Willow View Gardens Memory Care & Assisted Living

Allegation investigated: Staff do not clean resident properly after using the restroom. Staff do not treat resident with dignity and respect. Staff did not ensure resident was fed before a medical appointment. Staff do not allow resident to eat an alternative meal. Staff will not allow resident to leave the dining area until everyone is finished eating.

Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to deliver the findings on the above allegations. LPA met with the Med Tech and explained the purpose of the visit. The med tech called the Executive Director, who provided verbal consent that med tech can sign the report on her behalf. An initial complaint investigation visit took place on June 4, 2026. During the visit, LPA accompanied by staff conducted a tour of the facility's physical plant. LPA requested and obtained the resident and staff roster, facility menu, preplacement appraisal, unusual incident/injury report dated 05/09/2026 and 05/28/2026, resident appraisal, appraisal/needs and services plan, physician’s orders, daily progress notes, admission agreement dated 02/25/2026, physician’s report dated 02/26/2026, and post acute order summary report dated 02/12/2026. Nine staff and five resident interviews were conducted during the visit. Six resident interviews were conducted in total. The investigation revealed the following: Continued on LIC9099-C. Unsubstantiated Regarding the allegation that Staff do not clean resident properly after using the restroom, it was reported that resident was accompanied to the bathroom but didn’t receive assistance. Resident (R1) had to clean themselves. Per review of physician’s report dated February 26, 2026, R1 is legally blind. Per review of preplacement appraisal information, R1 uses wheelchair, requires assistance with bathing and personal hygiene, but does not require assistance with toileting. R1 reported that staff does not assist with changing and they had to change themselves. Two out of five residents interviewed stated they are not cleaned properly after the bathroom. Three out of five residents stated they don’t need assistance with cleaning. Two out of nine staff interviewed stated that R1 verbalized he did not require assistance with cleanup after toileting. Four out of nine staff stated they do assist R1 with cleaning. Three out of nine staff provided irrelevant answers. There is no evidence supporting the allegation. Regarding the allegation that Staff do not treat resident with dignity and respect, it was reported that resident was asked to say “please” before being provided food. R1 reported they been insulted in Spanish. Per admission agreement dated February 25, 2026, residents of residential care facilities for the elderly shall be accorded dignity in their personal relationships with staff, residents, and other persons. Two out of five residents interviewed confirmed the allegation that they are not treated with dignity and respect. Two out of five residents denied the allegation. One out of five residents did not provide an adequate answer. Eight out of nine staff denied the allegation. One out of nine staff confirmed the allegation but could not provide further information. There is no evidence supporting the allegation. Regarding the allegation that Staff did not ensure resident was fed before a medical appointment, it was reported that resident was not provided with a snack prior to their dialysis appointment. It was reported that R1 arrived at his appointment “hungry and dirty”. Per review of R1’s admission agreement, they are provided with three nutritious meals daily and between meals nourishment or snack. The facility does not document meals received. One out of five residents interviewed stated they receive snacks before and after an appointment. Four out of five residents did not have relevant information regarding the allegation. Two out of nine staff reported at times, they are not advised to feed them depending on the appointment. Seven out of nine staff reported residents are always provided with a snack prior to appointments. There is no evidence supporting the allegation. Regarding the allegation that Staff do not allow resident to eat an alternative meal, it was reported that resident was not brought a different meal despite asking for one. Continued on LIC9099-C. Per review of daily menu, breakfast, lunch, and dinner entrees are listed every day. Residents may request a different meal by 10:00am. If no orders are placed by that time, residents are given the “meal of the day”. Three out of five residents interviewed stated they are always provided with alternative meals. One out of five residents stated there are not a lot of options available. One out of five residents did not have anything relevant to add to the allegation. Nine out of nine staff interviewed denied the allegation. There is no evidence supporting the allegation. Regarding the allegation that Staff will not allow resident to leave the dining area until everyone is finished eating, it was reported that resident had to remain seated until other residents were finished during mealtimes. LPA toured the dining area and observed that residents came and left as they pleased. R1 reported that some staff would allow them to leave, while some didn’t. R1 did not recall the names of the staff members who did not let him leave. Five out of five residents interviewed denied the allegation. Eight out of nine staff denied the allegation. One out of nine staff reported that some of the residents use wheelchairs and they have to wait a while until a caregiver comes to assist them. There is no evidence supporting the allegation. Based on the evidence gathered during the investigation, the allegations are found to be Unsubstantiated, meaning that 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. An exit interview was conducted, and a copy of the present report was provided to the authorized representative. Appeal Rights were reviewed.the state’s words, verbatim · CDSS document, Jul 24, 2026 · control 22-AS-20260601123502

Allegation investigated: Staff mismanaged resident's medication

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed staff and resident as well as reviewed and obtained pertinent documentation such as medication orders. Regarding the allegation that staff mismanaged resident's medication, the investigation revealed the following: Resident 1 (R1) admitted into the facility late on March 19, 2026. R1 came from a hospitalization at Chapman Global Medical Center and arrived without clothing or medications. Medication orders were sent out and medications were received from the pharmacy at 6:30 PM on evening of March 20, 2026. Resident was sent out via 911 at 6 AM on March 21, 2026. Review of medication administration record shows resident is prescribed seven medications to be administered at 8:00 PM and did not receive those medications on the 20th. Based on record review, the preponderance standard has been met. Therefore the allegation is deemed substantiated. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the report provided as well as appeal rights. Substantiatedthe state’s words, verbatim · CDSS document, Mar 30, 2026 · control 22-AS-20260324083753

