Vividus Senior Living

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 07/21/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87307(e)(1)(A) pertaining to Personal Accommodations and Services has been cleared. During today's visit, LPA observed protective mechanisms on the cook top. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87608(a)(3) pertaining to Postural Supports has been cleared. During today's visit, LPA observed physician orders for bed rails. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87355(e)(3) pertaining to Background Clearance has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87633(a)(4) pertaining to Palliative Care Plan has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. Licensee in process of updating parameter medications and to provide an update to LPA by close of business September 4,2026. Licensee has been advised to maintain all items previously deficient in the facility. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 1, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Vividus Senior Living. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 2 residents and the facility has one resident on palliative care during today's visit. Administrator Bobby Sharifan has an administrator certificate valid until 08/06/2027. Upon entry, facility appears clean, safe and sanitary. Administrator Sharifan arrived during the visit. LPA toured the facility at 8:23 AM along with Caregiver Jeff Lutrania. LPA toured the physical plant, checked food service, first aid kit and reviewed records. The facility consists of five resident rooms, three restrooms, living room, dining room and kitchen with an attached garage. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with half bed rails on the bed and one resident with full rails. Resident restrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 111 and 122 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA observed the first aid kit with all the elements including thermometer, tweezers and scissors as well as a first aid manual. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher is fully charged. The outside grounds were toured and there is ample shaded seating for residents. Exit gates are self latching and operational. CONTINUED ON LIC 9099C DATED 07/21/2026 Emergency food was observed. The emergency disaster plan was reviewed during the visit. Plan is thorough and complete. Facility provided documentation of last fire drill conducted on 07/01/2026 and drills are conducted monthly. Facility provides activities in the form of exercise and games. LPA reviewed resident and staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. One out of four residents have physician orders for bed rails. Staff files reviewed contained required documentation of medical clearance, training and criminal record clearance. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. At 10:25 AM, LPA observed staff are taking blood pressure for two residents with parameter medication orders. None of the staff are skilled professionals. Medications appear to be administered per physician order. Licensee to forward an updated LIC 500, liability insurance and LIC 308 to LPA by close of business July 24, 2026. Based on the observations made during today's visit, deficiencies are being cited per Title 22 division 6 of the California Code of Regulations. An exit interviewed was conducted and a copy of the report along with appeal rights was provided.the state’s words, verbatim · CDSS document, Jul 21, 2026

Allegation investigated: Staff did not assist resident with ambulation Staff did not distribute resident's medication as prescribed Staff do not assist resident with showering Staff did not ensure that resident was hydrated Administrator is not present at facility a sufficient amount of time to manage facility

