Westgate Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator (ADM) Aidah Tayag. LPA explained the purpose of the visit. LPA toured the facility inside out with ADM which included the Living room, kitchen, dining room, restrooms and residents bedrooms. LPA toured the following, but not limited bedrooms: 26, 25, 24, 19, 17, 5, 7, 9, 11, 12. There was no obstruction to block the walkways. The staff area of the facility was also inspected. The front yard and backyard were inspected. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 72 degrees F, and hot water temperature was measured at 112 degrees F in bathrooms. Fire extinguisher was serviced in October 28, 2025. The facility was equipped with smoke and carbon monoxide detectors. Facility sprinkler system was last inspected on August 20, 2025. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on June 1, 2026. LPA reviewed facility disaster plan, which was last reviewed/updated on June 16,2026. LPA reviewed facility records for 4 staff and 4 residents. LPA reviewed 4 resident medications and centrally stored medication records. LPA requested a copy of the following documents be sent to the Department by June 25, 2026. 1. LIC500, Personnel Summary 2. LIC308, Designation of Administrative Responsibility 3. LIC400, Affidavit Regarding Client/Resident Cash Resources 4. Liability Insurance 5. Qualifications of Administrator (Certificate) No deficiencies cited during today's visit. This report was reviewed with Administrator Aidah Tayag and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Jun 16, 2026

Allegation investigated: Facility staff did not ensure that resident's private parts are cleaned thoroughly when changed. Facility staff did not safeguard resident's personal valuables/belongings. Facility staff is not providing personal hygiene care to resident Facility staff is not dressing the resident for bed. Facility staff did not report concerns brought to their attention. Facility staff is not providing liquids to resident resulting in dehydration.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and met with Executive Director (ED) Aidah Tayag. On 08/22/2025, the Department received a complaint with above allegations. On 08/28/2025, the Department conducted an initial investigation visit. LPA interviewed 4 facility staff, a resident, and a family member. LPA obtained the physician report, appraisal needs and service plan of resident R1. On 10/01/2025, LPA conducted an investigation visit and interviewed Executive Director (ED) and a hospice care nurse. Continue on LIC9099-C. Page 1 of 5. Unfounded Facility staff did not ensure that resident's private parts are cleaned thoroughly when changed: On 09/28/2025, LPA interviewed the facility Director of Nursing (DN). DN stated that the caregivers provide proper incontinence care with soap and water during changing of adult briefs especially when resident has a bowel movement. DN stated caregivers provide proper incontinence care using incontinence sanitary wipes if they have episodes of urine incontinence and caregivers will change the resident with new adult briefs. DN stated caregivers check/change resident R1's diaper every two hours. LPA interviewed 2 caregivers who have taken care of resident R1. Both caregivers stated they wash R1 if they find feces on the diapers when they change R1's diaper. Both caregivers stated they wipe R1 if they find urine on the diaper when they change R1's diaper. Both caregivers stated they check/change R1's diaper every two hours. LPA interviewed R1's family member (FM), POA of R1. FM stated he/she visits R1 3 to 4 times per week. FM stated he/she changes diaper for R1 whenever he/she visits R1. FM stated he/she never saw feces, urine or not clean in R1's private area when he/she changes R1's diaper. FM stated the facility staff change R1's diaper every two hours. On 10/01/2025, LPA interviewed executive Director (ED) Aidah Tayag. ED stated resident R1 is always kept clean and in hygiene. ED stated R1 receives diaper change every two hours and after toileting. ED stated caregivers wipe R1 if urine was found on the diaper when changing R1's diaper. ED stated caregivers wash R1 if found feces on the diaper when caregivers change R1's diaper. ED stated caregivers call Med Tech, Nurse, or management to assist if R1 refused to change diaper. LPA interviewed a hospice care nurse (N1). N1 stated he/she comes on site to take care of R1 every week. N1 stated hospice care aide comes on site to help R1 for showers, hygiene, changing diapers every Wednesday and Friday. N1 stated the facility provides good care to R1. Continue on LIC9099-C. Page 2 of 5. Facility staff did not safeguard resident's personal valuables/belongings: On 08/28/2025, LPA interviewed Director of Nursing (DN). DN stated there was a incident before regarding