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Mar 31, 2026

Basic services shall at a minimum include: Personal assistance and care as needed..., with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications...This req is not met as evidenced by: Based on record review, Licensee failed to ensure medications were administered to R1 which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 30, 2026

Plan of correction: Licensee to conduct an in-service on medication processing and forward proof to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kimberly Lyman and Fred Arias conducted an unannounced visit to Willow View Gardens. The purpose of today’s visit was to conduct the annual required inspection. LPAs were allowed entry into the facility and explained the reason for the visit. Facility is licensed for 130 non-ambulatory residents of which 50 may be bedridden. Facility has an approved hospice waiver for 50 residents and there are no residents on hospice during today's visit. Administrator Alma Espinal has an administrator certificate expiring on 04/01/2026. LPAs Lyman and Arias along with Administrator toured the facility at 8:28 AM. LPAs toured the physical plant, checked food service, and the first aid kit. The facility consists of two stories including a library, bistro, cinema room and hair salon. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105 degrees F and 110.3 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances are operational during today's visit. Toxins are secured in a closet. Smoke detectors and carbon monoxide detectors are tested in-house monthly and fire/ sprinkler inspections are conducted by a third party. Fire extinguishers were fully charged. Facility conducts monthly emergency drills with the last drill conducted on 10/20/2025. LPAs observed ample emergency food and water. Outside grounds were toured. LPAs observed multiple outside patio areas including a smoking area. There is ample outdoor shaded seating for residents.. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises. continued ON LIC 809C DATED 11/18/2025 First aid kit contained all required items including tweezers, scissors and thermometer. Facility provides activities in the form of music, art and puzzles. LPAs reviewed select resident files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. LPA to return at a later date to continue the annual inspection. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Nov 18, 2025

Allegation investigated: Staff abandoned resident at hospital

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the visit, LPA interviewed staff and reviewed pertinent documentation such as hospital discharge records. Regarding the allegation that staff abandoned resident at hospital, the investigation revealed the following: Resident 1 (R1) was hospitalized on 10/29/2025 after having a psychotic episode and breaking a window in the resident's room. Per UCI Hospital Social Worker and Psych Consultant RN, resident was medically cleared to return to the facility on 11/03/2025. Facility was contacted for discharge in the morning on 11/03/2025 and was unwilling to accept the resident back. Social Worker stated contacting Ombudsman at that time as well as notifying Licensing via an SOC 341 at 3:07 PM. Administrator contacted LPA on 11/03/2025 at 3:59 PM questioning discharge due to the window not being repaired in resident's room and mental status of resident. LPA advised at that time the resident needed to be accepted back. Resident was discharged at approximately 6 PM and returned to the facility. CONTINUED ON LIC 9099C DATED 11/12/2025 Substantiated Based on the evidence gathered, the preponderance standard has been met. Therefore the allegation is deemed substantiated. California Code of Regulations, (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the report provided as well as appeal rights.the state’s words, verbatim · CDSS document, Nov 12, 2025 · control 22-AS-20251104112811

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Nov 26, 2025

Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on interviews conducted, Licensee failed to provide care and supervision. Licensee was unwilling to accept resident back to the facility which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 12, 2025

Plan of correction: Resident returned to the facility in the evening on 11/03/2025. Licensee to submit a statement of understanding to LPA by POC due date.