On May 26, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to deliver the complaint findings. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Administrator Baabak Sharifan was notified via telephone and later arrived to assist with the inspection. During the course of the investigation, the Department interviewed three residents and five staff. The Department also reviewed and obtained pertinent documents to the complaint such as resident records and staff records. Regarding the allegation, staff did not assist resident with ambulation, the following has been concluded: It was alleged that staff did not assist Resident #1 (R1) with ambulation. The Department reviewed the file for R1 including R1's Physician's Report dated April 30, 2024. Per R1's Physician Report, R1 was diagnosed with Dementia and required full assistance with her activities of daily living (ADL's). The Department was unable to interview R1 for this complaint due to R1 passing away on October 23, 2025. CONTINUED ON LIC9099-C Unsubstantiated The Department attempted three resident interviews. However, the three residents were unable to be qualified for an interview due to their current cognitive conditions. The Department conducted five staff interviews. Five out of the five staff interviewed denied the allegation and stated that assistance with ambulation was provided to R1, and all other residents that require it. Regarding the allegation, staff did not distribute resident's medication as prescribed, the following has been concluded: It was alleged that staff did not distribute R1's medication as prescribed. The Department was unable to audit the medications for R1, due to R1 moving out of the facility on August 16, 2025. Additionally, R1's medication were released to her family on the same day she moved out. The Department reviewed the medication and medication records for the three current residents of the facility. The Department observed that the facility was providing medications in accordance to the prescribed orders for the three residents as per regulations. The Department also observed that each active medication order on file for the three residents were physically present at the facility. The Department did not observe any errors or discrepancies in the medication audit for the three current residents of the facility. The Department attempted three resident interviews. However, the three residents were unable to be qualified for an interview due to their current cognitive conditions. The Department conducted five staff interviews. Five out of five staff interviewed denied the allegation and reported no medication errors. Regarding the allegation, staff do not assist resident with showering, the following has been concluded: It was alleged that staff did not assist R1 with showering. The Department reviewed the file for R1 including R1's Physician's Report dated April 30, 2024, which stated that R1 required assistance with showering. The Department was unable to interview R1 for this complaint due to R1 passing away on October 23, 2025. The Department attempted three resident interviews. However, the three residents were unable to be qualified for an interview due to their current cognitive conditions. The Department observed each residents to be clean and no apparent hygiene issues were observed. The Department conducted five staff interviews. Five out of five staff interviewed denied the allegation and reported no issues with showering residents. Regarding the allegation, staff did not ensure that resident was hydrated, the following has been concluded: It was alleged that staff did not ensure that R1 was hydrated. The Department was unable to interview R1 for this complaint due to R1 passing away on October 23, 2025. The Department attempted three resident interviews. However, the three residents were unable to be qualified for an interview due to their current cognitive conditions. CONTINUED ON LIC9099-C The Department conducted five staff interviews. Five out of five staff interviewed denied the allegation and reported that resident hydration needs have always been met. Regarding the allegation, administrator is not present at facility a sufficient amount of time to manage facility, the following has been concluded: The Department conducted an interview with the facility administrator who reported that he is present at the facility five or six days out of the week. The facility administrator also stated that he is on call twenty four hours out of the day, seven days a week. The Department attempted three resident interviews. However, the three residents were unable to be qualified for an interview due to their current cognitive conditions. The Department conducted three additional staff interviews for this allegation. Three out of the three staff interviewed denied the allegation and corroborated the information provided by the facility administrator. All three staff also reported that they feel they have sufficient help and support from the facility administrator. Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the five allegations above are deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Baabak Sharifan. A copy of the report was provided to the facility at time of visit. The Department observed that the centrally stored medication log for R1 documented each medication that was prescribed to R1 between July 1, 2021, to August 16, 2025, which was the day that R1 moved out of the facility. The Department further observed that the centrally stored medication log for R1 contained all the necessary information that is required by regulations. The Department also observed that R1's Power of Attorney (POA), was provided with a medication release form on August 16, 2025, which described all of the medications that R1 was currently prescribed, and the amount of medication that was being provided. The medication release form was signed by R1's POA, acknowledging the contents of the document. The Department conducted five staff interviews. Five out of five staff interviewed denied the allegation and reported that centrally stored medication logs have always been maintained for each residents of the facility. Based on the evidence gathered during this investigation, the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Administrator Baabak Sharifan. A copy of the report was provided to the facility at time of visit.the state’s words, verbatim · CDSS document, May 26, 2026 · control 22-AS-20251021161230

Type of visit: Case Management - Deficiencies

On May 26, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Deficiencies visit. The visit is being conducted in conjunction with complaint control number 22-AS-20251021161230. Administrator Baabak Sharifan was notified via telephone and later arrived to assist with the inspection. During the investigation into complaint control number 22-AS-20260506115738, LPA reviewed the medication and medication records for the three residents of the facility. LPA observed that the facility was providing one over the counter medication, and two supplements to Resident #1 (R1) without valid physician orders. The Department attempted to conduct an interview with R1, however R1 was unable to be qualified for an interview due to her current cognitive condition. The Department conducted two staff interviews. Two out of the two staff interview confirmed that there were no physician's orders on file for the one over the counter medication and two supplements for R1. The two staff interviewed also stated that the two supplements were being provided to R1 on a daily basis and the one over the counter medications was being provided to R1 as needed. Based on the information gathered during the visit, a deficiency is being cited on the attached LIC809-D page. An exit interview was conducted with Administrator Baabak Sharifan. A copy of the report and appeal rights were provided to the facility at time of visit.the state’s words, verbatim · CDSS document, May 26, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e) · Plan of correction due date: Jun 5, 2026

87465 Incidental Medical and Dental Care: (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician.. This requirement is not evidenced by: Based on staff interviews and records reviewed, the Licensee did not ensure that physician's orders were obtained for the one over the counter medication and two supplements being provided to Resident #1. The poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 26, 2026

Plan of correction: The Administrator stated that he will stop providing the one over the counter medication and two supplements to Resident #1 until physician's orders are obtained. The Licensee stated that he will also conduct an in service training with all staffing regarding medication administration. The Administrator agreed to provide LPA proof of the training via email or fax by POC due date.

