West Park Senior Living

Allegation investigated: Staff do not ensure the facility is free of mold.

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced complaint visit on 08/18/2026 to deliver findings related to the above allegation. LPA was greeted by Executive Director Jeri Hillery and explained the purpose of the visit. The investigation included a review of the facility's resident roster, staff roster, and thirty (30) days of maintenance work orders and resident maintenance requests to determine whether there were documented concerns regarding mold, water leaks, plumbing issues, or moisture. The records reviewed did not contain work orders or maintenance requests documenting mold or water leaks. LPA conducted interviews with ten residents (R1–R10) and eight staff members (S1–S8), including staff familiar with the facility's maintenance concerns. Additionally, LPA toured the second, third, and fifth floors and inspected ten (10) resident rooms, laundry rooms, and other areas identified during the investigation. Unsubstantiated Allegation: Staff do not ensure the facility is free of mold. It is alleged that staff failed to ensure the facility was free of mold inside the walls of units. During staff interviews, the majority of staff denied knowledge of mold concerns and reported that they had not personally observed mold. Some staff reported ongoing plumbing issues and water leaks, and one staff member reported that residents had previously expressed concerns regarding mold. During resident interviews, the majority of residents reported that they had not observed mold in their rooms or other areas of the facility. Residents did report experiencing water leaks and plumbing-related issues. LPA observations, LPA inspected ten (10) resident rooms and did not observe visible mold. LPA observed evidence of water leaks and water damage in some resident rooms and photographed the observed conditions. Based on the investigation conducted, which included interviews with staff and residents, as well as a review of relevant records, there was insufficient evidence to support the reported 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 was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 18, 2026 · control 28-AS-20260811083320

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Gabriela Castro conducted a Case Management – Deficiencies visit stemming from Complaint Investigation #28-AS-20260811083320, conducted on 08/18/2026. LPA met with Executive Director Jeri Hillery and explained the purpose of the visit. Case Management – Deficiencies Findings: During the facility walkthrough, LPA observed portions of the walls behind the washers and dryers in the second- and third-floor laundry rooms were missing, exposing plumbing. LPA also observed water leaking from a washing machine. These conditions were not maintained in good repair. An exit interview was conducted. A copy of this report, LIC 809-D, and Appeal Rights were provided to Jeri Hillery, Executive Director.the state’s words, verbatim · CDSS document, Aug 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 18, 2026

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met by: Based on observations made during the facility walkthrough, the facility did not meet regulatory requirements by failing to maintain the facility in good repair. Portions of the walls in the second- and third-floor laundry rooms were missing, exposing plumbing, and LPA observed water leaking from a washing machine wihich poses/posed an immediate risk to the resident's health, safety, and personal rights.the state’s words, verbatim · CDSS document, Aug 18, 2026

Plan of correction: The facility shall repair the damaged walls in the second and third floor laundry rooms, ensure exposed plumbing is properly enclosed, and repair the leaking washing machine. The facility shall submit photographic proof and/or repair documentation to LPA by the POC due date.

Allegation investigated: Facility is not conducting emergency drills

Licensing Program Analyst (LPA) conducted an unannounced visit to the facility to investigate the above allegation. LPA met with Administrator Jeri Hilary and the purpose of the visit was explained. Today's visit consisted of a tour of the facility and interviews with ten (10) staff and ten (10) residents. The following documents were collected; a staff and client roster, facility emergency disaster plan and a log of disaster drills conducted on 03/26/26 and 05/27/26.. Regarding the allegation facility is not conducting emergency drills, it is alleged that the facility has not conducted an emergency drill or evacuation drill in the last two years. Interviews with seven (7) out ten (10) staff members deny the allegation that facility are not conducting emergency drills. Interviews with (7) out of ten (10) staff members reveal that an emergency drill was conducted by the facility within the last three months. Per Administrator Jeri Hillery the facility has been conducting quarterly disaster drills but not with Substantiated all shifts. The drills were conducted with the morning shift, not the afternoon or NOC shifts. Interviews with ten(10) out of ten (10) residents revealed that residents were not aware of the facility staff conducting any emergency drills. Interviews with ten (10) out of ten (10) residents revealed that residents were not aware of the facility staff conducting any emergency drills in the last three months. All of the residents interviewed stated the staff might have been conducting emergency drills but they the residents were just not aware of it. LPA's review of the facility file showed that the facility has a Disaster Plan that was reviewed on 02/25/26 by the Administrator and logs of disaster drills conducted with employees on the am shift on 03/26/26 and 05/27/26.The facility has three shifts, an AM shift, PM shift and Noc shift. Per Health and Safety Code 1569.695 a facility shall conduct a drill at least quarterly for each shift. From LPA's facility record reviews and staff interviews it has been shown with a preponderance of the evidence that the facility is not conducting emergency drills with all shifts and this allegation is deemed substantiated. An exit interview was conducted with Administrator Jeri Hillery and a copy of this Licensing Report along with Appeal right was provided. The facility was cited for Health and Safety Code 1569.695 during the annual visit on 01/21/26 so Civil Penalties in the amount of $250 will be assessed today.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 28-AS-20260730100045