Allegation investigated: - Staff did not provide mail to resident in care

On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conclude and deliver findings for a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the reason for the visit. Executive Director (ED) Alma Espinal arrived later to assist with the visit. The Department received a complaint on June 6, 2025. During the investigation, LPA Tea spoke to facility staff and residents and reviewed and collected pertinent documents and information. It was alleged that staff did not provide mail to resident in care. Per interviews with residents, six out eight residents stated that there were no issues with mail services. Most of the residents received their expected mail. A few of the residents complained that their mail was either stolen or went missing. One resident was waiting for a checkbook, and they had never received it. Despite that issue, a staff member was able to get them a replacement checkbook. One resident said before their mail was opened but since then it (Complaint Report continued on LIC9099-C) Unsubstantiated has improved, and they have no issues. Staff interviewed said there were no problems with mail. The mail is at the front desk and only staff have access to the mail. They file the mail by room number and the residents’ mail are locked and secure. ED Espinal said only Memory Care does not receive their mail. She stated packages are given to the residents at the end of the day and they never deny any residents mail service. It is the responsibility of the residents to ask and get their mail. Therefore, based on LPA Tea's observations and interviews conducted and records reviewed the allegation staff did not provide mail to resident in care has been determined to be UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiencies cited at this time and an exit interview was conducted with Executive Director Alma Espinal. A copy of the report was provided to the facility. handle their own medication, they can read, they administer their own insulin, so they want to request the doctor if they can handle their own medication. All staff agree that there is no mismanagement of medication. They try their best to give the medication on time but of course there is a delay at times because there are things that arise during their shift, like helping another staff assist with another residents and emergencies. One staff member stated they follow doctor’s order, and they have a lot of in-service trainings for medication and they use a MAR to document medication dosage. Nurse Consultant, Amie Pangilinan which is similar to a Health Service Director position, stated that she monitors her MedTech staff and so far, there are no medication errors. Her in-service training focuses on logging medication refusals and addressing questions about medication that MedTech staff have. It was alleged that staff did not prevent resident from harming another resident in care. LPA spoke to residents and eight out eight residents, although a few of them have never seen residents fight, they all have similarly agreed that staff at the facility try their best to prevent resident from harming another resident or further escalation. Some residents have seen staff stepping in and telling them to stop. R1 stated during a bingo game another resident got upset and hit their hand. The staff did intervene and later the resident who hit R1’s hand came to apologize for what had happened because of the staff intervention. All staff interviewed have agree that when they see residents arguing they try to de-escalate the situation. One staff said they try to talk to them to calm them down and separate them. Then the staff offers solutions to the resident, like asking if the resident can sit at this table for the time being. All staff feel they are doing a good job of protecting residents. It was alleged that staff did not provide housekeeping services to residents in care in a timely manner. Eight of eight residents interviewed said that facility provides adequate housekeeping services to them in a timely manner. The residents interviewed have stated that they thoroughly clean their rooms once a week on specific days. The bed linens are changed weekly, and staff do their laundry. Granted that most of the time staff are busy, when housekeeping requests are made, the residents mention they try their best to complete their requests. R1 stated that the staff missed wiping the dust underneath their mattress, but overall, they did a good job. All staff LPA interviewed as well agree that they try their best to clean and keep up with the resident’s housekeeping request, despite they can be demanding. One of the housekeepers who clean R1’s room said that R1 appreciates them cleaning their room and on days when she is not there she gets upset at (Complaint Report continued on LIC9099-C) other staff because they do not clean their room like the housekeeper that cleans their room regularly. Staff have all stated that resident rooms have a scheduled day where they clean their room. They clean the room as needed for spills, accidents, and soiled bedding. It was alleged that staff did not safeguard resident's personal items. Per interviews with residents, seven out of eight residents have felt their personal belongings were safeguarded by the staff. They never had issues with anyone stealing their personal belongings. R1 stated they left money on their night stand, and it was still there. R1 stated staff are honest, hard-working people who would never risk their jobs to steal something from residents and protect them from other residents. All staff interviewed have similarly acknowledge that they do their best to safeguard residents’ personal belongings. Two staff interviewed would make sure that the residents’ doors were closed. They would question any resident who is going into someone else’s room and redirect them out of the resident’s room. Often residents misplaced their stuff. They would say their stuff had been stolen and at the end of the day they would find it later because they do not remember where it was or it was misplaced. It was alleged that staff did not provide toileting assistance to resident in care in a timely manner. Per investigation, eight of eight residents interviewed feel the facility does a great job in assisting resident with toileting. Some residents interviewed say they do not need toileting assistance but however they said they never heard of any of issues with toileting assistance amongst other residents living at the facility. One resident spoken said one time they were sick the staff did a great job in assisting them to the restroom when they needed help. Another resident said they help them change their diapers and their clothes with no problem. R1 stated that the staff come right away to assist their roommate with toileting services. Just at night time, due to staff shortages it is a bit longer response. All staff interviewed have said that they do their best to help residents with toileting assistance. At times they are busy helping a lot of residents, but they do their best and change their diapers and clean them up. One staff member said unfortunately mishaps happen because residents have diarrhea, again they try their best to assist residents with their toileting needs. It was alleged that staff spoke inappropriately to resident in care. All residents interviewed unanimously agree they have never been spoken to inappropriately. They were treated with respect by the facility staff. R1 said the staff have never even raised their voices at them. R1 has seen residents treat staff disrespectfully. All staff interviewed have all agreed that they have always treated residents with respect and are careful with what they say to residents. One staff interviewed stated that they treat the residents like family just like how (Complaint Report continued on LIC9099-C) they would treat or talk to their own mother because the staff has had experience taking care of their mother who had Alzheimer’s for ten years. It was alleged that staff did not implement proper hand hygiene procedures. Per interviews with residents, seven out of eight residents felt that the staff implemented proper hand hygiene because they saw the staff wearing gloves most of the time especially when handling food, when cleaning their room. Residents have seen the staff wash their hands routinely. However, one resident, R1 has seen a staff who helped in the kitchen use their bare hands to scoop the ice. R1 acknowledge that to the staff and refused the ice. All the staff interviewed have said they do practice proper hand hygiene, they wash their hands and wear gloves, when necessary, especially cleaning and handling with food. LPA interviewed one of the kitchen staff and said when they handle or serve food and take out the trash they always wear gloves. They said they would never use their bare hands to scoop ice because there are two ice scoopers in the kitchen for them to use to scoop ice for the residents. They wash their hands, and they have convenient soap dispenser and sink to wash their hands. They are afraid to get sick from residents and protect their health by wearing gloves and washing their hands frequently. During all visits, LPA has observed staff such as caregivers have gloves on. LPA also observed all kitchen staff wearing and using gloves in the kitchen as well. Therefore, based on LPA Tea's observations, interviews conducted, and records reviewed the allegations that facility staff mismanaged resident's medications, staff did not prevent resident from harming another resident in care, staff did not provide housekeeping services to resident in care in a timely manner, staff did not safeguard resident's personal items, staff did not provide toileting assistance to resident in care in a timely manner, staff spoke inappropriately to resident in care, and staff did not implement proper hand hygiene procedures has been determined as UNFOUNDED, meaning the allegations are false, could not have happened and/or is without a reasonable basis. No deficiencies cited at this time and an exit interview was conducted with Executive Director Alma Espinal. A copy of the report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 12, 2025 · control 22-AS-20250606123601

Allegation investigated: -Facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections

On this day Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegation listed above. LPA Vanegas was greeted and granted entry to the facility by Administrator (AD) Alma Espinal LPA introduced themselves and stated the purpose of the visit. An initial investigation visit was conducted on May 28, 2025. During the visit, LPA Vanegas gathered and reviewed pertinent records pertaining to residents in care in regard to the allegations stated above. LPA Vanegas interviewed residents. LPA Vanegas also gathered and reviewed employee files relevant to the allegations being investigated. The investigation into the allegation, facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections, revealed the following. It was alleged that facility staff are injecting residents with insulin. No dates or times were provided of when the alleged violation took place. Staff that were interviewed denied that allegation. The Administrator reported that they have never witnessed facility staff injecting residents in care, and that they have registered nurses on call, but they do not inject residents. CONITNUED ON LIC9099C Substantiated Resident 4 (R4) reported that they inject themselves with their own insulin, but a few years ago staff would inject them, but they have not done so in the past two years. Resident 3(R3) reported that they inject themselves with their own insulin, but in the past staff has injected them, no time or dates were provided in regard to the last time staff injected them. Resident 2 (R2) reported that they inject themselves with their insulin, and they have never witnessed any staff injecting residents in care with insulin. Resident 1 (R1) reported that staff does not inject them with insulin, and if anyone helps them it is their daughter who comes to visit them. Based on the evidence gathered the preponderance standard has been met therefore the allegation stating, Facility staff are not ensuring that an appropriately skilled professional is assisting the resident with injections, is deemed substantiated. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Jun 19, 2025 · control 22-AS-20250520155200

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87629(b)(1) · Plan of correction due date: Jul 3, 2025

87629(b)(1) (b)In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensees who admit or retain residents who require injections shall be responsible for the following: (1)Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance.the state’s words, verbatim · CDSS document, Jun 19, 2025

Plan of correction: Administrator advised that they will ensure that an appropriatley skilled nurce will be in the facility seven days a week to administor injections to residents in care. Administrator wil send proof of correction to LPA via email on or before P.O.C due date.

Allegation investigated: Staff did not safeguard resident’s personal belongings.

Licensing Program Manager (LPM) Mota spoke with Alma Espinal, Administrator via telephone visit to discuss the findings for the above allegation. The investigation consisted of interviews with staff, residents, reporting party, and Resident (R1). The investigation also consisted of obtaining Police Records, facility, photographs, and medical records. The investigation revealed the following: An inspection of R1’s room on 5/16/2024 revealed the room to be cluttered with large amounts of clothing and jewelry. Interviews conducted with six (6) out of seven (7) residents stated that they have not had any items missing or stolen from the facility. One (1) resident stated that three (3) items of clothing were missing, but did not feel that they had been stolen, but misplaced. R1 stated during an interview on 5/16/2024 that their entire wardrobe is missing, although photos that same day show many items of clothing on hangars along with shoes, stockings, gold jewelry, and a belt in the room. R1 was observed wearing gold jewelry when interviewed. Continued on LIC9099-C Unsubstantiated Continued from LIC9099-A A review of Santa Ana Police records shows that R1 stated to police on 5/8/2024 that “R1 has not had any thefts. R1 was allowed to change locks to prevent anyone from coming into R1’s room and was confused as to why an officer was there” Based on interviews, photographs, room inspection, and police reports, due to conflicting information, LPM is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of the report was sent to Alma Espinal via email for signature.the state’s words, verbatim · CDSS document, May 27, 2025 · control 22-AS-20240508154100

Allegation investigated: Resident's personal rights were violated.

Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of initiating the complaint investigation into the above allegation. LPA was greeted and granted entry by Housekeeper Alice Castillo and stated the purpose of the visit to Activity Director (AD) Maroma Herrera. During the course of the investigation, LPA interviewed three staff, however the resident in question, (R1), had passed away due to natural causes on May 3, 2025, and could not be interviewed. LPA obtained pertinent records such as the resident/staff rosters, March/May 2025 activity calendars, R1's face sheet, physician's report, admission agreement, death certificate, as well as the employee handbook, and resume of Staff #1 (S1). The investigation revealed the following: Regarding the allegation, Resident's personal rights were violated, it was reported that a TikTok video of R1 and S1 dancing was posted on S1's TikTok account. Based on the review of S1's Tiktok account, there were no videos of residents posted for the public viewing. Substantiated S1 indicated that the video in question was not uploaded publicly by demonstrating that TikTok videos could be saved and downloaded with the TikTok watermark without being uploaded. LPA confirmed no evidence of videos were posted publicly. However, LPA viewed a total of six videos set privately which is often indicated by a lock icon under the "lock" tab. Per Google, the lock tab on TikTok refers to the option to make your profile and videos private, meaning only your followers can see them, or you can further restrict visibility to "only me." LPA observed four out of the six privately set Tiktok videos had views ranging from 8-274 views with comments. Based on the review of the Employee Handbook, S1 violated Section Five: Standards of Conduct, which documents that inappropriate behavior such as "interaction with residents that is unprofessional during the course of providing resident care." It is determined that there were sufficient corroborating evidence based on the interviews and record review, therefore, the allegation of Resident's personal rights were violated, is deemed SUBSTANTIATED. See the attached LIC9099-D. An exit interview was conducted with Licensee Christine Juarez, and a copy of this report along with the LIC9099-C, LIC9099-D, LIC811, and the appeal rights were provided at the end of the visit.the state’s words, verbatim · CDSS document, May 20, 2025 · control 22-AS-20250515094714

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: May 27, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) "To have a reasonable level of personal privacy..." This requirement was not met as evidenced by: Based on interviews and record review, there were four out of six private videos with views from followers ranging from 8-274 which poses a potential Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, May 20, 2025

Plan of correction: Licensee and Administrator stated that proof of an in-service training covering the personal rights of residents will be conducted and an addendum will be created regarding a written/opt out consent to take photgraphs and video recordings will be submitted to LPA via email by POC due date.