resident R1 missed valuables. DN stated the facility conducted an investigation, and the finding is UNFOUNDED. LPA interviewed resident R1's family member (FM), R1's POA in financial and in health. FM stated before R1 moved in the facility, he/she received a notice from the facility, do not bring any expensive or valuables in the facility. FM stated R1 does not bring any valuables in the facility. FM stated R1 is forgetful and is with neurocognitive issue. FM stated sometimes R1 forgot he/she displaced something. FM stated he/she bought a headband for R1 which R1 likes. FM stated one day R1 found another resident has the same headband on the head. FM stated R1 might be confused the headband is his/hers. FM stated the price of the headband is $3.00. On 10/01/2025, LPA interviewed ED. ED stated he/she notified R1's family, R1's POA, do not bring any valuable personal belongings to the facility. ED stated R1 did not bring any valuable personal belongings to the facility. ED states R1 is forgetful with neurocognitive issue and without any valuable belongings in the facility. Facility staff is not providing personal hygiene care to resident: On 08/28/2025, LPA interviewed Director of Nursing (DN). DN stated resident R1 has 2-3 showers per week. DN stated R1 has a laundry per week. DN stated all the residents have at least 2 times teeth brushing every day. DN stated R1 receives teeth blushing after wake up and after meals. LPA interviewed 2 caregivers who have provided care to R1. Both stated they provide 3 times teeth brushing to R1 during their shifts. On 10/01/2025, LPA interviewed ED. ED stated R1 has 3 showers per week, two from hospice care aide, and one from the facility caregiver. ED stated R1 has 2 laundries per week. ED stated R1 did not have rash on skin. ED stated R1 has one deep cleaning for the room per week. ED stated staff provide R1 house keeping maintenance daily. ED stated R1 receives teeth blushing in the morning and before bed time daily.. Continue on LIC9099-C. Page 3 of 5. LPA interviewed hospice care nurse (N1). N1 stated hospice care aide come on site twice per week to provide showers, grooming, hygiene, changing diaper, dressing, and mouth care to R1. Facility staff is not dressing the resident for bed: On 8/28/2025, LPA interviewed DN. DN stated AM shift caregivers dress residents up in the morning when get up, and PM shift caregivers change resident to have pajama on when get to bed. LPA interviewed R1's family (FM), POA in financial and in health. FM stated he/she visits R1 3 to 4 times per week. FM stated he/she observed R1 was changed to pajamas for bed time. On 10/01/2025, LPA interviewed ED. ED stated staff help R1 to have pajama on before goes to bed every day, and gets change to wear day clothes in the morning every day. ED stated management always checks all residents to wear appropriate dressing every day. ED state Med Tech and caregivers always check and verify residents are dressed appropriately before going to bed. Facility staff did not report concerns brought to their attention: On 8/28/2025, LPA interviewed DN. DN stated he/she did not receive any complaint from R1's family. LPA interviewed Marketing Director (MD). MD stated he/she was told by R1's family member (FM), POA, that only to answer the general question regarding R1, and let FM to answer for any sensitive information regarding or care plan about R1 if anyone asks. MD stated he/she did not receive any complaint regarding R1. LPA interviewed R1's family member (FM), R1's POA. FM stated he/she knows another R1's family member brought some supplement to R1 but those were not doctor order, so the facility refused to give to R1. On 10/01/2025, LPA interviewed ED. ED stated there is no complaints or concern from R1's family. ED stated one of R1's family member asked about R1's care plan, but that family member is not R1's POA. ED stated the facility provided R1's care plan to R1's POA and asked the other R1's family member to talk with R1's POA. ED stated the facility policy is that resident's care plan, medical information are only provided to resident's POA. Continue on LIC9099-C. Page 4 of 5. Facility staff is not providing liquids to resident resulting in dehydration: On 8/28/2025, LPA interviewed DN. DN stated R1 has water at meals and has water between meals/events. LPA interviewed 2 caregivers who have provided care to R1. 