered the resident's room and threw the resident's clothes and shoes on the floor. The department interviewed administrator #1(A1), who stated that the staff never entered the resident's room and threw their clothes and shoes on the floor because the staff knows the residents have rights, the staff needs permission from the resident to even throw away expired food inside the refrigerator. On 12/ 03/24, between 10:30 am -12:00 pm, LPA interviewed six residents #2-7 (R2-R7) 5 out of 6 stated that the staff never threw their clothes on the floor. The staff always asked them if they could throw away the expired food inside the refrigerator when cleaning the room. On 12/03/24, between 12:00 pm- 2:00 pm, LPA interviewed six (6) staff #S (S1-S6), and 6 out of 6 stated that the resident has the right to say no to us and we cannot throw away their stuff. The staff also stated that they have not received a complaint from the resident in care that facility staff threw away their stuff. LPA was unable to interview resident R1. Regarding the allegation, Staff threw the president’s personal belongings. Based on interviews, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Report Continues, see LIC9099C Allegation #5: Staff made a false report about a resident in care. The complaint alleged that the staff made a false report about a resident, resulting in the facility calling law enforcement and filing false reports to get the client arrested. On, 12/03/24, between 12:00 pm – 2:00 pm, LPA interviewed administrator #1 (A1), who stated that the facility did call law enforcement for the resident it was a resident, who was choking one of our residents. When police arrived, the victim didn’t want to press battery charges. On 12/03/24, between 12:00 – 2:00 pm, LPA Records reviewed of law enforcement report receipt dated 11/23/24 and confirmed that law enforcement did receive a call from the facility about an altercation. The department interviewed six residents #2-7 (R2-R7), and 6 out of 6 stated that they didn’t know anything about the staff making false reports about them, all they knew was that the staff always tried to help when there was fighting among the residents. LPA was unable to interview R1. Regarding the allegation, Staff made a false report about a resident in care. Based on interviews, and record reviews, the department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. As a result, the allegation is Unsubstantiated. Report Continues, see LIC9099C Allegation #6: Staff prevented the resident from having a visitor in care. It is being alleged that the staff is not allowing the resident visitors to visit residents and stated that the resident is not there. On 12/03/24, between 12:00 pm -2:00 pm, LPA interviewed administrator #1, Maria Bravo (A1), who denied the allegation. A1 stated that all the residents have visitors seven days a week. If the residents share rooms, the residents cannot have visitors inside the room, unless it’s a private room. On 12/03/24 between 12:00 pm - 2:00 pm, LPA interviewed the facility front desk (S2) and stated that most of the residents have visitors, and they must sign in and out. Sometimes, the family members refuse to sign in and out, but we never denied them entry. On,12/03/24, between 10:30 am -12:00 pm, LPA interviewed six (6) residents (R2-R7), and 6 out of 6 stated that they do have family members visit them, they all know if they have a roommate, they cannot have visitors inside their room. On, 12/03/24, between 12:00 pm – 2:00 pm LPA interviewed six (6) staff (S1-S6) all denied the allegation. The records reviewed, dated 09/30/2024, showed that most of the residents had visitors at the facility. During the visit to the facility on 12/03/2024, the department observed several family members visiting the residents some of them signed in, and some of them refused to sign in. Based on interviews, observations, and records reviewed, there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed unsubstantiated. No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to the Administrator Maria Bravo.the state’s words, verbatim · CDSS document, Mar 20, 2025 · control 11-AS-20241125214045

Allegation investigated: Staff leave resident in wet diapers for extended period of time. Staff do not respond to resident's calls for assistance in timely manner.

On 2/21/25, the department conducted an unannounced complaint visit. The department met me with staff Yvonne Garcia and explained the purpose of this visit. The department and staff toured the facility. Later, the department was joined by the Administrator, Maria Bravo. The Investigation Considted of: The department Interviews the Administrator (A1), six Staff (S1-S6), and six Residents (R1-R6). The department obtained and reviewed the following documents: Resident’s roster, Personnel roster, (R1-R6) Identification, and Emergency Information, (R1-R6) Physicians Report or LIC 602A. Facility Changing schedules residents wearing diapers and Alarms by apartment. Evaluation Report continues LIC 9099-C Unsubstantiated Allegation #1: Staff leave resident in wet diapers for extended periods of time. The details of the complaint alleged that facility staff are not changing resident's diapers, resulting in residents experiencing rash and burning. The department interviewed the administrator (A1), stated that the facility has a schedule, and that the facility staff also changed the resident's diapers as needed. The department interviewed six residents (R2-R7) 4 out of 6 residents stated that the staff regularly changed their diapers, including incontinence services. The department interviewed six staff (S1-S6), 6 out of 6 stated that the facility has a diapers and incontinence schedule, and in addition, the facility staff changes residents' diapers every 2 hours and as needed. The department records review of facility changing diapers and incontinence services dated 04/01/24 to the present indicated that all the residents who wear diapers have a scheduled time to check and change diaper services between one to two hours seven days a week. The department was unable to interview (R1). Based on the interviews, observation, and record reviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated Continued LIC-9099-C Page 2 Allegation: Staff do not respond to resident’s calls for assistance in a timely manner. The details of the complaint alleged that the resident called the night shift, and the staff failed to respond in a timely manner. The department interviewed the administrator (A1), who stated that the facility staff tends to the residents' needs as fast as possible, even in the middle of the night, between 5 to 10 minutes. Additionally, (A1) stated they encourage all staff to answer the Emergency Call System (ECS) if they hear it ringing. A1 stated they have five (5) residents who usually call the facility, averaging 150 times per shift, for assistance just to get the TV remote or to close the bathroom door (etc.) for them. In interviews with six Staff (S1-S6), 6 out of 6 stated if they are available and if they hear the (ECS), they will answer it. The staff also stated that the resident must initiate the (ECS), and the caregivers or the Medical Technician (MedTech) would assist the resident. The department inspected four residents' bedrooms, #219, #220, #303, and # 313, and found that the (ECS) was accessible to residents, and once pressed, the facility staff answered in less than a minute. The department confirmed it. The department interviewed six residents (R2-R7) 5 out of 6 residents interviewed indicated that they had used the (ECS) and that staff members had assisted them in less than five minutes. Once the (ECS) is pushed, the system sends an alert to the MedTech station and the caregiver's cell phone for assistance. The MedTech or the caregivers were notified of the alert and went to the resident's room to assist. The department was unable to interview (R1). Based on the interviews, observation, and record reviews, there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. The exit interview was conducted, and a copy of this report was given to Administrator Maria Bravo.the state’s words, verbatim · CDSS document, Feb 21, 2025 · control 11-AS-20250212150220