Allegation investigated: Facility did not safeguard resident's personal belongings

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit on this day for the purpose of initiating an investigation into the above allegation. On this day, LPA was greeted and met with Maintenance Director Tony Ruiz. LPA met with Administrator Alma Espinal via telephone. During the course of the investigation, LPA toured the facility and interviewed staff and residents. Regarding the allegation that facility did not safeguard resident's personal belongings, the investigation revealed the following: Facility indicates a pipe repair occurred in the facility on 04/07/2025 which resulted in Resident 1 (R1) being unable to use the resident's toilet for a couple hours. On 04/08/2025, Staff 1 (S1) unclogged the resident's toilet which took about four hours. S1 denies taking any items out of the resident's room. R1's roommate, R2, denies ever having anything taken out of the resident's room and states that R1 did not have any of the noted stolen items in the room at any time. Review of R1's inventory list did not mention any of the noted missing items. Facility documentation indicates six instances between 11/2024 and 03/2025 of resident accusing others of stealing cash or documents. Administrator indicates the documents were found in the resident's room. CONTINUED ON LIC 9099C DATED 05/13/2025 Unsubstantiated LPA interviewed three residents who stated having items go missing from time to time with sometimes the items would be found or misplaced. All three could not confirm if missing items had been stolen or misplaced. Due to conflicting information, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, May 13, 2025 · control 22-AS-20250507101501

Allegation investigated: Resident sustained unexplained injuries due to lack of supervision Resident sustained unwitnessed fall due to lack of supervision

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit on this day for the purposes of delivering findings into the above allegation. On this day, LPA was greeted and met with Maintenance Director Tony Ruiz. On September 12, 2024, the Department received a complaint alleging Resident sustained unexplained injuries due to lack of supervision; Resident sustained unwitnessed fall due to lack of supervision; and Facility staff did not dispense medications as prescribed. A health and safety visit was conducted by the Department on September 13, 2024, and an investigation initiated. The investigation determined as follows: Resident 1 (R1) was admitted to the facility on August 07, 2024. Per Physician Report dated August 07, 2024, R1 has a diagnosis of generalized weakness and Alzheimer’s disease and requires some assistance with activities of daily living (ADLs) such as bathing, toileting, and dressing. Per Physician Report, R1 requires 24-hour monitoring due to cognitive impairment and impaired functional mobility. R1’s pre appraisal plan dated August 13, 2024, notates R1 cannot walk long distances due to prior broken hip. Continued on LIC 9099C dated 02/19/2025 Unsubstantiated On September 11, 2024, R1 was found by Staff 1 (S1) at approximately 1 PM laying on their bedroom floor. S1 reported they had heard R1 calling for help prompting their response. Upon finding R1, facility staff sought emergency medical services. R1 reported they were attempting to reach for their walker when they fell. S1 reported last observing R1 at 12PM, approximately an hour earlier, when they had passed out medications. Upon being admitted to Norwalk Community Hospital, R1 was diagnosed with facial contusions, knee abrasions and forehead hematoma. R1 reported to hospital staff they had fallen after reaching for a napkin. Due to inconsistency in R1’s report and injuries observed, Santa Ana Police arrived to speak with R1. Per Santa Ana Police report, R1’s injuries appeared consistent with injuries sustained from a fall. R1 reported being beaten by “four women” but was unable to provide further elaboration. The Department attempted a separate interview with R1 but was unable to due to R1’s cognitive decline. R1 did not appear oriented to time and space. Interviews with four of four staff reported R1 was independent prior to fall and received hourly to bi-hourly checks. Staff reported being aware R1 was a fall risk. The facility provided R1 with a fall matt and a call light to ask for assistance when needed. Interviews with R1’s nurse practitioner revealed no concerns of neglect. Per interview with R1’s responsible party, no concerns with R1’s care were expressed. Based on interviews conducted and records reviewed, the allegations that Resident sustained unexplained injuries due to lack of supervision and Resident sustained unwitnessed fall due to lack of supervision is deemed to be Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred. This agency has investigated this complaint. An exit interview was conducted and a copy of this report and confidential names list was provided to facility representative.the state’s words, verbatim · CDSS document, Feb 19, 2025 · control 22-AS-20240912142400