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.695(c) · Plan of correction due date: Aug 12, 2026

1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift... The above requirement was not met as the facility file did not contain documentation of quarterly emergency drills being conducted with the Pm and Noc shifts.the state’s words, verbatim · CDSS document, Aug 4, 2026

Plan of correction: By POC due date , Administrator will submit to LPA via office fax proof an emergency drillsconducted will all shifts.

Allegation investigated: Staff do not provide a safe and comfortable environment for residents Staff do not ensure facility is in good repair

Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced complaint visit on 07/24/2026 to deliver findings related to the above allegation. LPA was greeted by Executive Director Jeri Hillery and explained the purpose of the visit. The investigation included a review of the facility's resident roster, staff roster, maintenance logs, maintenance work orders, elevator service records, plumbing work orders, resident maintenance requests, resident notifications regarding repairs, and other documentation related to facility maintenance concerns. LPA conducted interviews with ten residents (R1–R10) and five staff members (S1–S5), including the Maintenance Director. Additionally, LPA toured the facility and observed the elevators, dining room during meal service, common areas, hallways, resident rooms with reported maintenance concerns, restroom facilities, and air conditioning units to assess the allegations regarding elevator delays, plumbing issues, air conditioning concerns, and the facility's response to maintenance requests. Substantiated Allegation: Staff do not provide a safe and comfortable environment for residents. It is alleged that staff do not provide a safe and comfortable environment for residents due to extended elevator wait times, delayed maintenance repairs, unresolved plumbing issues, and air conditioning concerns, resulting in inconvenience, discomfort, and delays in residents' access to meals and other areas of the facility. The investigation revealed that one of the facility's two elevators had been out of service for approximately one and a half weeks due to a failed compressor that was on back order. Interviews with S1–S5 confirmed that only one elevator remained operational during the outage. Although staff implemented interim measures, including meal delivery to resident rooms upon request, escorting residents requiring assistance to the dining room before peak meal times, and encouraging ambulatory residents to use the stairs, residents continued to experience extended wait times for the operational elevator. Interviews with R1–R10 consistently confirmed the elevator outage caused significant inconvenience. Residents reported waiting between 10 and 45 minutes for the elevator, particularly during peak meal periods when many residents traveled to the dining room between approximately 11:00 a.m. and 11:30 a.m. Several residents reported altering their schedules to avoid the busiest times, while others expressed frustration with the prolonged waits and the impact on their daily routines. The investigation further revealed delays in addressing maintenance concerns. S2 reported inheriting approximately 64 outstanding work orders upon assuming the position. Staff acknowledged that maintenance response times had been delayed due to the absence of maintenance personnel prior to the new hire. Residents reported maintenance requests were often not completed promptly and stated they frequently did not receive updates regarding the status of submitted work orders. One resident reported their air conditioning unit had not been functioning properly for over one month and that, despite repeatedly notifying staff, the issue remained unresolved at the time of the investigation. Although the resident had been provided with a fan, replacement of the air conditioning unit was still pending. While the facility had begun addressing the maintenance backlog and implementing corrective actions, the evidence demonstrated that residents experienced ongoing inconvenience and discomfort due to delayed maintenance repairs, prolonged elevator wait times, delayed replacement of air conditioning units, and inadequate communication regarding maintenance requests and repair timelines. (continued on 9099C) Allegation: Staff do not ensure facility is in good repair. It is alleged that staff do not ensure the facility is maintained in good repair due to delayed maintenance repairs, prolonged response times to resident maintenance requests, unresolved work orders, delayed replacement of air conditioning units, and inadequate communication regarding the status of maintenance requests. The investigation revealed the facility experienced a period without maintenance staff prior to hiring a new Maintenance Director. Interviews with S1–S5 confirmed maintenance requests were submitted through the facility's work order system; however, staff acknowledged delays in completing repairs. S2 stated they inherited approximately 64 outstanding work orders upon beginning employment and prioritized plumbing repairs and other urgent maintenance issues. S2 also reported several air conditioning units had been repaired, while additional units remained pending replacement through the corporate office. S4 and S5 stated their role is limited to creating maintenance work orders for reported concerns. Once submitted, responsibility for repairs shifts to the maintenance department. Both staff members stated they are not routinely updated by maintenance or management regarding the status of repairs and are therefore unable to provide residents with updates when asked. S5 stated they occasionally submit additional work orders if residents report the issue remains unresolved. The majority of residents interviewed (R1–R10) corroborated staff statements regarding delayed maintenance response times and limited communication. Residents reported that repairs were eventually completed but often took longer than expected and that they were not informed of repair timelines or the status of their work orders. Many residents were unaware a new Maintenance Director had recently been hired. R1 reported an air conditioning unit had not been functioning properly for over one month despite previously reporting the issue and, although provided with a fan, the unit had not yet been replaced at the time of the investigation. Records reviewed confirmed the facility had a significant backlog of maintenance requests before the new Maintenance Director assumed the position. Although the facility had begun addressing the backlog, the investigation determined that delayed maintenance response times, delayed replacement of air conditioning units, and inadequate communication regarding maintenance requests resulted in ongoing inconvenience to residents. Based on LPA's interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.the state’s words, verbatim · CDSS document, Jul 24, 2026 · control 28-AS-20260716133340