Type of visit: Case Management - Incident

On December 05, 2024 at 8:10 am Licensing Program Analyst (LPA) Zina Brown conducted an unannounced health and safety check to follow up on a incident that occurred on November 27, 2024. During today visit we met with Maria Bravo (Administrator) and explained the purpose of the visit. During today's visit, LPA conducted interviews with staff and clients. LPA also reviewed and collected the following: LIC 500: Personnel Report LIC 601: Identification and Emergency Information (Resident #1 - Resident #2) LIC 602: Physician's Report for Community Care Facilities (Resident #1 - Resident #2) LIC 625: Appraisal/Needs and Services Plan (Resident #1 - Resident #2) LIC 624: Unusual Incident/Injury Report Medication list for (Resident #1 & Resident #2) Reviewed and received video surveillance footage of the incident that occurred on 11/27/2024 Due to insufficient information available at this time a further investigation is needed. A exit interview was conducted with Maria Bravo (Administrator), and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 5, 2024

Allegation investigated: Staff did not prevent resident from causing harm to another resident. Staff did not report incident.

The investigation consisted of the following: On 09/27/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s). LPA met with Staff Kyra Olguin and explained the purpose of the visit. The Administrator Maria Bravo joined us later. During today’s investigation, LPA Cloyd reviewed facility records, two resident records, observed lunch, and interviewed residents and staff members. On 10/04/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA met with Staff Kyra Olguin and explained the purpose of the visit. During today’s investigation, LPA Cloyd interviewed residents, Assistant Administrator, and reviewed facility records. Continue to LIC9099-C. Unsubstantiated Allegation(s): Staff did not prevent resident from causing harm to another resident. The investigation revealed the following: Regarding the allegation "Staff did not prevent resident from causing harm to another resident,” it is being alleged that on 02/10/24 8:00 AM and 09/05/24 8:00 AM, Resident #1 (R1) was scratched in the face by Resident #2 (R2). The Report of Suspected Elder Abuse (02/10/24) revealed that the police were contacted to file a report and both residents were advised to stay away from one another. The Unusual Incident Report (09/05/24) revealed that responsible parties were notified, R1 and R2 will be monitored for changes in condition, R1’s behavior would be monitored, and residents will be encouraged to keep their distances. Interview with the Administrator indicated that both residents have been encouraged to use different elevators to avoid being in the same hallway for breakfast. The Administrator also indicated that conversations have been had with both Power of Attorneys regarding the incidents and the facility rules. Four out of five residents indicated staff supervise the area near the dining room halls around breakfast. Four out of six residents indicated that they feel safe at the facility. Regarding the allegation “Staff did not prevent resident from causing harm to another resident,” based on record review and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Allegation(s): Staff did not report incident. The investigation revealed the following: Regarding the allegation " Staff did not report incident,” it is being alleged that resident-on-resident (Resident #1 and Resident #2) incident was not reported to the Long-Term Care Ombudsman Program. Record review revealed that The Report of Suspected Elder Abuse (02/10/24) was reported to the Police Department, Community Care Licensing, and Ombudsmen. The Unusual Incident Report (09/05/24) was sent to Community Care Licensing and a police report was filed. Interview with the Administrator indicated that the Wellness Director left a voicemail on the general line at the Ombudsmen’s office. Administrator also indicated that the Licensed Vocation Nurse documented and sent the Elder Abuse form and the Wellness Director documented and sent the Unusual Incident Report. Continue to LIC9099-C. Regarding the allegation “Staff did not report incident,” based on record review and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegations. An exit interview was conducted and a copy of this report was provided to the Staff Kyra Olguin.the state’s words, verbatim · CDSS document, Oct 4, 2024 · control 11-AS-20240925143751

Allegation investigated: Staff did not prevent resident from causing harm to another resident. Staff did not report incident.