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809 D on 11/06/2024 LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. During today's visit, medications are secured. Licensee has complied with the POC. *Deficiency cited under Title 22 Regulation 87464(f)(4) pertaining to Basic Services has been cleared. Licensee provided proof of correction. *Deficiency cited under Title 22 Regulation 87411(f) pertaining to TB testing has been cleared. Licensee provided proof of correction. Licensee has been advised to remain in compliance with items previously cited at the facility. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Nov 13, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kimberly Lyman and William Vanegas conducted an unannounced visit to Willow View Gardens. The purpose of today’s visit was to conduct the annual required inspection. LPAs were allowed entry into the facility and explained the reason for the visit.. Facility is licensed for 130 non-ambulatory residents of which 50 may be bedridden.. Facility has an approved hospice waiver for 50 residents and the facility has 59 residents in assisted living and 19 in memory care. There are 10 residents on hospice. Administrator Alma Espinal has an administrator certificate expiring on 04/01/2026. LPAs Lyman and Vanegas along with Administrator toured the facility at 8:48 AM. LPAs toured the physical plant, checked food service, and the first aid kit. The facility consists of two stories including a library, bistro, cinema room and hair salon.. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. At 9:15 AM, LPAs observed unsecured medications and supplements in Resident 6's apartment. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 105.4 degrees F and 108.3 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPAs toured the main level medication room and observed medications are unsecured and accessible to residents in care. Common areas were clean and clear of hazards, doorways were free of obstructions. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances are operational during today's visit. Toxins are secured in a closet. Smoke detectors and carbon monoxide detectors are tested in-house bi-monthly and fire/ sprinkler inspections are conducted by a third party, Hilltop Alarms. Fire extinguishers were fully charged. LPAs reviewed the infection control plan and emergency disaster plans and plans are complete. Facility conducts monthly emergency drills with the last drill conducted on 10/14/2024. LPAs observed ample emergency food and water. Outside grounds were toured. LPAs observed multiple outside patio areas including a smoking area. There is ample outdoor shaded seating for residents.. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises. continued ON LIC 809C DATED 11/06/2024 First aid kit contained all required items including tweezers, scissors and thermometer.Facility provides activities in the form of music, art and puzzles. LPAs reviewed eight resident files and six staff files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. Staff files reviewed contained required documentation including required annual training, medical assessment, criminal record clearance and proof of CPR training. At 1:15 PM, LPAs observed three out of three staff do not have proof of TB testing in the file. At 3:00 PM, LPAs reviewed medication storage and administration. LPAs observed four out seven medications reviewed are not being administered per physician order or are lacking documentation. Medications are stored in locked medication carts, Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 the California Code of Regulations. This report was discussed with the facility representative and a copy was provided as well as appeal rights.the state’s words, verbatim · CDSS document, Nov 6, 2024

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Kimberly Lyman and Sam Haddadin conducted an unannounced case management visit to follow up on an incident report submitted on 05/31/2024. LPAs were greeted and granted entry into the facility and explained the reason for the visit. Incident report dated 05/29/2024 indicated Resident 1 (R1) was sent out on a 5150 psychiatric evaluation after allegedly making threats to kill everyone in the facility. Resident was evaluated by psychiatrist and referred for the hold. Resident was sent to LA Downtown Medical Center. Resident has a history of bi-polar, depression, paranoia and anxiety. Resident has not returned to the facility. LPAs toured the facility and observed residents relaxing and eating lunch. Facility appears clean, safe and sanitary during today's visit. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 28, 2024

Allegation investigated: Illegal eviction

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed staff and resident. Regarding the allegation of Illegal eviction, the investigation revealed the following: Resident 1 (R1) was served an eviction notice on 04/17/2024 for violation of house rules, alcohol usage. The department approved the eviction notice as legal. The resident as well as two out of two staff confirm alcohol usage in the resident's room. Resident 1 initially denied receipt of eviction notice but openly discussed the terms of the notice and the violation with LPA. Based on interviews conducted and record review, the allegation is deemed unfounded, meaning the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to facility representative. Unfoundedthe state’s words, verbatim · CDSS document, May 7, 2024 · control 22-AS-20240502094405

Allegation investigated: Staff did not provide comfortable living accommodations for resident

Licensing Program Analysts (LPAs) Kimberly Lyman and Michael Tea made an unannounced complaint visit to initiate an investigation into the above allegation. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPAs toured the facility and interviewed staff and residents. Regarding the allegation that staff did not provide comfortable living accommodations for resident, the investigation revealed the following: Residents 1 and 2 (R1, R2) became roommates on 04/12/2024. On 04/26/2024, staff informed Administrator that the residents were arguing and unhappy with the living situation. Administrator spoke with both residents same day to come up with a solution. On 04/30/2024, Administrator spoke with residents to advise they would be residing in separate rooms. LPA observed staff getting R2's room ready and moving personal affects. Both residents confirm acceptance of the move. Facility indicates this is the sixth roommate for Resident 1. Based on interviews conducted, the allegation is deemed unfounded, meaning the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to Administrator. Unfoundedthe state’s words, verbatim · CDSS document, May 1, 2024 · control 22-AS-20240426103500

Allegation investigated: Staff did not assist resident with meeting dining needs Staff do not provide adequate activities for residents

Licensing Program Analysts (LPAs) Kimberly Lyman and Michael Tea made an unannounced complaint visit to initiate an investigation into the above allegations. LPAs were greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPAs toured the facility and interviewed staff and residents as well as reviewed and obtained pertinent documentation such as activities schedule. Regarding the allegations that staff did not assist resident with meeting dining needs and staff do not provide adequate activities for residents, the investigation revealed the following: On 04/17/2024, facility had a dining staff call out. Administrator as well as Activity Coordinator pitched in to serve the residents lunch. There are no activities during lunch time. Six out of six residents confirm receipt of lunch and the server call out had no impact on receiving lunch or participating in activities. Six out of six residents state ample activities at the facility and LPA observed residents participating in activities during two different visits. LPA observed the activity schedule as well. Based on interviews conducted, the allegations are deemed unfounded, meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to Administrator. Unfoundedthe state’s words, verbatim · CDSS document, May 1, 2024 · control 22-AS-20240418134733

Allegation investigated: Staff did not seek timely medical attention for resident.