From the deficiency page — Deficiency type: Type B · Section cited: ILS 87303(a) · Plan of correction due date: Aug 21, 2026

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on interviews and records reviewed, it was determined that the facility failed to ensure the facility was maintained in good repair by not timely addressing maintenance requests, resulting in a backlog of approximately 64 work orders, delayed repairs, delayed replacement of air conditioning units, and inadequate communication with residents regarding the status of maintenance requests. This posed a potential health, safety, and personal rights risk to residents wihich poses/posed an immediate risk to the resident's health, safety, and personal rights.the state’s words, verbatim · CDSS document, Jul 24, 2026

Plan of correction: The facility shall submit the following to the LPA by the POC due date: A written plan for tracking, completing, and communicating maintenance requests.Proof that the outstanding air conditioning units have been repaired or replaced.Proof of staff training on the revised maintenance work order and communication procedures.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Aug 21, 2026

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by Based on interviews and records reviewed, it was determined that the facility failed to ensure residents were provided safe, healthful, and comfortable accommodations by not timely addressing maintenance issues elevator outage delay updates, delayed air conditioning repairs, and a backlog of maintenance work orders, resulting in inconvenience and discomfort to residentswihich poses/posed an immediate risk to the resident's health, safety, and personal rights.the state’s words, verbatim · CDSS document, Jul 24, 2026

Plan of correction: The facility shall submit the following to the LPA by the POC due date: 1. A written plan describing how residents' comfort and safety will be maintained during equipment outages or other conditions affecting accommodations. 2. Documentation demonstrating residents are offered reasonable alternatives or assistance (e.g., meal delivery, relocation, fans, or other accommodations) when services are disrupted. 3. Proof that staff have been trained on ensuring residents' personal rights to safe, healthful, and comfortable accommodations during service interruptions.

Type of visit: Office

An informal office meeting was held at the Monterey Park Adult and Senior Care Licensing Office. Regional Manager (RM) Tony Vasallo, Licensing Program Manager (LPM) Adeline Ho, Licensing Program Manager (LPM) Fernando Fierros and Licensing Program Analyst (LPA) Blanca Gonzalez met with Executive Director Jeri Miles-Hillery, Regional Director of Operations Sheila Bottinelli and Senior Vice President of Operations Beau Ayers. The purpose of this meeting is to discuss the “delicensing” of the 6th and 7th floor. Office visit 10/29/24- initial discussion regarding the request to “delicense” 7th floor. There was further indication to “delicense” the 6th floor. The request has not been approved by CCLD. Attendees provided Health and Safety code 1569.17(b)(1)(B) and stated comingling is allowed. Annual visit 01/21/26, deficiencies cited for incomplete resident files. Attendees stated there are no “renters” on site and they did not move forward with “delicensing.” The capacity on the 7th floor is 20. The capacity on the 6th floor in 22. Currently there are 28 RCFE residents on the 6th and 7th floor. These residents will have a complete file. During today's meeting, the following Title 22 Regulation Sections were discussed and materials provided during the meeting. 87204 Limitations - Capacity and Ambulatory Status (RCFE) 87507 Admission Agreements. 87455 Acceptance and Retention Limitations Report continues on the next page Licensee agreed to the following: 6th and 7th floor have not been “delicensed” Will continue update client records to reflect RCFE residents who are living on the 6th and 7th floor. Plan to submit new request in approximately 30 days with updated Plan of Operation Attendees understood that the floors cannot be “delicensed” without CCLD’s response to the request. An exit interview was conducted, and a copy of this LIC 809 report was providedthe state’s words, verbatim · CDSS document, Feb 11, 2026