1 out of 2 caregivers stated he/she gives water to R1 as needed. The other caregiver stated he/she gives water to R1 every two hours. LPA interviewed R1's family member (FM), POA in financial and in health. FM stated he/she visits R1 3-4 times per week. FM stated he/she observed R1 has water or drinks for the meals. FM stated he/she observed staff provided water or drink to R1 between meals. On 10/01/2025, LPA interviewed ED. ED stated the facility staff hydrate R1 every meal and R1 is offered water another 3 times between meals. ED stated the activity staff passing liquid to R1 and residents during the activity. Based on the interview on 08/28/2025 with R1's family member (FM) and the explanation on the email that FM sent to LPA on 09/15/2025, FM stated he/she is R1's POA in financial and in heath and all the allegations of the complaint are not true. FM stated the facility staff provide good care to R1. The Department has investigated the above allegations. Based on the investigation, record reviewed, and interviews conducted, the Department found that the above allegations are UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citation noted today. Exit interview was conducted with ED. The report was provided to ED for signature. A copy of the report was provided to ED. Page 5 of 5.the state’s words, verbatim · CDSS document, Nov 19, 2025 · control 26-AS-20250822164951

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management visit and met with Executive Director (ED) Aidah Tayag. On 7/17/2025, the Department receive an incident report regarding the way resident R1's family member (FM) manages R1's fund. On 7/24/2025, LPA interviewed ED. ED stated R1 does not pay the monthly rent since May 2025. ED stated the facility contacted FM and FM kept telling the facility that he/she is going to pay R1's monthly rent. ED stated on 7/16/2025, FM told the facility that FM lost job since April 2025. ED stated after 7/16/2025, the facility notified FM to pay partial monthly rent but the facility did not receive any money from FM for R1's monthly rent. ED stated FM notified the facility that FM will get refinance from the house or sell the house by August 1, 2025, or move R1 back to Home. ED stated FM lives in R1's house. ED stated FM notified the facility that on August 1, 2025 FM will pay R1's monthly payment if FM gets the refinance from the house or sell the house. ED stated the facility will set up a conference with FM on 8/2/2025 if the facility does not receive the fund for R1's monthly rent. LPA will follow up with ED in August 2025 for this case. Exit interview was conducted with ED. The report was provided to ED for review and signature.the state’s words, verbatim · CDSS document, Jul 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's required - 1 year annual inspection. LPA met with Administrator Aidah Tayag. During visit, LPA toured the facility with the ADM to include the entrance, dining room, kitchen, resident bedrooms, bathrooms, office, and exterior. All fire exit routes were free and clear of obstruction. The front door observed with operable door alarms. Posters observed to include the ombudsman, complaint poster, and personal rights. Facility temperature maintained between 73 - 75 degrees F. Fire extinguishers last serviced on 10/07/2024. Carbon monoxide detectors present on the first and second floor. Emergency lighting observed in the hallways. Activity calendar posted throughout the facility. LPA observed residents participating in activities in the activity room. Facility has at least 2 days worth of perishable and 7 days worth of non perishable foods. Refrigerator temperatures maintained between 36 - 38 degrees F. Freezer temperature maintained at -5 degrees F. Resident bedrooms #1, 2, 5, 7, 8, 10, 12, 24, 25, 28, and 30 was inspected. Bedrooms are equipped with beds, linens, night stand, dresser, and adequate lighting. Bathroom hot water temperature measured on the first and second floor (RM #8 and #28) initially measured between 133.5 - 135.5 degrees F. ADM states they just installed a new hot water heater. During visit, staff adjusted the hot water temperature which was measured between 114 - 116 degrees F before end of visit. See LIC809-C LPA reviewed 5 resident files. 5 resident files observed complete and up-to-date. 5 residents centrally medications and centrally stored medication records observed maintained, with no issues noted. LPA reviewed 5 staff files. 5 staff files observed complete and up-to-date. 3 out of the 5 staff has an active first aid certification. The 5 staff has at least 20 hours of annual training and 24 hours of initial training. Facility has an emergency disaster plan. The last emergency drill was completed on 05/18/2025. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Aidah Tayag and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 25, 2025