Allegation investigated: Staff did not issue resident's responsible party a refund.

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Administrator Bobbi Sharifan and explained the reason for the visit. The investigation into the allegation revealed the following. It was reported that after R1 passed away a refund was requested by the responsible party but no refund was issued. R1 passed away on March 7, 2026. R1's responsible party reported that they informed the Administrator and requested a refund. The Administrator reported that the responsible party did not remove R1's bed until April 2, 2026. R1's responsible party verified that R1's bed was not removed from the facility until April 2, 2026. Health and Safety Code 1569.652(c) states, "A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed." R1 passed away on March 7, 2026 and their bed was not removed until April 2, 2026. Unfounded Based on the evidence gathered the allegation is deemed unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with the Administrator, and a copy of the report was provided.the state’s words, verbatim · CDSS document, May 6, 2026 · control 22-AS-20260505095702

Allegation investigated: Questionable death. Facility does not have adequate staffing to care and supervise residents.

LPA Ruth Martinez made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Administrator (AD) Baabak "Bobbi" Sharifan and explained the reason for the visit. During the course of the investigation, Department staff inspected the facility, interviewed AD, witnesses, and staff, and obtained and reviewed the following records, staff roster, staff schedule, Resident 1’s (R1) emergency contact information, R1’s medication administration record (MAR) for April and May 2023, Death Certificate for R1 dated May 15, 2023, R1’s physician’s report dated March 16, 2023, R1’s care plan, R1’s resident appraisal dated September 13, 2021, R1’s admission agreement dated March 14, 2023 and R1’s hospice notes for May 2023. Continued on LIC9099-C Unsubstantiated The investigation into the allegation, questionable death, revealed the following. It was alleged that Resident 1’s (R1) death was caused by the facility staff because of their lack of care and improper administration of R1’s medication. Witness 1 (W1) reported that R1 passed away 4 days after their return from the hospital and that R1 was alert and cognitive when they returned to the facility and within 24 hours was incoherent and began to decline rapidly. W1 reported that the decline led to R1’s death which was caused by facility staff. W1 did not provide any information on how staff caused the decline and death of R1. A review of records shows R1 was on hospice and passed away under the care of a Hospice Nurse (HN1). LPA attempted to contact the Hospice Nurse (HN1) but never received a response to a request for an interview. LPA attempted to contact the Hospice Doctor who signed the final hospice documents showing R1 had passed away, but no response was ever received, no interview was conducted with the Hospice Doctor. R1 moved into the facility on March 17, 2023. R1 was hospitalized on or around on April 24, 2023, and returned to the facility on April 27, 2023. R1 passed away on May 1, 2023, at 11:56 am. R1’s death certificate lists cardiopulmonary arrest as the primary cause of death and malignant neoplasm of the right lung as the secondary cause of death. Staff 1 and Staff 2 denied the allegation of not providing care to R1 and reported that unless the family was visiting, they constantly checked R1 and contacted hospice daily regarding R1. S1 and S2 reported that R1 received all their medication as prescribed and any medication administered was noted on the medication administration record (MAR). Staff 3 (S3) and Staff 4 (S4), who mainly worked in the evening, are longer employed at the facility and their contact information is no longer valid. No contact was made with S3 and S4 so they were never interviewed. Staff 5 (S5) and Staff 6 (S6) who were backup staff reported that they did not work from April 24 to April 27. S5 and S6 reported that they followed all instructions regarding the care and administration of medication for all residents and never observed any evidence that any resident was not receiving proper care. S1 and S2 reported that they followed all hospice orders and communicated with hospice regarding the care of R1 daily. A review of records shows a hospice nurse visited R1 on April 27, 2023, twice on April 28, 2023, and on May 1, 2023. R1’s MAR shows they were prescribed 7 prn medications prescribed by R1’s hospice doctor. R1’s MAR shows 1 Lorazepam 0.5 mg tablet was administered on April 30, 2023. Hyoscyamine 0.125 mg sublingual tablet was administered once on April 30, 2023, and twice on May 1, 2023. Morphine Sulfate 15 mg tablet was administered once on April 27, 2023, twice on April 28, 2023, three times on April 29, 2023, six times on April 30, 2023, and twice on May 1, 2023. Each of the medications administered