Allegation investigated: Staff did not advise resident of rate change

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA was greeted by staff and explained the reason for the visit. The investigation consisted of the following: On 12/12/25 LPA Gonzalez conducted an initial complaint visit and obtained copies of Personnel Roster, Resident Roster, interviewed staff #1-2 (S1- S2) and obtained copies of Admission Agreement, Face Sheet, Medical Assessment, Resident Assessment, Physician’s Orders, Resident Financial Responsibility Form, and AL Advantage Residential Assessment for S1. During today’s visit, LPA interviewed staff #3-4 (S3-S4), interviewed residents #1-10 (R1-R10). continued on LIC9099C Substantiated Regarding the allegation “Staff did not consider resident's dietary preferences,” it is alleged that R1 had asked for soft food, no spicy food and no peppercorns. Interview with R1 revealed that their diet had been modified to soft foods and the staff are meeting their dietary needs. 7 out of 10 residents interviewed are satisfied with the food service provided and indicated their dietary needs are met. 3 out 10 residents interviewed stated they do not always like the meals being provided and are aware of alternate meal choices offered. Interview with S3 revealed a physician’s order for permanent “soft food” diet had been received 09/02/2025 for R1. S3 stated, the kitchen staff are aware of modified diets for residents and offer an alternate menu daily for residents that do not want to have the meal being offered. Based on interviews and record review, although the allegation may have happened or is valid, there is no 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 report was provided to Kayla Lazo Activities Director. The investigation revealed the following: Regarding the allegation “Staff did not advise resident of rate change,” it is alleged that R1 was not advised of their rate change prior to the increase being implemented. Interviews with S1 and S2 revealed that R1’s family was notified of the change in level of care resulting in a rate increase, However, per the facility’s Resident Financial/Responsibility Form dated 11/11/22, located in R1’s file, R1 is the responsible party and was not notified prior to implementing the change. Record review revealed, per the facility’s Resident Assessment and Service Plan, the procedure is for the Resident Care Director to ensure the service plan is signed and dated by the resident and/or responsible party, as appropriate. Per the Admission Agreement, the facility shall give sixty (60) days prior written notice of any changes in fees for levels of care, R1’s Resident assessment was dated 10/29/2025 indicating the effective date 11/01/2025, giving R1 less than sixty (60) days notice. Deficiency cited. Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency is being cited on the attached LIC9099D. Exit interview was held and a copy of this report along with the appeal rights were provided tothe state’s words, verbatim · CDSS document, Jan 26, 2026 · control 28-AS-20251202090428

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Mar 2, 2026

87507(f)Admission Agreement. The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above in that R1, as responsible party, was not given prior written notice of change in fees due to level of care.the state’s words, verbatim · CDSS document, Jan 26, 2026

Plan of correction: Licensee agees to advise resident prior to changes. S3 will email LPA a written statement indicating the have read the admission agreement and will comply with Title 22 regulations.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Christian Gutierrez conducted the required annual inspection. LPA met with Administrator Jeri Miles and discussed the purpose of today’s visit. This facility is approved for (81) ambulatory and (119) non-ambulatory residents (of which 10 may be bedridden). This facility has an approved hospice waiver for (15) residents. The following bedrooms are approved for bedridden residents: #206,207,208,209,210,106,107,108,109 and 110. A tour of the facility contains 2 buildings: Building #1 has 2 floors, first floor containing a lobby, 5 offices, ballroom, staff break room, store, salon, 2 community men's restrooms, 2 community women's restrooms, pantry, mail room, kitchen, private dining room, dining room and a living room. Building #2 contains 7 floors. First floor contains a medication room, activity room and 23 resident bedrooms, each with its own bathroom. From the second floor to the seventh floor: Each floor contains 24 resident bedrooms, each with its own bathroom, laundry room, community restroom and an activity room. SEE LIC 809C Resident bedrooms were randomly chosen for review on each floor. Each bedroom has a bed, linen, dresser, light, and sufficient closet space. The residents’ bathrooms have the required grab bars and non-skid mats. The hot water was between 109.4-115.3 degrees, which is within the required 105 - 120 degrees. Multiple carbon monoxide detectors were observed on each floor (tested and operable). Fire extinguishers are located throughout the facility and on each floor. Kitchen was inspected. There is a sufficient supply of 2-day perishable and 7-day non-perishable food. All the appliances are clean and seem to be operating properly. The common areas include the activity room, dining room, living room, and patio areas. These areas are clean and have the required furniture. There are no firearms or weapons stored at the facility. Evacuation chairs were observed at each stairwell. All required postings were observed throughout the facility. The facility does not have a swimming pool or bodies of water on the premises. Passageways and exits are free of obstruction. Eight (8) staff files were reviewed and included Criminal clearance record, and health screening with TB. Three staff did not have the required training, four (4) out of six (6) residents files that were reviewed were missing admission agreements, current physicians report with TB reading, consent forms, and appraisal needs and service plans. No fire/earthquake drill was conducted. Infectious control plan was reviewed. Facility had insurance that expired October of 2025. After record review it was discovered that facility did not follow operation plan for sixth and seventh floor. Random resident medications were reviewed. No errors observed. Medications are centrally stored and locked. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was deficiencies observed during the visit (Refer to LIC 809-D). Exit interview held and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 21, 2026