The investigation consisted of the following: On 09/27/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s). LPA met with Staff Kyra Olguin and explained the purpose of the visit. The Administrator Maria Bravo joined us later. During today’s investigation, LPA Cloyd reviewed facility records, two resident records, observed lunch, and interviewed residents and staff members. On 10/04/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA met with Staff Kyra Olguin and explained the purpose of the visit. During today’s investigation, LPA Cloyd interviewed residents, Assistant Administrator, and reviewed facility records. Continue to LIC9099-C. Unsubstantiated Allegation(s): Staff did not prevent resident from causing harm to another resident. The investigation revealed the following: Regarding the allegation "Staff did not prevent resident from causing harm to another resident,” it is being alleged that on 02/10/24 8:00 AM and 09/05/24 8:00 AM, Resident #1 (R1) was scratched in the face by Resident #2 (R2). The Report of Suspected Elder Abuse (02/10/24) revealed that the police were contacted to file a report and both residents were advised to stay away from one another. The Unusual Incident Report (09/05/24) revealed that responsible parties were notified, R1 and R2 will be monitored for changes in condition, R1’s behavior would be monitored, and residents will be encouraged to keep their distances. Interview with the Administrator indicated that both residents have been encouraged to use different elevators to avoid being in the same hallway for breakfast. The Administrator also indicated that conversations have been had with both Power of Attorneys regarding the incidents and the facility rules. Four out of five residents indicated staff supervise the area near the dining room halls around breakfast. Four out of six residents indicated that they feel safe at the facility. Regarding the allegation “Staff did not prevent resident from causing harm to another resident,” based on record review and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Allegation(s): Staff did not report incident. The investigation revealed the following: Regarding the allegation " Staff did not report incident,” it is being alleged that resident-on-resident (Resident #1 and Resident #2) incident was not reported to the Long-Term Care Ombudsman Program. Record review revealed that The Report of Suspected Elder Abuse (02/10/24) was reported to the Police Department, Community Care Licensing, and Ombudsmen. The Unusual Incident Report (09/05/24) was sent to Community Care Licensing and a police report was filed. Interview with the Administrator indicated that the Wellness Director left a voicemail on the general line at the Ombudsmen’s office. Administrator also indicated that the Licensed Vocation Nurse documented and sent the Elder Abuse form and the Wellness Director documented and sent the Unusual Incident Report. Continue to LIC9099-C. Regarding the allegation “Staff did not report incident,” based on record review and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegations. An exit interview was conducted and a copy of this report was provided to the Staff Kyra Olguin.the state’s words, verbatim · CDSS document, Oct 4, 2024 · control 11-AS-20240925143751

Type of visit: Case Management - Incident

On 10/04/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced visit at the above facility to address two separate physical altercations on 02/10/24 8:00 AM and 09/05/24 8:00 AM between Resident #1 (R1) and Resident #2 (R2). LPA met with Staff Kyra Olguin and explained the purpose of the visit. Based on record review and interviews, the facility did not complete a reappraisal for R1 and R2 after either incident. The last reappraisal for R1 is dated 06/02/23 and 08/31/23 for R2. Interviews conducted indicated that R1 makes inappropriate remarks. Record review and interviews revealed that R2 has a history of aggression. A Technical Violation is being cited based on interviews and record review in accordance with the California Code of Regulations, Title 22, see LIC9102. LPA observed two video surveillance recordings of R1 and R2 fighting on both dates listed above. Both incidents occurred in the hallway near the dining room prior to breakfast. The recordings did not capture staff in the frame to break the altercation up. Technical Assistance provided in accordance with the California Code of Regulations, Title 22, see LIC9102. An exit interview was conducted and a copy of this report was provided to the Staff Kyra Olguin.the state’s words, verbatim · CDSS document, Oct 4, 2024

Type of visit: Case Management - Annual Continuation

On 10/03/2024 at 8:15 am , LPA Zina Brown conducted an unannounced continuation annual visit using the CARE Inspection Tool. LPA met David Hernandez (Assistant Administrator) with the purpose of today’s visit was explained. The annual facility fee renewal is a balance of $0. Liability Insurance Policy (Policy # IYG426175E) is current and valid from 08/06/2024 - 08/26/2025 and as followed occurrence at $1,000,000 and general aggregate at $3,000,000. Upon document review by LPA, the inspection and drills were conduct: Fire Marshall Inspection on 11.21.2023 Fire Drill & Disaster Drill 09.13.2024 Fire extinguisher are fully charged and were inspected on 09.09.2024. Carbon monoxide and smoke detector are operational. In the following residents rooms, water temperature tested at: 108.0 F in Rm 203 | 107.6 in Rm 206 | 111.8 F in Rm 207 | 109.4 F in Rm 303 | 105.4 in Rm 3034 LPA reviewed (10) client records, (10) Client Medication Administration Records, (8) Hospice Plan of Care Orders and (12) Personal & Incidental Records (P & I's)and did not observe any discrepancies at the time of visit. First Aid kit was checked and is fully stocked. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the report was provided to David Hernandez (Assistant Administrator).the state’s words, verbatim · CDSS document, Oct 3, 2024