Allegation investigated: Facility staff are not meeting residents' housekeeping needs. Facility staff are not meeting residents' basic care needs (showering, laundering, checks on residents). Facility staff are not following resident's doctors notes. Facility staff does not provide residents a daily menu. Facility staff mixed sick residents with uninfected residents.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and met with Executive Director (ED) Aidah Tayag. On 11/29/2022, the Department received a complaint with the above allegations. On 12/06/2022, the Department conducted an initial investigation visit. LPA interviewed ED, 3 staff, and 3 residents. LPA requested resident roster, staff roster, staff schedule, weekly menu, resident physician report, Appraisal/Needs and Services Plan, Medication Administration Records, and showering schedule. On 4/19/2024, the Department conducted an investigation visit. LPA interviewed 7 staff and 6 residents. Continue on LIC9099-C. Page 1 of 6. Unfounded Facility staff are not meeting residents' housekeeping needs: On 12/06/2022, LPA interviewed Executive Director (ED) Aidah Tayag. ED stated the housekeepers conduct deep cleaning one time per week and as needed for resident rooms. LPA interviewed 2 residents and toured the rooms. 2 out of 2 residents stated the facility staff clean the resident room at least one time per week. 1 out of 2 residents stated the facility has good cleaning staff and he/she has no concern about the house keeping service. LPA did not see the resident rooms were not in sanitary condition. LPA toured and interviewed resident R1. LPA did not see R1's room was not in sanitary condition. LPA interviewed R1. R1 has a disorder that affects the communication and speech capabilities. R1 was unable to answer the questions exactly but just talking about his/her personal property issue. R1 was unable to describe what housekeeping needs were not met. On 4/19/2024, LPA interviewed 2 staff. 2 out of 2 staff stated the facility housekeepers clean resident rooms one time per week and as needed. LPA interviewed Housekeeper Supervisor (HS). HS stated the facility housekeepers clean the cognitive impairment resident rooms every Monday through Friday and 1- 2 times per week for remaining resident rooms. HS stated the housekeeper conducted the clean including changing residents' sheets. LPA interviewed 6 residents and toured the rooms. 6 out 6 residents stated housekeepers clean their rooms at least one time per week and as needed. LPA did not see any resident room was not in sanitary condition. Based on the observation and interviews, no evidence to indicate the facility staff are not meeting residents' housekeeping needs. Continue on LIC9099-C. Page 2 of 6. Facility staff are not meeting residents' basic care needs (showering, laundering, checks on residents): On 12/6/2022, LPA interviewed ED. ED stated residents have two scheduled showers per week and as needed, and caregivers conduct the laundries for residents after residents' showers. ED stated staff check residents every two hours. ED stated staff check residents with special health condition more often than every two hours. LPA interviewed 2 residents. 2 out of 2 residents stated they have 2 showers per week and staff check them every two hours or even less than two hours. On 4/19/2024, LPA interviewed 4 staff. 4 out of 4 staff stated residents have at least 2 showers per week. 4 out of 4 staff stated each resident has a scheduled laundry per week. 4 out of 4 staff stated staff check residents every two hours. 1 out of 4 staff stated before the facility had resident laundries after residents' showers, and now the facility improves to that each resident to have a scheduled laundry per week and as needed. LPA interviewed 6 residents. 5 out of 6 residents stated they have two showers per week, and 1 out 6 resident stated he/she has 3 showers per week. 5 out of 6 residents stated they have one laundry every week. 1 out 6 residents stated he/she has 3 laundries per week. 6 out of 6 residents stated the facility staff check them every two hours. Based on the interviews with staff and residents, there is no evidence to indicate residents' basic care needs were not met. Continue on LIC9099-C. Page 3 of 6. Facility staff are not following resident's doctors notes: The facility staff are alleged that the facility did not administer nutritional supplement to resident. On 12/06/2022, LPA interviewed ED. ED stated the facility staff administer medications to residents based on doctor's order/prescription in writing. ED stated PRN medications or nutritional supplements also need doctor's order/prescription in writing for the facility staff to administer to residents. On 4/19/2024, LPA interviewed staff Community Nursing Director (CNR). CNR stated the facility staff administer medications, PRN medications, nutrition supplements to residents based on doctor prescriptions in writing. CNR stated he/she was not aware of resident R1 had doctor prescription of nutrition supplements. Based on the review of R1's physician report, medication list and medical documents, no doctor's order/prescription of nutritional supplement was found for R1. Based on the interviews and records reviewed, no evidence to indicate that the facility staff are not following resident's doctor notes. Facility staff does not provide residents a daily menu: On 12/06/2022, LPA interviewed ED. ED stated the facility always has weekly menu available and posted. ED stated there are daily menu on the dining tables and available in front of the entrance of the dining room. ED stated the dietary supervisor talked to resident R1 for the food he/she wants before meal time. LPA interviewed 2 staff. 