can only be administered a Continued on LIC9099-C maximum of 6 times per day. The medications administered are as needed (PRN) medications and there is no mismanagement of medications indicated on the MAR. All 4 staff members interviewed denied mismanagement of medications. W1 and Witness 2 (W2) reported they did not witness anything that Staff did that would lead to R1’s death. No specific details were provided as to what facility staff did that would have led to R1’s death. Staff 1 and Staff 2 denied doing anything that would lead to R1’s death. W1, W2 and HN1 were present at the time of R1’s passing. W2 reported that S1 was present at the time of R1’s passing but S1 denied the allegation. S1 reported that they entered the room after R1’s passing. W1 and W2 reported that during their last visit on May 1, 2023, they did not witness any interactions between staff and R1. S1 reported that on May 1 around 8:30 am they noticed R1 was not responding to them, and their breathing was shallow, so they contacted hospice and R1’s responsible party. All witnesses reported different times for the arrival of HN1. It is unclear what time each witness arrived at the facility, but what is clear is that at the time of R1’s passing W1, W2 and HN1 were present and R1 passed away at 11:56am. None of the evidence gathered supports the allegation. R1 passed under the care of hospice and there is no evidence that R1’s medications were mismanaged. The investigation into the allegation, facility does not have adequate staffing to care for and supervise residents, revealed the following. Facility had 6 staff members at the time of the complaint. 2 regular staff work 5 days a week 6 am – 2 pm, 2 secondary staff work in the evening 2-10 pm, 5 days a week and 2 backup staff if the other staff are not available and they work on the days from the other staff. 2 regular staff live at the facility and are on call for the overnight hours, 10 pm to 6 am. The Administrator works 20 hours a week and is on call if necessary. The facility did not report any unusual incidents for July 2023, and only 1 report for August 2023 (R1’s death report). No unusual incident reports received for September 2023. No specific details were provided, other than 2 staff members had terminated their employment sometime in May of 2023 and this could have impacted the care and supervision provided by staff. The Administrator reported that 2 staff members did resign but they were quickly replaced and there was no interruption of staff coverage or services. LPA interviewed 3 out of 5 residents who reported no issues with care provided. 4 out of 4 staff interviewed reported there are no issues with the care provided. Witness 1 and Witness 2 reported that they have never seen any issues with the care provided and could not recall any incidents where Continued on LIC9099-C residents were not provided with care and supervision. LPA attempted to contact the party responsible for 5 residents but never received any response so no interviews were conducted. No evidence was gathered to support the allegation. Based on the evidence gathered the allegations are deemed Unsubstantiated. Although the allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted with the Administrator, and a copy of the report was provided. The investigation into the allegation, staff did not provide resident’s authorized representative a refund, revealed the following. Resident 1 (R1) moved into the facility on March 17, 2023, and passed away on May 1, 2023. R1’s responsible party and Administrator both reported that R1 passed away on May 1, 2023, and a refund for May 2023 was requested on May 2, 2023. The Administrator reported that the refund check was mailed to R1’s responsible party and the check was cashed but R1’s responsible party reported they never received the check. A review of facility records shows that the Administrator received a letter from Bank of America reporting that the refund check for R1’s responsible party was fraudulently cashed, and the facility’s account was credited on August 17, 2023. The Administrator reported that a new refund check was sent to R1’s responsible party on August 18, 2023. R1’s responsible party reported that they received the refund check in September 2023, but they do not remember the exact day. The Administrator reported that the delay was due to the first refund check being fraudulently cashed and waiting for the bank to complete their investigation. R1’s responsible party reported they told the Administrator they never received the refund check and then didn’t hear anything until August 2023 when they received the refund check. R1’s responsible party reported that after they received the refund check it was deposited into their account with no issues. Based on the evidence gathered the allegation is deemed Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with the Administrator, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 23, 2026 · control 22-AS-20230801131957