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegation that staff did not seek timely medical attention for resident, the investigation revealed the following: Resident 1 (R1) admitted into the facility on 03/27/2024 with a diagnosis of Parkinson's Disease. Resident was hospitalized at Kaiser prior to admittance into facility. When resident admitted into the facility, Kaiser failed to provide medication/ medication orders. Facility and family were working on getting the situation remedied. On 03/29/2024, R1 was observed by staff on the ground by the resident's bed in the resident's room. Staff assisted getting the resident up and was assessed to have no injuries. Three out of three staff confirm no injury on resident. Due to the resident missing medications, the resident was agitated. Per interviews conducted with Administrator and family, resident was sent out for agitation and confusion later that day, CONTINUED ON LIC 9099C DATED 4/16/24 Unsubstantiated unrelated to the fall that was observed. Family confirms no injuries noted on resident and facility documents confirm the reason for the resident's send out. Due to conflicting information, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Apr 16, 2024 · control 22-AS-20240402090752

Allegation investigated: Staff did not provide a resident an admission agreement

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility, interviewed staff as well as reviewed and obtained pertinent documentation such as admission agreement. Regarding the allegation that staff did not provide a resident an admission agreement, the investigation revealed the following: Resident 1 (R1) admitted into the facility on 02/29/2024 and admission agreement on file at facility is signed and dated by R1 on 02/29/2024. Billing invoice is dated 02/29/2024-03/31/2024. Administrator indicates admission agreement was signed at time of admission on 02/29/2024. Based on record review and interviews conducted, the allegation is deemed unfounded, meaning the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to Administrator. Unfoundedthe state’s words, verbatim · CDSS document, Apr 16, 2024 · control 22-AS-20240405084807

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809 D on 04/08/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87458(a) regarding Medical Assessment has been cleared. Licensee provided proof of medical assessment for Resident 1. Licensee has complied with the POC. Licensee has been advised to remain in compliance with items previously cited at the facility. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 16, 2024

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit in conjunction with complaint #22-AS-20240402090752. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the complaint investigation, LPA reviewed Resident 1's (R1) file. The resident does not have a physician report on file. Based on the observations made from today's visit, deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the Administrator and a copy was provided to Administrator as well as Appeal Rights.the state’s words, verbatim · CDSS document, Apr 8, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Apr 22, 2024

Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year...This req is not being met as evidenced by: Based on record review, Licensee failed to ensure R1 has a medical assesssment prior to admission. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 8, 2024

Plan of correction: Licensee to forward a copy of the medical assessement to LPA by POC due date.

Allegation investigated: Staff did not follow proper eviction procedures

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA interviewed staff and resident as well as reviewed and obtained pertinent documentation such as text messages. Regarding the allegation that staff did not follow proper eviction procedures, the investigation revealed the following: Resident 1 (R1) moved out of the facility on 02/24/2024 with the resident's family member who is also the durable power of attorney (DPOA). DPOA provided a 30 day notice to the facility via text message but moved the resident out same day. Interview with resident indicated the resident is happy and satisfied with the move out of facility. Administrator as well as witness confirm resident was not evicted out of the facility and moved out voluntarily. Based on record review and interviews conducted, the allegation is deemed unfounded, meaning the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was emailed to Administrator. Unfoundedthe state’s words, verbatim · CDSS document, Mar 12, 2024 · control 22-AS-20240306123021

Allegation investigated: Staff inappropriately placed resident on an involuntary 72hr hold Staff did not provide resident with keys in a timely manner Staff are not providing activities for residents Staff are not allowing resident to leave the facility

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility, interviewed staff and residents as well as reviewed and obtained pertinent documentation such as psychiatric hospital documentation. Regarding the allegations that staff inappropriately placed resident on an involuntary 72hr hold, staff did not provide resident with keys in a timely manner, staff are not providing activities for residents and staff are not allowing resident to leave the facility, the investigation revealed the following: Resident 1 (R1) was evaluated by a mental health professional on 06/10/2023 due to increaing behaviors and was sent out to LA Downtown Medical Center for a 72 hour hold. Resident was transferred to the medical center as the resident was deemed to have a grave disability per psychiatric paperwork. The resident states being hospitalized for 28 days. R1 has a history of schizoaffective disorder, anxiety, bipolar disorder, depression and psychoactive substance abuse. CONTINUED ON LIC 9099C DATED 02/27/2024 Unfounded Resident did not return to facility after hospitalization. Four out of four staff indicate the resident had a history of losing keys as the resident would leave the facility for weeks at a time. The resident's keys were replaced timely per all staff interviewed and LPA observed the key making machine on-site at the facility as well as all the master keys to be utilized. Facility provides activities to residents and LPA observed residents participating in activities on multiple occasions. Activities are provided in the way of bingo, music therapy and cooking classes and three out of three residents interviewed confirmed activities. Four out of four staff interviewed stated that resident would leave the facility for weeks at a time or would leave in the morning to hang out outside the local 7-11. Staff would not deny the resident to leave facility. Physician report dated 02/23/2023 indicated resident was allowed to leave the facility unassisted. Preplacement appraisal as well as appraisal needs and services indicate resident leaves facility daily. Based on record review and interviews conducted, the allegations are deemed unfounded, meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was emailed to Administrator.the state’s words, verbatim · CDSS document, Feb 27, 2024 · control 22-AS-20240215130307

Allegation investigated: Staff does not serve dinner to residents at an appropriate time Staff does not ensure that residents' food is served warm Staff are not able to effectively communicate with the residents due to a language barrier

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the investigation, LPA toured the kitchen, interviewed staff and residents as well as reviewed and obtained pertinent documentation such as room meal delivery list. Regarding the allegations that staff does not serve dinner to residents at an appropriate time, staff does not ensure that residents' food is served warm, and staff are not able to effectively communicate with the residents due to a language barrier, the investigation revealed the following: LPA toured the kitchen and observed food supply on-site on two different occasions. On both occasions there is adequate food supply available. LPA observed food warmers in kitchen as well as the process to send out delivered meals. Six out of seven residents state food is warm when delivered to the room. Administrator indicated dinner delivery being early on one occasion when kitchen pipe was being repaired. Six out of seven residents stated dinner deliveries are between 4-5 PM and the times can be personalized upon request. CONTINUED ON LIC 9099C DATED 02/20/2024 Unsubstantiated Six put of seven residents interviewed denied communication issues with staff and LPA did not experience any communication issues with staff during visits. Due to conflicting information, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Feb 22, 2024 · control 22-AS-20240201105417