Allegation investigated: Licensee did not ensure equipment was in good repair Licensee did not ensure resident was afforded dignity

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced initial complaint investigation visit on 12/12/2025 regarding the above allegations. During today’s visit, LPA Gonzalez was greeted by Executive Director Jeri Miles and the purpose of the visit was explained. The investigation consisted of the following: LPA Gonzalez requested and obtained copies of Personnel Roster, Resident Roster, Admission Agreement, invoice for services provided, maintenance log, interviewed staff #1-4 (S1- S4) and Residents #1-10 (R1-R10). Continued on LIC9099C Unsubstantiated continued from LIC 9099 The investigation revealed the following: Regarding the allegation "Licensee did not ensure equipment was in good repair," it is alleged that residents have not had television service for five weeks. Interviews with staff revealed 4 out of 4 staff deny the allegation. Staff indicated there had been technical issues with a service provider but the issues were resolved within a week of the initial complaint. Interviews with residents revealed 1 out of 10 residents interviewed stated there are ongoing problems, service hasn't been consistent for months. 2 out of 10 residents indicated just recently there was an issue with service but it had been quickly resolved. 7 out of 10 residents indicated they had not had any problems with their television service. Regarding the allegation "Licensee did not ensure resident was afforded dignity," it is alleged that when resident advised staff of the television service issue, staff laughed and disregarded the resident. Interviews with residents revealed 10 out 10 residents did not have concerns. Residents stated staff is respectful when residents address concerns. !0 out of 10 residents stated they had not heard anyone complain about staff laughing at a resident after expressing a concern. R3 stated "no concerns, this place is beautiful." R10 stated "they try their best." Based on interviews and observation, although the allegation may have happened or is valid, there is no 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 report was provided to Executive Director Jeri Miles.the state’s words, verbatim · CDSS document, Dec 12, 2025 · control 28-AS-20251205120229

Allegation investigated: Staff do not provide adequate supervision to residents.

Licensing Program Analyst (LPA) Alberto Lopez made an unannounced visit to investigate the above allegation. LPA met with Jeri Hillery, Administrator/Executive Director, and discussed the purpose of the visit. The investigation consisted of reviewing and obtaining resident and staff rosters, interviewing four (4) staff, ten (10) residents, obtaining copy of rental agreement, and R1 physician’s report and other pertinent medical information. The investigation revealed regarding allegation: Staff do not provide adequate supervision to residents. It is alleged that residents from the fifth (5th) floor and lower floors are accessing floors six (6) and seven (7) and trying to get into the rooms. (continued on 9099C) Unsubstantiated (continued from 9099) LPA interviewed four (4) staff, and all four (4) staff denied the allegation. All staff stated they knew who the resident is that is going up to those floors. One staff member stated that resident wants to move to either the 6th or 7th floor and went up to see the rooms. Staff stated that they have told the resident that they can provide resident with a tour. Staff stated they cannot prevent residents from 5th floor and lower from accessing floors six (6) or seven (7) since it is all part of the facility and residents have right to the common areas on floors six (6) and seven (7). LPA interviewed ten (10) residents, and nine (9) of ten (10) residents could not corroborate the allegation. One (1) resident heard about an incident involving R1 trying to open door of one resident on 7th floor. R1 stated R1 has gone up to the 7th floor to see the rooms because R1 would like to move up there because those rooms have a microwave and stove. R1 denied going into any of the rooms. All ten residents stated they have never had any items missing from their rooms. R1 does not require a 1:1 and is clear and oriented according to physician’s report. There is insufficient evidence to support this allegation. 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 allegation is Unsubstantiated.the state’s words, verbatim · CDSS document, Nov 3, 2025 · control 28-AS-20251027202259

Allegation investigated: Staff do not provide residents with housekeeping services. Staff do not ensure that the facility is maintained clean. Staff do not ensure that passage way is free from obstruction. Facility smells malodorous.