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Baabak "Bobbi" Sharifan and explained the reason for the visit. The Administrator's certificate expires on August 6, 2025. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry way of the facility. LPA and the Administrator toured the facility. Facility is a single story home with an attached 2 car garage with 5 bedrooms, 3 bathrooms, kitchen, dining room and a living room with a fireplace. LPA observed the fireplace is screened. The fire extinguisher in the kitchen is fully charged. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. There is 3 day emergency food and water supply in the kitchen. LPA observed knives are kept locked under the kitchen sink. LPA observed the medications are kept locked in a kitchen cabinet. LPA and Administrator toured the resident rooms. 4 of the resident rooms are private and one is shared. LPA observed all resident rooms are clean and organized. All resident rooms had the required furnishings and bed linens. LPA toured the garage. The garage is kept locked and used for storage of extra supplies and food. Smoke detectors/carbon monoxide detectors tested operational. LPA observed all 3 bathrooms are clean and operational. Hot water measured 108.6 degrees Fahrenheit in all 3 bathrooms. LPA and staff toured the backyard. No bodies of water observed. There is a table with an umbrella and chairs for residents to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPA reviewed 5 resident files. 1 out of 5 residents did not have a current appraisal/needs and service plan. Resident 1 (R1) did not have a current appraisal/needs and service plan. LPA reviewed 5 resident medications, no discrepancies observed. LPA reviewed 2 staff files. No discrepancies observed. LPA inspected first aid kit. The first aid kit has all the required elements. Deficiencies are being cited per Title 22 division 6 of the California Code of Regulations. LPA consulted with Administrator concerning reporting requirements. An exit interviewed was conducted and a copy of the report along with appeal rights was provided.the state’s words, verbatim · CDSS document, Jul 2, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry way of the facility. LPA and staff toured the facility. Facility is a single story home with an attached 2 car garage with 5 bedrooms, 3 bathrooms, kitchen, dining room and a living room with a fireplace. LPA observed the fireplace is screened. The fire extinguisher in the kitchen is charged. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed that the front left burner on the 4 burner gas burner stove does not light unassisted. LPA observed knives are kept locked under the kitchen sink. LPA observed the medications are kept locked in a kitchen cabinet. LPA and staff toured the resident rooms. 4 of the resident rooms are private and one is shared. LPA observed all resident rooms are clean and organized. All resident rooms had the required furnishings and bed linens. LPA toured the garage. The garage is kept locked and used for storage of extra supplies and food. Smoke detectors/carbon monoxide detectors tested operational. LPA observed all 3 bathrooms are clean and operational. Hot water measured 105.8 degrees Fahrenheit in all 3 bathrooms. LPA and staff toured the backyard. No bodies of water observed. There is a table with an umbrella and chairs for residents to sit outside. Both exit gates are operational. No obstacles or hazards observed in the backyard. LPA reviewed 6 resident files. 1 out of 6 residents did not have a current medical assessment (LIC 602A, physician's report). Resident 2 (R2) did not have a current physician's report. LPA reviewed 6 resident medications, no discrepancies observed. LPA reviewed 4 staff files. 2 out of 4 staff did not have the required 20 hours of annual training. Staff 1 (S1) and Staff 2 (S2) did not have any current annual training. All 4 staff members had current CPR/First Aid training. No other discrepancies observed. Deficiencies are being cited per Title 22 division 6 of the California Code of Regulations. An exit interviewed was conducted and a copy of the report along with appeal rights was provided.the state’s words, verbatim · CDSS document, Jul 16, 2024

Allegation investigated: Licensee did not abide by the terms of the admission agreement.

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by staff on duty (S1) Edgardo Sevilla, who notified facility administrator about the visit. It was alleged that licensee did not abide by the terms of the admission agreement. LPA De Perio conducted a total of 7 interviews. 5 out of the 5 interviews with residents did not corroborate with the allegation due to being unable to provide information regarding the allegation. 2 out of the 2 staff interviews conducted also did not corroborate with the allegation by stating that the facility does abide by the terms of the admission agreement, and disclosed that prior to admission, the facility administrator will go over the agreement with the residents responsible party, and that the responsible party will review and sign it. Unsubstantiated Per documentation review, when resident (R1) moved into the facility, R1 was under an insurance agency that required the facility to provide monthly invoices. On August 29, 2023, R1's responsible party stated that R1 would be moving out by September 5, 2023. Per review of communication between R1's responsible party and facility administrator, an agreement was made that if R1 moved out of the facility by August 31, 2023, there would be no financial charges due to another resident wanting to move in. On September 1, 2023, a move-out invoice was issued to R1 for the amount of $175.00, however, it was removed by the facility. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with S1. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Dec 26, 2023 · control 22-AS-20230920142902