Type of visit: Required - 1 Year

On 10/02/2024 at 12:10pm, Licensing Program Analyst (LPA) Zina Brown and Licensing Program Manager (LMP) Janae Hammond conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one- year inspection. LPA met with Maria Bravo , Administrator and David Hernandez, Assistant Administrator and the purpose of the visit was discussed. Facility is licensed to serve 73 non- ambulatory residents, 7 bedridden residents and an approved hospice waiver for 7 residents. The facility does handle residents cash resources. The facility has residents diagnosed with the following: 15 dementia residents 15 receiving home health residents 10 hospice care services residents. The facility is a 3 story building consisting of: 1st floor: Lobby, business offices, conference room, salon, laundry, designated smoking area outside, and parking lot 2nd floor: 20 resident rooms, outdoor shaded area, kitchen, and dining room and an emergency evacuation chair is located on the 2nd floor stairwell. 3rd floor: 20 resident rooms, activity room, library, medication and storage room. LPA and LPM toured the facility with David Hernandez, Assistant Administrator and inspected resident bedrooms which had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Common areas were clean and clear of hazards; doorways were free of obstructions. Report continues on LIC 809-C Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Outside grounds were toured and no bodies of water were observed. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises. Due to time constraints, LPA was unable to complete the inspection, LPA will return at a later date. No deficiencies were cited during the time of this visit. An exit interview was conducted, and a copy of report was provided.the state’s words, verbatim · CDSS document, Oct 2, 2024

Allegation investigated: Resident sustained an unexplained fracture while in care. Resident is being physically abused while in care. Staff leave residents soiled for an extended period of time.

On 06/19/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA met with Administrator Maria Bravo and explained the purpose of the visit. The investigation consisted of the following: During today’s investigation, LPA Cloyd reviewed records and video recording, and interviewed eight (8) residents and six (6) staff members which included the Administrator, Wellness Coordinator, Lead MedTech, Caregiver/MedTech, and (2) Caregivers. On 06/03/2024 around 09:00AM Licensing Program Analyst (LPA) Jose Calderon initiated an investigation with Villa Redondo Care Home for the allegations listed above. Today’s complaint investigation was conducted face to face with Administrator Maria Bravo A1. During today’s visit, LPA Jose Calderon conducted face to face with Administrator Maria Bravo A1. LPA Calderon and Administrator A1 toured the facility including all common areas. Continue to LIC9099-C Unsubstantiated LPA Calderon requested copies of the following: Copy of R1-R3 facility file to include Staff and Resident Roster, Needs and Service plan, SIR reports for current complaint and 3 months. MAR for 3 months, physician report admission agreement, Hospital records, admission agreement for R1-R3. It has been determined that the complaint of “Personal Rights” will require further investigation. Allegation(s): Resident sustained an unexplained fracture while in care. The investigation revealed the following: Regarding the allegation "Resident sustained an unexplained fracture while in care,” it is being alleged that Resident #1 (R1) sustained an unknown broken arm a few months ago. On 06/19/24, LPA observed that R1 was not in a cast nor sling but complained of pain. Record review revealed R1 was sent to the hospital on 07/13/23 for a swollen arm. R1 returned to the facility the same day with new prescription and a fracture to the left arm. Interview with the Wellness Coordinator indicated that R1 was placed on hospice shortly after the arm swelling and hospice tended to the arm fracture. Record review revealed that R1 was admitted to hospice on 07/20/23. Interview with the Administrator indicated that the cause of arm swelling was unknown and that in 2023 R1 would get up unassisted, (unwitnessed) fall, and unable to recall the incident. Regarding the allegation “Resident sustained an unexplained fracture while in care,” based on observation, record review, and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation(s): Resident is being physically abused while in care. The investigation revealed the following: Regarding the allegation "Resident is being physically abused while in care,” it is being alleged Resident #1 (R1) had a red bruise on R1’s leg due to a kick and R1 was pushed into a wall. Record review revealed that R1 hit R1’s leg on R1’s wheelchair on 05/23/24 and Hospice provided care on the same day. Interview with MedTech indicated that R1 was startled by her knock on the door and R1 quickly lifted R1’s leg and hit R1’s wheelchair. Continue to LIC9099-C MedTech indicated that R1 sleeps diagonally. LPA Cloyd observed R1 laying diagonally. Staff interviews indicated that they have not witnessed residents being physically abused. Interview with the Administrator indicated that on 05/23/24, a resident reported R1 being pushed into a wall in the dining room hallway. LPA observed the 05/23/24 hallway video recording with the Administrator and did not observe R1 being pushed into a wall in the dining room hallway. Regarding the allegation “Resident is being physically abused while in care,” based on observation, record review, and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation(s): Staff leave residents soiled for an extended period of time. The investigation revealed the following: Regarding the allegation "Staff leave residents soiled for an extended period of time,” it is being alleged that residents go hours without being changed. It is being alleged that residents remain soiled for hours until someone decides to check on them. Staff interviews, including the Administrator, indicated that residents are checked every 1 - 2 hours. Six (6) out of six (6) resident interviews indicated that they have not received incontinence complaints from other residents. Two (2) out of three (3) residents indicated that they are changed every two hours. Regarding the allegation “Staff leave residents soiled for an extended period of time,” based on interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Administrator Maria Bravo.the state’s words, verbatim · CDSS document, Jun 19, 2024 · control 11-AS-20240531123105

Allegation investigated: Facility staff are not properly addressing altercations between residents.

Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit to this facility to investigate the allegation mentioned above. LPA met with Leslie Estrada, Wellness Director, and explained the purpose of this visit. Administrator Maria Bravo joined LPA shortly after. The investigation consisted of: Interviews conducted with Administrator, Maria Bravo, Facility Staff #1-#2 (S1-S2), Residents #1-#6 (R1-R6). LPA reviewed four client files and requested copies of the following records: Staff Roster, Resident Roster, R1-R4 Physicians Report, R1-R4 Individualized Service Plan, House Rules (page 16-18) of the Admissions Agreement, 30-Day Eviction Notice for R2, Unusual Incident Reports dated: 04/12/24, 04/18/24, and a copy of a written notice from resident. Investigation revealed the following: Allegation: Facility staff are not properly addressing altercations between residents. Unsubstantiated The details of the complaint allege that the resident is being threatened both physically and verbally and the facility staff are not properly addressing altercations between residents. Interviews conducted with 4 out of 6 residents revealed that staff are addressing altercations between residents. R1 stated that in the beginning staff would tell R1 to ignore R2 and avoid contact but is now noticing that the facility is more active in assisting R1 with altercations with R2. R1 stated that on one occasion, R2 purposely bumped into them as they were walking by, and facility staff immediately separated both R1 and R2. R1 stated that the facility has called the police on various occasions and are constantly redirecting both R1 and R2 to deescalate these altercations. R1 also stated that the facility has offered them to move to a different room in a different floor, but R1 stated that they are not ready to move just yet and said that they were going to wait another month to see if things got better, if they didn’t, then they will consider moving. Interviews conducted with 3 out 3 staff revealed that facility staff is actively addressing altercations between residents. LPA spoke with Administrator, Maria Bravo and she stated that she has have been working with both residents to try and avoid altercations between them. The facility has reached out to R2’s physician and has also offered R2 for a phycological evaluation but R2 continues to deny any help. Maria Bravo stated that R1 and R2 were once roommates, and as soon as the facility knew of these altercations, they immediately separated both residents into separate rooms. She stated that she has had several meetings with R2 and has tried talking with them to see how to resolve this issue, but it has not helped. Lastly, R2 was provided with a 30-Day Eviction Notice for violation of house rules. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held. A copy of the report was provided to Maria Bravo, Administrator.the state’s words, verbatim · CDSS document, Jun 12, 2024 · control 11-AS-20240605132411

Allegation investigated: Staff are not ensuring that resident is administered their medication(s) as prescribed. Licensee is not ensuring that resident(s) have access to clean water while in care.

On 04/18/24, at 09:00am, Licensing Program Analyst (LPA) Perry Scott conducted a 10-day complaint visit to the facility and was greeted by David Hernandez, Assistant Administrator. LPA explained the purpose of this visit is to gather information about the complaint and deliver findings for the allegations mentioned above. The investigation consisted of the following: LPA investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S5) and residents (R1-R8) on 04/18/24. Resident Roster, Staff Roster, ID/Emergency Information, Physicians Report, Unusual Incident Report, & Needs and Service Plan for R1 and ID/Emergency Information for R2-R8 were obtained from the facility. The investigation revealed the following: Allegation #1- Staff are not ensuring that resident is administered their medication(s) as prescribed. Report continued on LIC 9099-C Unsubstantiated The details of the complaint alleged that the facility was not ensuring that the resident is given assistance with insulin injections because the resident doesn’t have proper use of one of their hands. On 04/18/24, from 09:00am-12:00pm, LPA interviewed staff (S1-S5) and residents (R1-R8) regarding the allegation. 5 of 5 staff denied the allegation that the Staff are not ensuring that resident is administered their medication(s) as prescribed. All staff (S1-S5) stated that they are ensuring that the resident is administered all medication as prescribed. S1-S5 stated that R1 requires insulin injections and that R1 is fully capable of giving R1 injections but wants others to do it. Staff state that the facility has an LVN on shift for eight hours and doesn’t mind helping the resident with the injections but when the LVN is not on the schedule R1 needs to give R1 the injection because the caregivers or the Med-Techs are not trained to give insulin injections. S1 explained to R1 that the caregivers and Med-Techs are only allowed to give hand over hand assistance and R1 must inject the medicine by R1’s self, the staff cannot plunge the needle into R1’s flesh. LPA reviewed the Physicians Report LIC 602, and it states the resident was trained and can administer their own injections. LPA also reviewed the Pre-Placement Appraisal Information LIC 603, and it informs the resident that they can only assist the resident with hand over hand injection assistance and the resident agreed to this prior to moving into the facility. LPA interviewed R1-R8 about the allegation and 9 of 10 residents that were interviewed denied the allegation that Staff are not ensuring that resident is administered their medication(s) as prescribed. Most of the resident’s state that the facility staff advised them that the caregivers and Med-Techs are not allowed to plunge the needle into to them, only the LVN. Rather, they can assist with hand over hand assistance with injections of their insulin medication and that they have been trained to inject themselves by their primary care physician. They also state that the staff ensures that their medication is administered as prescribed. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff are not ensuring that resident is administered their medication(s) as prescribed. 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. Report continued on LIC 9099-C Allegation: #2- Licensee is not ensuring that resident(s) have access to clean water while in care. The details of the complaint alleged that the facility was not ensuring the resident has access to clean water. It was reported that a resident ingested water from the bathroom sink while attempting to cook a meal with the water and became ill. On 04/18/24, from 09:00am-12:00pm, LPA interviewed staff (S1-S5) and residents (R1-R8) regarding the allegation. 5 of 5 staff denied the allegation that Licensee is not ensuring that resident(s) have access to clean water while in care. All staff (S1-S5) stated that all residents have access to clean water. Staff stated that there is a filtered water dispenser on the second floor, bottled water available to all residents, and that all residents have access to the kitchen if water is needed. LPA interviewed R1-R8 about the allegation and 9 of 10 residents that were interviewed denied the allegation that Licensee is not ensuring that resident(s) have access to clean water while in care. The residents state that they have not become ill from drinking water in the facility and that they have access to clean water, in that they can request bottled water or use the filtered water dispenser if needed. Based on interviews, there is insufficient evidence to support the allegation that the Licensee is not ensuring that resident(s) have access to clean water while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted with David Hernandez, Assistant Administrator, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 3, 2024 · control 11-AS-20240416103623