Allegation investigated: Staff are not allowing resident to participate in the planning of their care

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility, interviewed staff and witness as well as reviewed and obtained pertinent documentation such as durable power of attorney and physician report. Regarding the allegation that staff are not allowing resident to participate in the planning of their care, the investigation revealed the following: Resident 1 (R1) has a responsible party per power of attorney paperwork dated 03/02/2016. Facility administrator acknowledges resident's power of attorney. Resident was signed up for hospice care in the facility effective 10/06/2023 without approval or consultation with responsible party who acts as an agent for the resident. R1's responsible party was only informed of the enrollment when the resident's insurance company called to inquire about the enrollment. Administrator indicates normal protocol is to consult with resident families prior to enrollment and acknowledges there was no consultation or notification to the resident's agent. CONTINUED ON LIC 9099C DATED 12/13/2023. Substantiated Administrator confirms knowledge of responsible party acting as agent for resident. Based on interviews conducted and records reviewed, 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, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility administrator along with appeal rights. meaning the allegations was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was emailed to Administrator.the state’s words, verbatim · CDSS document, Dec 13, 2023 · control 22-AS-20231122171857

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Dec 26, 2023

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services..This req is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1's responsible party was consulted before hospice enrollment. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 13, 2023

Plan of correction: Licensee to conduct an in-service on personal rights and forward proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20231122171857. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the complaint investigation, LPA toured the facility and interviewed Administrator and witness. Resident 1 has a power of attorney acting as agent for the resident concerning healthcare decisions. LPA reviewed the power of attorney paperwork and confirmed the designation. Administrator confirmed knowledge of resident having a power of attorney for decisions however indicates the paperwork may have been displaced in the facility. Administrator acknowledges the resident was signed up for hospice care at the facility but indicates not being sure of the circumstances surrounding the enrollment and lack of notification to responsible party. Hospice agency was provided resident's personal information without release from responsible party. Resident was disenrolled from hospice after responsible party was advised of the decision via a third party agency. Based on the observations made from today's visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the Administrator and a copy was provided to Administrator as well as Appeal Rights.the state’s words, verbatim · CDSS document, Dec 13, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(d)(1) · Plan of correction due date: Dec 14, 2023

The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7).... Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement is not being met as evidenced by: Based on interviews conducted and record review, Licensee failed to ensure facility has a qualified administrator. Facility administrator is not aware of what is occurring in facility and not managing resident's private information. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 13, 2023

Plan of correction: Licensee to submit a statement of understanding to LPA by POC due date.

Allegation investigated: Facility illegally evicted resident

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility, interviewed resident and staff as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegation that facility illegally evicted resident, the investigation revealed the following: Facility gave Resident 1 (R1) a thirty day eviction notice dated 10/20/2023 indicating the reason for eviction was "Refusing to log in personal/ valuable properties as inventoried items." Facility admission agreement states that facility will only inventory/ provide an inventory log if resident's property is entrusted to the care of the facility. Resident has no items entrusted to the care of the facility. The eviction notice is not legal per department guidelines. 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, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility administrator along with appeal rights. Substantiatedthe state’s words, verbatim · CDSS document, Oct 26, 2023 · control 22-AS-20231023121324

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Nov 2, 2023

The licensee may, upon thirty (30) days written notice to the resident, evict the resident for nonpayment of the rate for basic services, failure to comply with state or local law, failure to comply with the general policies of the facility...This req is not being met as evidenced by: Based on record review and interviews conducted, Licensee failed to ensure eviction notice was provided for a valid reason. Eviction reason given contradicts admission agreement. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 26, 2023

Plan of correction: Licensee to rescind eviction notice and forward proof to LPA by POC due date.

Allegation investigated: Facility did not ensure resident's medication was administered correctly Facility does not have sufficient staffing Resident room has a cigarette odor

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility, interviewed staff and residents as well as reviewed and obtained pertinent documentation such as physician report and staff schedule. Regarding the allegations that resident room has a cigarette odor, facility does not have sufficient staffing and facility did not ensure resident's medication was administered correctly, the investigation revealed the following: Resident 1's (R1) room is on the opposite side of the designated smoking area. R1 indicates residents smoke after hours in the courtyard below resident's room. Administrator acknowledges discovering a resident had smoked in the un-designated area and facility has taken steps to ensure all smoking is occurring in the designated area. R1 indicated facility staff attempted to provide the resident with another resident's medication on or about Sunday October 1, 2023. The staff in question has not worked as a med tech for approximately three months and is currently CONTINUED ON LIC 9099C DATED 10/09/2023.. Unsubstantiated employed as the full time Activity Director. Two out of two staff deny the error as well as Administrator. Facility staffing schedule indicates the following: Four caregivers/ 1 med tech on 1st shift, Four caregivers/ 1 med tech on second shift and 1 caregiver/ 1 med tech for NOC shift. Six out of six residents and two out of two staff state staffing levels have increased in the last few months. Administrator indicates hiring new staff. Due to conflicting information, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to facility. Therefore, the allegations are deemed UNFOUNDED, meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was emailed to Administrator.the state’s words, verbatim · CDSS document, Oct 9, 2023 · control 22-AS-20231003163937