2 out of 2 staff stated the weekly menu are always posted. LPA interviewed 2 residents. 2 out of 2 residents stated the facility posts the weekly menu. On 4/19/2024, LPA interviewed 2 facility manager/directors. Both stated the facility always has weekly menu posted. Both stated there are daily menu available on the dining table and available in the front of the dining room. Both stated facility staff provides daily menu to resident R1 or talk to R1 for the meal food before the meal time. Continue on LIC9099-C. Page 4 of 6. LPA interviewed 3 staff. 3 out of 3 staff stated the facility has weekly menu. 1 out 3 staff stated he/she takes the daily menu to residents every day. 1 out 3 staff stated he/she takes the week menu to residents and there are daily menu available in the dining room. 1 out 3 staff stated the kitchen staff always give weekly menu to residents. LPA interviewed 6 residents. 6 out of 6 residents stated the facility has weekly menu. 2 out 6 residents stated the facility has daily menu in the dining room. 1 out of 6 resident stated he/she does not care about the menu because the facility food is good. Marketing director showed LPA the daily menu during LPA's visit the facility. LPA observed the facility weekly menu were posted, and the daily menu was placed at the dining table and in front of the dining room By Title 22, weekly menu is required to posted or provided. Daily menu is not mandatory to provide directly to residents. Based on the interviews, observation, and document reviewed, there is no evidence to indicate the staff does not provide daily menu. Facility staff mixed sick residents with uninfected residents: On 12/6/2022, LPA interviewed ED. ED stated on the beginning of November, the facility had gastrointestinal cases. ED stated the facility took actions on that and reported to local health department and CCL office. ED stated the facility closed the dining room, and stopped the facility activities, and had resident to stay at their rooms. ED stated the facility isolated the infected residents in their rooms. LPA interviewed a resident who stated at the beginning of November 2022, he/she got diarrhea, the facility activity was stopped, the dining room was closed, and he/she was isolated at the bedroom. Page 5 of 6. Facility staff are not meeting resident's nutritional health needs/religious food beliefs: Resident R1 cannot eat pork due to religious reasons. The facility was alleged that the facility staff are not meeting R1's nutritional health needs. On 12/06/2022, LPA interviewed ED. ED stated R1's family member already communicated with him/her regarding that R1 cannot eat pork due to religious reason before R1 moved in the facility. ED stated he/she already notified dietary supervisor regarding R1's special needs for the meals before R1 moved in the facility. ED stated the facility provides meal menu with the options/alternatives to choose if residents do not like the meals provided. ED stated the facility has daily menu on the dining room table and daily menu by the entrance of the dining room. ED stated R1 is particular at meal food. ED stated the dietary supervisor always contacted R1 to make sure what kind of food he/she likes for the meal before the meal time. ED stated the facility provides chicken, beef, turkey, shrimp and seafood for R1's protein needs. LPA interviewed dietary supervisor (S1). S1 stated he/she knows R1 cannot eat pork. S1 stated the facility provides different options/alternatives for residents to choose. S1 stated he/she or other staff talks to R1 before the meal time to make sure what kind of food he/she likes. LPA interviewed 2 staff. 2 out of 2 staff stated they know R1 does not eat pork. Both stated the facility did not provide pork to R1. Both stated R1 is particular on the meal food. On 4/19/2024, LPA interviewed Community Nursing Director (CNR). CNR stated R1 does not eat pork, but R1 eat kitchen, beef, turkey, shrimp and seafood. CNR stated the facility staff talk to R1 before the meal time to know what kind of food he/she likes. CNR stated R1 is particular at meal food. LPA interviewed 4 staff. 4 out 4 staff stated the facility provides weekly menu, and there are daily menus on the dining table and in front of the dining room entrance. 