Allegation investigated: Staff did not inform resident's authorized representative of a change in resident's condition.

On 3/29/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Maria Bravo /Administrator and explained the purpose of this visit. Investigation Consisted of: Interview with Administrator(A#1), Facility Staff (S#1-S#3), Residents (R#1-R#5) and Reporting Party (RP). LPA Iniguez reviewed the following records: Staff Roster, Residents Roster, (R#1-R#5) Physicians Report for Residential Care Facilities for the Elderly or LIC 602, (R#1-R#5) Admissions Agreement, (R#1-R#5) Identification and Emergency Information LIC 625, (R#1-R#5) Appraisal/Needs Service Plan LIC 625, (R#1-R#5) Medication Administration Record (MARS) for the month of March 2024, (R#1)’s Dath Report dated:1/2/24, (R#1)’ Basic fact Sheet, copy of (R#1)’s Unusual Incident Report dated: 12/26/2023 and a physical tour of the facility. Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Staff did not inform resident's authorized representative of a change in resident's condition. The details of the complaint alleged that the facility staff did not inform the resident’s authorized representative when they went to the hospital. During the records review, LPA Iniguez examined the facility face sheet of resident (R#1). It was noted that (R#1) did not list a contact person, nearest kin, or legal guardian, but rather listed themselves as their legal representative. Additionally, LPA observed the Identification and Emergency Information sheet was reviewed, and it was found that (R#1) did not list a legal guardian or conservator, but only their insurance company as the entity responsible for paying for their care while living at the facility. Moreover, LPA reviewed (R#1)'s Physicians Report for Residential Care Facilities for the Elderly (RCFE), or LIC 602A, where (R#1) again listed themselves as their legal representative. Lastly, a copy of an Unusual Incident Report-LIC 624 dated 12/26/23 was reviewed, which indicated that when (R#1) went to the hospital that day, the facility informed (R#1)'s physician and CCLD. During an interview with the Administrator (A#1), she stated that the facility's sending residents to the hospital is based on a case-by-case basis; the residents will choose to go. If the resident decides to go to the hospital, the facility will inform the resident's physician and the responsible party if they have one. Once the resident returns from the hospital, we will assess the resident in case they need more care. Also, we submit an Unusual Incident Report to CCLD when a resident goes to the hospital. Also, (A#1) stated that (R#1) was self-responsible; they needed a representative listed on their identification and emergency information form and were not conserved. In addition, (A#1) stated that the facility has always notified residents' legal representatives and their physicians; we try to build a relationship with the residents' representative and their physicians. Evaluation Report continues LIC 9099-C During an interview with staff (S#1-S#3), (3) out of (3) staff stated that the facility process when it comes to sending a resident to the hospital is: "We call 911, the resident is sent out we notify their physician and their responsible party. If the resident does not have a responsible party, we only notify their doctor and CCLD about the event in an Unusual Incident Report." Also, (3) out of (3) staff stated that when (R#1) went to the hospital on December 2023, they just informed their physician and CCLD since (R#1) was their legal representative. Additionally, (3) out of (3) staff stated that the facility has always communicated with the residents' legal representatives and physicians in case they go to the hospital. During interviews with residents (R#2-R#6), (5) out of (6) residents stated that they feel the facility offers a safe environment for them and the other residents in care. Also, (5) out of (6) residents think the facility will contact their families, legal representatives, and doctors in case of an emergency. In addition, (3) out of (6) state that they have gone to the hospital before, and the facility informed their legal representatives and doctors. During this investigation, LPA found did not find sufficient evidence to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of the Complaint Report was given to Maria Bravo /Administrator.the state’s words, verbatim · CDSS document, Mar 29, 2024 · control 11-AS-20240325115658