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent visit in response to the above-mentioned allegations. LPA met with Claudia Ruiz, Business Office Manager and explained the reason for the visit. Investigation consisted of the following: On 12/17/2024, LPA D. Konishi requested a copy of staff and resident rosters. During today's visit, LPA Pena obtained a copy of the staff & resident rosters, House rules, Housekeeping schedule and Resident #1 (R1) files such as; Admission Agreement, Identification & Emergency Information, Physician Report and Needs and Services Appraisal. LPA conducted a tour of the facility focusing on the hallways, laundry room, storage/trash room, 1st floor stairwell, 7th floor hallway, and (14) random residents rooms including room #s 709 & 721. LPA conducted interviews with Resident #2 (R2) - Resident #14 (R14) and Staff #1 (S1) - Staff #5 (S5) and telephonically interviewed Resident #1 (R1). *****CONTINUED ON LIC 9099-C***** Unsubstantiated In regards to the allegation: “Staff do not provide residents with housekeeping services and Staff do not ensure that the facility is maintained clean .” It is alleged that the garbage cans in the hallways, inside of the laundry room and in the storage closet are not emptied and the flooring on the 7th floor is never swept or mopped. Interviewed staff denied the allegation and stated that housekeepers complete a list of their daily and weekly housekeeping duties. LPA toured the facility including the hallways, laundry rooms, storage/trash rooms, 1st floor stairwell, 7th floor hallway, and random and specific residents rooms. (2) housekeepers were observed cleaning the residents bedrooms and bathrooms. The facility appeared clean at the time of the visit. Interviews conducted with staff and residents did not corroborate the allegation. Based on the information obtained, the allegation is unsubstantiated. In regards to the allegation: "Staff do not ensure that passage way is free from obstruction." It is alleged that the 1st floor stairwell has mildew, rags, cans of paint rags and wood stored in it. Interviewed staff denied the allegation. S1-S2 stated that a 3rd party contractor work on some of the resident bedrooms for updating but they take their equipment and supplies in the rooms where they are working. Staff interviewed denied seeing any items in the 1st floor stairwell. (13) out of (14) residents interviewed indicated that they did not see the 1st floor stairwell with mildew or other obstructing items. Interviews conducted with staff and residents did not corroborate the allegation. During the tour, LPA did not observe any items like rags, cans of paint rags, wood or mildew in the 1st floor stairwell. Based on observation and information obtained, the allegation is unsubstantiated. In regards to the allegation: "Facility smells malodorous." It is alleged that room #709 smells "like funk and the facility smells like "urine and funk." Staff interviewed denied the allegation and stated that the residents in the 7th floor are all independent living and manage their own housekeeping. (5) out of (5) staff interviewed stated that they never smelled urine or funk in the room. (13) out of (14) residents interviewed also denied the allegation and indicated that they never smelled any room in any floors like urine and funk. During the tour, LPA observed that there's a cat in a specific room but it did not smell malodorous. LPA did not observe urine on the walls or on the floor on the specific resident's room during the visit. Based on the observation and information obtained, the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Jan 14, 2025 · control 28-AS-20241211100006

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 24, 2025

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, interviews, records review, the Administrator did not comply with the section cited above in which LPA's observation and resident/staff interviews revealed that the air conditioning in Room #721 was replaced because of mold which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 14, 2025

Plan of correction: Administrator will ensure that the facility continues to have inspections for mold or mildew in the residents rooms and provide LPA a written statement stating the plan on how to avoid the issue in the future by POC due date.

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA) Tyler Reyes conducted a subsequent annual inspection visit. LPA met with Crystene Char and discussed the purpose of today’s visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator and (9) staff files. Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Staff are also trained on Abuse Reporting and Resident Rights. Resident Records-Incident Reports: LPA reviewed (11) Resident files. Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent For Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Appraisal/Needs and Services Plan, Resident Rights were observed. Resident Rights-Information: Resident rights are posted and included in Resident files. Planned Activities: Facility has an activity calendar posted. Disaster Preparedness: The facility has a Disaster Preparedness plan in place. Last Emergency Disaster Drill Completed on July 31st 2024. Physical Plant & Environment Safety: LPA toured facility grounds. Multiple carbon monoxide detectors were observed in each floor (tested and operable). Fire extinguishers are located throughout the facility and on each floor. Hot water temperature measured within regulations. The hot water supply measured at the following temperatures: Room 103(105.4), Room 117(106.6), Room 209 (105.1), Room 303 (107), Room 405 (106.1), Room 521(111.5), Room 621 (109.4), and Room 711(113.5). Bathrooms had non-skid surfaces and grab bars. **Continued LIC809-C** Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. The facility also has emergency water supply and emergency paper goods. Posted menu observed. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining area has adequate seating. Health Related Services/Incidental Medical Services: The medications are stored inside locked carts located in the medication room. The facility utilizes an electronic program to document residents’ medication administration. LPA reviewed medication for Resident #1 (R1-R5) Exit interview conducted, a copy of this report was provided to Crystene Char.the state’s words, verbatim · CDSS document, Oct 29, 2024