4 out of 4 stated kitchen staff or caregivers talk to R1 before the meal time to make sure what kind of food he/she likes. Based on the interviews and document reviewed, there is no evidence to indicate that the facility staff are not meeting resident's nutritional health needs. Continue on LIC9099-C. Page 2 of 6. Facility staff served residents raw meat: On 12/06/22, LPA interviewed ED. ED stated the facility staff always check the food before delivered to residents. ED stated if staff found meal with raw meat, they won't deliver to residents. LPA interviewed 2 residents. 2 out of 2 residents stated they never received meal with raw meat. On 4/19/2024, LPA interviewed Community Nursing Director (CNR). CNR stated the facility staff always check the food before delivering to residents. CNR stated if staff find meal with raw meat, they will return to kitchen. LPA interviewed 6 residents. 6 out of 6 residents stated they never received meal with raw meat. Based on the interviews, there is no evidence to indicate the facility staff served residents with raw meat. Facility staff engaged in a verbal altercation with resident: On 12/06/2022, LPA interviewed Executive Director (ED) Aidah Tayag. ED stated on 11/20/2022 he/she received a report regarding an incident happened in the kitchen between staff S1 and resident R1. Resident R1 was upset about the food. ED stated on 11/21/2022, he/she interviewed S1. S1 denied that he/she engaged in an alteration with R1. ED stated he/she interviewed R1 but R1 refused to talk about the incident. LPA interviewed staff S1. S1 stated resident R1 came to kitchen to question him/her and yelled at him/her. S1 stated he/she explained to R1 carefully and clearly. S1 stated he/she did not yell at R1 or threaten R1. LPA interviewed 2 staff (S2, S3). Both stated resident R1 is particular at food. Both stated they heard there was an incident that R1 and S1 had alteration in the kitchen, but they did not observe what happened. On 4/19/2024, LPA interviewed a staff S4. S4 stated he/she saw resident R1 went to kitchen to argue with staff S1 in November 2022, but he/she was unable to hear what they were talking about. S4 stated he/she was washing dishes and was unable to hear if any yelling between R1 and S1. Continue on LIC9099-C. Page 3 of 6. Facility staff threatened resident: On 12/06/2022, LPA interviewed ED. ED stated on 11/20/2022 he/she received a report regarding an incident happened in the kitchen between staff S1 and resident R1. Resident R1 was upset about the food. ADM stated he/she did not receive any report that facility staff threatened residents. LPA interviewed 2 staff. 2 out of 2 staff stated they heard an incident that a staff and a resident had an alteration but they did not see the incident in person. Both stated they did not see or hear staff threatening resident. LPA interviewed staff S1. S1 stated resident R1 came to kitchen to complain about the food. S1 stated R1 is hard to communicate. S1 denied he/she threatened R1. LPA interviewed resident R1. R1 is hard to communicate with. R1 was unable to answer the questions. LPA interviewed 2 residents. 2 out of 2 residents stated they were not aware of any incident that staff threatened resident. On 12/07/2022, ED contacted LPA via email regarding the incident S1 threatened resident R1. ED stated that on 11/18/2022, R1 went to kitchen to argue with staff S1 regrading the food provided by the facility. R1 was angry and yelled at S1. S1 tried to clam down R1 but unsuccessful. ED stated R1 had an alteration with S1. But S1 did not threatened R1. ED stated he/she tried to talk with R1 regarding the incident, but R1 refused to talk about it. ED interviewed 2 staff on site in the kitchen when the incident occurred. Both stated they did not see or hear S1 threatened R1. ED stated S1 denied he/she threatened R1. On 4/19/2024, LPA interviewed a kitchen staff who was on site when the incident occurred on 11/18/2022 that R1 had an altercation with S1 in the kitchen. The kitchen staff stated he/she did not see/hear S1 threatened R1. LPA interviewed 6 residents, 6 out of 6 residents stated they were not aware of any incidents that staff threatened residents. Based on the interviews, no evidence to indicate that the facility staff threatened residents. Continue on LIC9099-C. Page 4 of 6. Facility staff does not ensure that residents' items don't go missing (clothes, personal items): On 12/06/2022, LPA interviewed ED. ED stated he/she received some reports that residents were missing clothes after laundry. ED stated the lost clothes were not in residents' valuable property list. ED stated staff were helping to find residents' clothes in the laundry room after residents reported missing clothes. LPA interviewed 3 residents. 2 out of 3 residents stated they lost clothes after laundry. On 4/19/2024, LPA interviewed 7 staff. 