Allegation investigated: Staff do not treat resident with respect

On 02/28/2024 at around 9:58 AM Licensing Program Analyst (LPA) Socorro Leandro initiated a complaint investigation regarding the allegation listed above. LPA met with the Administrator Maria Bravo and the purpose of the visit was explained. The investigation consisted of the following: During today’s investigation LPA and the Administrator Assistant conducted a tour of the facility which included the library, activity room, and random resident bedrooms. LPA interviewed 5 out of 61 residents and 4 out of 32 staff members. LPA reviewed several documents: Personnel Report; Resident Roster; 6 Resident Personal Rights; 1 Resident’s Basic Fact Sheet; 1 Resident’s Physicians Report; Safety Training for Staff Topic: Personal Rights of Residents; 30 Staff Certificates of Completion – 20 Hours Annual CEU (Continuing Education Units) which includes one hour Resident Rights Training. Unsubstantiated The investigation revealed the following: Regarding the allegation "Staff do not treat resident with respect” it is being alleged that staff threatened to evict resident with no reason. 5 out of 5 resident interviews indicated that the facility staff treats residents with respect, and they have not seen or heard staff threaten residents with evictions. 4 out of 4 staff interviews indicated that staff treat residents appropriately. Record reviews indicated that there was an In-service training of Personal Rights of Residents dated 03/13/2023 and staff have completed their 20 hours of Annual CEU training's which included a one hour of Resident Rights Training. Regarding the allegation " Staff do not treat resident with respect” The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 28, 2024 · control 11-AS-20221121154843

Type of visit: Required - 1 Year

On 10/26/2023 at 11:30 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at Facility Villa Redondo Care Home. LPA Calderon was allowed entry into the facility by Administrator Maria Bravo. The facility is licensed to serve residents (age 60 and older) for (73) non-ambulatory and (7) bedridden residents. The facility has an approved Hospice Waiver for (7) residents. Currently, there are (68) residents and (30) staff employees. LPA Calderon explained to Administrator Maria Bravo, the purpose of the 1 year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: four (4) resident service records, four (4) resident medication records, and LPA Calderon interviewed four (4) residents and four (4) staff members for visit. LPA Calderon inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 09/08/2023. The three story commercial building consists of sixty (60) resident bedrooms, sixty (60) resident bathrooms, six (6) common bathrooms, dining room, commercial kitchen, staff room, office area, library, washer and dryer/ storage area, backyard with umbrella with table and chairs. No weapons are stored in the premises. Commercial Kitchen was inspected and observed to be clean and operational. A 2 day supply perishable and 7 day supply of non-perishable foods are present in the facility kitchen. Emergency Water is found in the storage unit.. LPA advised the Administrator Maria Bravo to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID 19 guidance. . According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Maria Bravo. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of resident’s rooms #100, #103, #200, #206, #300, #302: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 112 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 109 degrees Fahrenheit, and Bathroom #3 hot water temperature properly measured at 111 degrees Fahrenheit. Commercial kitchen hot water temperature properly measured at 115 degrees Fahrenheit. Facility sixty (60) Carbon Monoxide and sixty (60) Smoke Detectors hard wired and connected were tested and are working properly. The facility twenty (20) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked medication room. Facility first aid five (5) kit is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. Four (4) staff files were checked and have the required documents. The facility does not handle resident's money/cash resources. All the required documents are posted in the facility in a clearly visible area. LPA Calderon noted the Administrator Maria Bravo Certification # 6024958740 expiration date of 04/07/2025 was valid at time of visit. Commercial General Liability Policy #IYG426175D policy period from 08/06/2023 to 08/06/2024 underwritten by General Star Insurance Company coverage 1,000,000/3,000,000 is valid at time of inspection. LPA Calderon spoke to Administrator Maria Bravo who will email full copy of insurance contact which shows all coverages to LPA Calderon no later than 11/06/2023. All the required documents are posted in the facility in a clearly visible area to all staff, clients, and guests. LPA Calderon reviewed LIC500 and noted all staff associated to facility per LIS. LPA Calderon reviewed the resident roster, LPA Calderon confirmed residents’ interview are on resident roster.the state’s words, verbatim · CDSS document, Oct 26, 2023

Allegation investigated: Staff failed to meet resident's medical needs Staff failed to properly assess resident before accepting Staff failed to seek medical attention for resident in a timely manner Staff failed to administer resident's medication as prescribed Staff failed to provide appropriate transportation for resident Staff refused to assist resident while in care Staff failed to assist resident with showers