Type of visit: Office

Licensing Program Analyst (LPA), Daniel Konishi, Licensing Program Managers (LPMs), David Sicairos and Fernando Fierros conducted a Virtual Office Meeting and met with West Park Senior Living Executive Director, Crystene Char, and Pacifica Senior Living Director of Regulatory Compliance, Marlene Nelson to discuss the de-licensing of the 7th floor. During the meeting, the following was discussed: How facility will not share any common areas including front lobby, elevator with the independent living residents. Independent living to have its own private entrance/exit that is separate from the Assisted living. Licensee to ensure that the Assisted Living and Independent Living maintain an approved fire clearance. Licensee to submit the LIC200 Application along with fees for change of capacity (decrease). Assisted living staff is not to be shared with Independent living staff. Administrator will contact the local fire authority regarding independent residents using the stairwell for private entrance. Administrator stated the licensee is not interested in operating as a Continuing Care Retirement Community (CCRC). The department will follow up with the administrator regarding the request to de-license the 7th floor. LPA Konishi will email the report to the Administrator for signature.the state’s words, verbatim · CDSS document, Oct 29, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Tyler Reyes conducted the required annual inspection. LPA met with Administrator Crystene Char and discussed the purpose of today’s visit. This facility is approved for (81) ambulatory and (119) non-ambulatory residents (of which 10 may be bedridden). This facility has an approved hospice waiver for (15) residents. The following bedrooms are approved for bedridden residents: #206,207,208,209,210,106,107,108,109 and 110. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an Infection Control Plan in place. Operational Requirements: This facility is approved for (81) ambulatory and (119) non-ambulatory residents (of which 10 may be bedridden). This facility has an approved hospice waiver for (15) residents. The following bedrooms are approved for bedridden residents: #206,207,208,209,210,106,107,108,109 and 110. Staffing: Facility is adhering to staffing requirements. Due to time constraints, LPA will return at a later date to complete all (12) CARE Tool domains. Exit interview conducted with Administrator Crystene Char and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 24, 2024

Allegation investigated: Staff are not following residents physicians order for a special diet Due to lack of supervision, residents money was stolen from residents wallet

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Crystene Char and explained the reason for the visit. The purpose of the visit is to investigate the above allegations. At today's visit the following occurred: Resident and Staff Roster was submitted. Review of Resident R1's file was done and Physician's Report, Resident Agreement and Emergency ID page was submitted. Tour of the dining room and kitchen was conducted at 10:00 AM. Interview was conducted with the Administrator at 9:35 AM and Staff S1 at 10:10 AM. Interview was conducted with Resident's R1-R7 from 10:30 AM to 11:30 AM. In regards to the allegation Staff are not following residents physicians order for a special diet, based on interviews conducted and information gathered 6 of 7 residents stated that they have choices and sugar free meals are provided. They also have vegetarian meals. They can also have substitute meals. Unsubstantiated Also stated the food is good and nutritious. Interview with Staff S1 who stated that everyday on menu they have sugar free items and there is a diet board with pictures of those who are on a diabetic diet. Stated that Resident R1 chooses his own meals and they can help set manage it. Also stated that R1 is non-compliant and will often choose cheeseburgers. Spoke with Administrator who stated that R1 is independent and chooses his own meals. Stated that there is not a written order from the doctor specifying a specific diet. Resident Agreement signed 06/01/2022 under section 6E Meals states we will accommodate some special diets if prescribed by your physician as a medical necessity. 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. In regards to the allegation Due to lack of supervision, residents money was stolen from residents wallet, based on interviews conducted and information gathered it was revealed by R1 that he has been here 20 months and in his 1st month here he told the facility that he did not want staff in his room. Interviews with 6 of 7 residents who all stated that they have never had their belongings taken from their room. 1 resident who knows R1 stated that she is very suspicious of R1's allegation because no one else on floor had items stolen. Interview with staff who all stated that there have been no complaints about items stolen from their room. 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.the state’s words, verbatim · CDSS document, Jun 18, 2024 · control 28-AS-20240612140945

Type of visit: Case Management - Annual Continuation

Licensing Program Analysts (LPA) Elizabeth Irra conducted a subsequent annual inspection visit. LPA met with Crystene Char and discussed the purpose of today’s visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant & Environment Safety: LPA toured facility grounds. Multiple carbon monoxide detectors were observed in each floor (tested and operable). Fire extinguishers are located throughout the facility and on each floor. Fire extinguishers were last services on 02/21/2023. Signal system was tested in the following rooms and were operational. Room 121, Room 222, Room 401, Room 415, Room 503, Room 504, Room 513, Room 602, Room 609 and Room 718. Hot water temperature measured within regulations. The hot water supply measured at the following temperatures: Room 121(109*), Room 222 (106.1*), Room 401 (106*) Room 415 (109.6*) Room 503 (110*), Room 504 (108*), Room 513 (107*), Room 602 (107*), Room 609 (109.1*) and Room 718 (108*). Bathrooms had non-skid surfaces and grab bars. Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. The food is properly stored in the refrigerator. The facility also has emergency water supply and emergency paper goods. Posted menu observed. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining area has adequate seating. Health Related Services/Incidental Medical Services: The medications are stored inside locked carts located in the medication room. The facility utilizes an electronic program to document residents’ medication administration. LPA reviewed medication for R-5, R-6, R-7, R-8 and R-10. Exit interview conducted, copy of appeal rights and a copy of this report was provided to Crystene Char.the state’s words, verbatim · CDSS document, Nov 30, 2023