4 out of 7 staff stated they heard residents complaining about losing clothes after laundry. LPA interviewed 6 residents. 2 out of 6 residents stated they missed clothes after laundry. 1 out of 6 residents stated he/she was able to find his/her clothes in the laundry room if he/she found missing clothes after laundry. 3 out 6 residents stated they did not lose clothes after laundry. LPA interviewed CNR. CNR stated the facility makes improvement from conducting laundry after residents' showers to have scheduled laundry for residents to prevent residents missing clothes after laundry. CNR stated this prevents the resident losing clothes after laundry. CNR stated it is easier to locate the owner of the missing clothes in the laundry room if clothes were found in the laundry room after the laundry. Based on the interviews, the facility made some actions to ensure resident not to lose clothes after laundry. Continue on LIC9099-C. Page 5 of 6. Facility staff are insufficient to meet the needs of the residents: On 12/06/2022, LPA interviewed ED. ED stated the facility had 45 residents and the facility had 4 caregivers at the first and the second shifts, and 3 caregivers at the third shift. LPA interviewed a staff who stated the facility has 4 caregivers and 1 Med Tech at the first shift, 4 caregivers and 1 Med Tech at the second shift, and 1 Med Tech/caregiver and 2 caregivers at the third shift. LPA interviewed 2 residents. 1 out 2 residents stated the facility does not have insufficient staffing issue. 1 out of 2 resident stated the facility could hire more staff. on 04/19/2024, LPA interviewed 6 residents. 5 out 6 residents stated the facility does not have insufficient staffing issue. 1 out 6 resident stated the facility could hire more staff. Based on the interviews, there is no evidence to indicate the facility staff are insufficient to meet the needs of the residents. Based on investigation, observations, and interviews conducted, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. No citations noted at today’s complaint investigation visit. Exit interview was conducted with ED. This report was provided to ED for signature. A copy of the report was provided to ED. Page 6 of 6. On 4/19/2024, LPA interviewed Community Nursing Director (CNR). CNR stated around October 2022 or November 2022, the facility had 5 residents had gastrointestinal infections. The facility closed the dining room and stopped the facility activity. CNR stated the facility isolated the infected residents in their rooms. LPA reviewed the email log that the facility communicated with the local health department. The facility followed the instructions provided by the local health department. Based on the interviews and record reviewed, the facility stopped the facility activity, closed the dining room, and isolated infected residents in their rooms. The facility notified the local health department and followed the local health department's instructions. There is no evidence to indicate the facility staff mixed sick residents with uninfected residents. The Department has investigated the above allegation. Based on the investigation, records reviewed, and interviews conducted, the Department found that the above allegations is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. No citation noted today. Exit interview was conducted with ED. The report was provided to ED for signature. A copy of the report was provided to ED. Page 6.the state’s words, verbatim · CDSS document, Sep 17, 2024 · control 26-AS-20221129092607

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Simi Rai and Steve Chang arrived to the facility unannounced to conduct a case management visit to follow up on resident (R1) who was admitted after the previous facility was closed due to TSO (Temporary Suspension Order). LPAs met with Administrator, Aidah Tayag. LPAs toured R1's room and observed bed with available bedding, a night stand and functioning lights. LPAs observed a bathroom attached to R1's room which had a working toilet, sink and functioning lights. LPAs toured the kitchen and pantry closet to observed 2 days of perishable foods and 7 days of nonperishable foods. The facility staff is working with R1's responsible party and R1's physicians to obtain the necessary required documents for R1's file. R1 is assigned a 1:1 caregiver at night for the next three days to observe R1. The facility staff is continuing to monitor and assess the resident to ensure the appropriate care and supervision is provided to R1. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator (ADM) Aidah Tayag and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 8, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an annual inspection today and met with Executive Director (ED) Aidah Tayag. LPA checked 5 residents' files and 5 staff's files. The facility has 53 residents and 20 staff in the facility. LPA toured the facility with ED. The visiting hours poster was observed in the main entrance. License, Administrator Certificate, and Personal Rights posters were observed in the main entrance. LPA inspected main entrance, lobby area, the dinning room, restrooms, break room and activity rooms. Laundry room and kitchen were observed and inspected. Chemical storage room, medication room and medication cart were observed locked. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Fire extinguishers were observed serviced on 12/11/2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors were tested by ED, and were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. Room temperature was observed at 74 degree F. Hot water temperature was observed at 117 degree F. The temperature of refrigerator is 38 degree F and the temperature of the freezer is -5 degree F. Emergency light system and first aid boxes were observed in the facility. The last time the facility conducted the emergency drill was on 6/3/2024. Exit interview was conducted with ED. This report was provided to ED for signature. A copy of the report was provided to ED.the state’s words, verbatim · CDSS document, Jun 26, 2024

Allegation investigated: Resident is not provided an adequate amount of showers. Resident was left soiled for a long period of time.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Administrator (ADM) Aidah Tayag. On 04/05/2022, the Department received an complaint with the above allegations. On 04/12/2022, the Department conducted an initial investigation visit. LPA interviewed Administrator and 2two residents (R1, R2). LPA obtained Resident Physician report, Appraisal Needs and Services Plan, showering schedule and Admission Agreement. Continue on LIC9099-C. Page 1 of 3. Unsubstantiated Resident is not provided an adequate amount of showers: Resident was left soiled for a long period of time: On 04/12/2022, LPA interviewed Administrator (ADM) Aidah Tayag. ADM stated the facility policy is that, by default, the residents are scheduled 2 times for showers per week with caregivers' help, however, if the residents need more than 2 times and requested, then the facility will provide the shower service by as needed basis. ADM stated if the residents need more showers regularly, then the facility will discuss with resident's family members to modify the admission agreement/service plan. ADM stated the facility caregivers check the residents' diapers every two hours. ADM stated the facility caregivers always come to help residents if the residents need to change diaper and requested for help. LPA interviewed 4 resident (R1 - R4). R1 stated he/she takes showers two times per week with caregivers' help. R1 stated that he/she thought it should be more often for shower, for example, at least 3 times, but he/she did not request for it. R1 stated the caregivers came to check his/her diaper every two hours. R1 stated the caregivers always came to help when he/she requested help to change diaper. R1 stated caregivers help him/her with laundry one time per week. R1 stated the laundry could be more often, but he/she did not request for it. R2 stated he/she had 3 showers per week because he/she requested one more shower per week, and he/she did not need help for changing diaper. R3 stated originally, he/she had a shower every 3 days and later he/she had a shower every 2 days because he/she requested to have more showers per week. R3 stated he/she did not wear diaper, but the facility caregivers checked him/her every two hours. R4 stated he/she had 2 showers per week, and he/she thought that was enough for him/her. R4 stated he/she did not wear diapers at day time but wears diaper at night time but the caregiver checked him/her every two hours. LPA interviewed 2 staff. 2 out of 2 staff stated the residents receive at least two showers per week, and the caregivers checked residents every two hours and changed resident's diaper if needed. S1 emphasized that the residents can request more showers. Continue on LIC9099-C. Page 2 of 3. Based on the interviews, the residents received at least two times showers per week and residents can request more showers if needed. Staff checked residents every two hours and changed the diaper if needed. 4 out of 4 residents did not complain the services of the facility. Based on the residents' shower schedule, each resident received at least two showers per week. The Department has investigated the above allegations. Based on interviews conducted and documents reviewed, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Exit interview was conducted with ADM. This report was provided for signature. A copy of this report was provided to ADM.the state’s words, verbatim · CDSS document, Feb 12, 2024 · control 26-AS-20220405164117