On 09/28/23 at 8:30 am Licensing program analyst (LPA) Lizeth Villegas and Licensing analyst manager (LPM) Janae Hammond conducted a subsequent complaint visit to render investigation finding. LPA met with Assistant Administrator David Hernandez as the purpose of today’s visit was explained. The investigation consisted of the following: On 09/28/2023 LPA obtained copies of Staff and resident roster, R1's face sheet, emergency I.D. form, Physician's order, shower refusal form (01/12/23), Preplacement appraisal, individualized service plan, Resident assessment form, unusual incident reports, receipt of controlled substances and Admission agreement. On 09/28/23 LPA and LPM interviewed Staff #1-6 (S1-S6), and Residents #2-8. On 09/26/23 LPA attempted to interview R1 but was unsuccessful. The investigation revealed the following: Allegation: Staff failed to meet resident's medical needs It is alleged that R1 had diarrhea for 3 weeks and it is not being adressed by facility staff, it is also being alleged that staff are not conducted blood pressure checks for R1. On 09/28/23 at 8:45 am LPA and LPM interviewed staff # 1-6 (S1-S6), 6 of the 6 staff interviewed denied the allegation above and Unsubstantiated indicated residents needs are being met. On 09/28/23 at 9:30 am LPA and LPM interviewed residents #2-8 (R2-R8) 7 of 7 residents interview denied the allegation. LPA and LPM reviewed R1's file and checked physician's orders, medication list ,resident assessment form and pre appraisal form which reveled there is no documented physician's orders indicating resident requires blood pressure checks and there is no indication that resident has diarrhea for consecutive weeks. Allegation: Staff failed to properly assess resident before accepting. It is being alleged that staff failed to properly assess resident before being accepted into the facility. On 09/28/23 LPA and LPM interviewed staff # 1-6 (S1-S6), 6 of the 6 staff interviewed denied the allegation and reported that staff will go out to conduct assessment prior to admission. On 09/28/23 LPA and LPM interviewed residents #2-8 (R2-R8) 7 of 7 residents interview denied the allegation and reported that staff conducted assessment before admission. LPA and LPM reviewed R1's file and checked resident's assessment form dated 06/08/2022, individualized service plan dated 06/06/2022, and pre appraisal form dated 11/30/2022 which reveals R1 was assessed prior to admission to facility. Allegation: Staff failed to seek medical attention for resident in a timely manner It is being alleged that on two different occasions Resident fell and scraped Residents knees and toes and after the incidents Resident waited for an hour for the paramedics team. On 09/28/23 LPA and LPM interviewed staff # 1-6 (S1-S6), 6 of the 6 staff interviewed denied the allegation, during the interview 1 of 6 staff interviewed stated staff recall 2 separate incidents when R1 sustained a fall and facility staff informed R1 they could not provide the medical attention needed and called paramedics to assist. On 09/28/23 LPA and LPM interviewed residents #2-8 (R2-R8) 7 of 7 residents interview denied the allegation and reported staff will assist with medical needs when needed. On 09/28/23 LPA and LPM reviewed unusual incident reports dated 08/19/22, 11/23/22 and 11/28/22, incident reports revealed resident was provided with medical attention following incidents. Allegation: Staff failed to administer resident's medication as prescribed On 09/28/23 LPA and LPM interviewed staff # 1-6 (S1-S6), 6 of the 6 staff interviewed denied the allegation and reported that certified med techs are following Physicians orders. On 09/28/23 LPA and LPM interviewed residents #2-8 (R2-R8) 6 of 7 residents interview denied the allegation and reported medications are being administered correctly, 1 of 7 residents interviewed indicated that some med techs will not administer medications if a resident is late to med pass. On 09/28/23 at 2:30pm LPA and LPM conducted medication review of 7 residents. LPA did not observe any deficiencies. Allegation: Staff failed to provide appropriate transportation for resident On 09/28/23 LPA and LPM interviewed S1-S6, 5 of 6 staff interviewed denied the allegation, 1 of 6 staff interviewed stated not being sure if the facility provides transportation or not. On 09/28/23 LPA and LPM interviewed R2-R8, 7 of 7 residents interviewed denied the allegation and stated residents obtain transportation as needed. On 09/28/23 LPA and LPM reviewed R1's admission agreement which indicates facility will "plan, arrange and/or provide for transportation to medical and dental local appointments." Allegation: Staff refused to assist resident while in care On 09/28/23 LPA and LPM interviewed S1-S6, 6 of 6 staff interviewed denied the allegation. On 09/28/23 LPA and LPM interviewed R2-R8, 7 of 7 resident's interviewed denied the allegation. 7 of 7 residents interviewed stated staff do not refuse to assist them. Allegation: Staff failed to assist resident with showers On 09/28/23 LPA and LPM interviewed S1-S6, 6 of 6 staff interviewed denied the allegation. 6 of 6 staff interviewed reported that residents shower 2-3xs a week deepening on their care plan. On 09/28/23 LPA and LPM interviewed R2-R8, 7 of 7 resident's interviewed denied the allegation or indicated not requiring assistance with hygiene needs. On 09/28/23 LPA and LPM reviewed R1's file, Pre appraisal dated 11/30/22 indicates R1 requires "help with bathing, hair care, and personal hygiene by staff." On 09/28/23 LPA and LPM reviewed unusual incident reports that indicate resident was provided with shower schedule and resident has been refusing assistance with showers. On 09/28/23 LPA and LPM reviewed refusal of shower notification dated 01/12/23 which indicates resident refused to shower on designated shower day. 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 to Assistant Administrator David Hernandez, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 28, 2023 · control 11-AS-20221214153652