Allegation investigated: Facility staff mismanages resident's medication.

Licensing Program Analyst (LPA) Alberto Lopez made a subsequent unannounced visit to the facility and was greeted by Crystene Char, Administrator explained the reason for the visit. During previous visit LPA interviewed 4 staff (S#1- S#4)Staff Ana Contreras, Katelyn Maloof, Jenny Ceballos, Crystene Char via phone, and 13 residents (R#1-R#13). LPA reviewed R1 file and obtained copies of pertinent medical information. LPA also interviewed W1 and W2. The investigation revealed. (Continued on 9099C) Substantiated Allegation: Facility staff mismanages resident's medication. It is alleged that the facility failed to administer medications according to doctor’s orders. On 09/13/2023 R1 stated her blood pressure was high and asked Med-Tech for additional ½ dose of Hydralazine as her doctor had ordered back on 12/29/2022. Facility staff refused to give it to R1 telling her that they required a doctor’s order and could not locate any current doctor’s order that allowed facility to provide an extra ½ a tablet. On new doctor’s orders dated 05/16/2023 provided to facility it only included for Hydarlazine to be provided 3 x per day without the additional ½ tablet PRN and facility was acting based on that order. However, on the actual medication for Hydarlazine bottle filled on 7/23/2023, The orders are for 3 tablets per day and additional ½ tablet if SPB is over 150. The doctor’s order’s and label on the bottle must be identical and it was not. Based on LPA observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. See 9099D for details. Exit interview conducted with Crystene Char, Administrator, a copy of this report is being provided and Appeal Rights were given.the state’s words, verbatim · CDSS document, Nov 28, 2023 · control 28-AS-20230920090825

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(e)(2) · Plan of correction due date: Dec 19, 2023

87465 (e)(2) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. (2) The exact dosage The requirement is not met as evidenced by: Doctor’s order dated 5/16/23 for Hydralazine dosage does not match the label dosage on the bottle dispensed on 07/23/23. The doctor’s order is for 1 tablet by mouth 3 times per day and label reads: Take 1 tablet by mouth 3 times per day. Ok to take extra one-half tablet if SHIP is above 150. Both the doctor’s order and the label should mirror each other. This posed/poses a health and safety hazard to persons in care.the state’s words, verbatim · CDSS document, Nov 28, 2023

Plan of correction: Administrator will write a letter stating how this will be addressed by facility and provide in service to all Medication Technicians on save medication handling.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Elizabeth Irra conducted the required annual inspection. LPA met with Claudia Ruiz and Crystene Char and discussed the purpose of today’s visit. This facility is approved for (81) ambulatory and (119) non-ambulatory residents (of which 10 may be bedridden). This facility has an approved hospice waiver for (15) residents. The following bedrooms are approved for bedridden residents: #206,207,208,209,210,106,107,108,109 and 110. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Facility has an Infection Control Plan in place. Operational Requirements: This facility is approved for (81) ambulatory and (119) non-ambulatory residents (of which 10 may be bedridden). This facility has an approved hospice waiver for (15) residents. The following bedrooms are approved for bedridden residents: #206,207,208,209,210,106,107,108,109 and 110. Staffing: Facility is adhering to staffing requirements. Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator/S-1 through Staff #6 (S-6). Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Staff are also trained on Abuse Reporting and Resident Rights. Refer to LIC 809C for the continuation of this report. Resident Records-Incident Reports: LPA reviewed Resident files for Resident #1 (R-1) through Resident #10 (R-10). Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent For Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Appraisal/Needs and Services Plan, Resident Rights were observed. Resident Rights-Information: Resident rights are posted and included in Resident files. Planned Activities: Facility has an Activities Director and Activities Assistant. Disaster Preparedness: The facility has a Disaster Preparedness plan in place. The following domains remain pending: Physical Plant & Environment Safety Food Service Health Related Services/Incidental Medical Services Exit interview conducted, copy of appeal rights and a copy of this report was provided to Crystene Char.the state’s words, verbatim · CDSS document, Nov 28, 2023