Woodruff Care Home

Allegation investigated: Staff lack of care and supervision resulted in resident on resident altercation

Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced complaint visit regarding the above allegation. LPA met with Khrysta Margaros (Assistant Administrator) and explained the purpose for the visit. The investigation consisted of the following: LPA reviewed and obtained staff and resident rosters, Fact sheet for R1 and R2, Medical Assessment for residential Care Facilities for Elderly for R1 and R2, incident report dated 02/03/2026 and 03/17/2026, Lakewood Police Report number and updated Individualized Service Plan for R1 dated 02/12/2026 The investigation revealed regarding allegation: Staff lack of care and supervision resulted in resident on resident altercation. It is alleged that due to lack of care and supervision of staff, two residents got into altercation. (continued on 9099C) Unsubstantiated (continued from 9099) LPA interviewed three (3) staff and all three (3) denied the allegation. LPA interviewed nine (9) residents and all nine (9) where not able to corroborate the allegation. Based on interviews with staff, one (1) staff member was making rounds by R1 and R2 room on 03/12/2026 at around 4:30 pm and heard R2 in distress, Staff entered the room and saw R1 holding a hollow metal bar, that belongs on the outer part of the bathroom sink. Staff immediately removed the metal bar from R1 and separated the residents. R2 confirmed R2 was struck on her buttocks. R1 told staff that R1 thought that R2 had stolen R1 money and that is why R1 attacked R2. Police were called and R1 was detained until Los Angeles County Psychiatric team arrived and R1 was transported via ambulance and placed on 5150 hold. R1 remains on hold to date. R2 was assessed and did not suffer any injuries. R2 confirmed this. On 02/03/2026, R1 hit another resident and then returned to facility. On 02/12/2026, facility completed an updated Individualized Service Plan to address R1 behavioral issues that included extra wellness checks every two (2) hours. R1 medication was adjusted by R1 doctor. After this incident on 03/12/2026, facility can no longer accommodate higher level of care for R1 and is working with Telecare representative to find appropriate placement. The two (2) residents that were assaulted on different dates by R1 both stated that it was not due to lack of care and supervision of staff. Both stated they feel safe at facility. R1 stated that the staff does provide care and supervision to the residents. Based on statements and interviews conducted with staff and residents and record review, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 13, 2026 · control 28-AS-20260409153340

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Gemma Deoso and explained the purpose for today’s visit. The facility is licensed to serve 88 Residents ages 60 and over (20 Ambulatory / 68 Non-Ambulatory), with a Hospice waiver for 8 Residents. Facility currently has 83 residents (3 of which are receiving hospice services). The Facility is a 2 story building located in Bellflower, CA. A tour of the facility included: 1st floor: Multiple resident rooms with private 1/2 bath or shared full bath (those without a bath are able to utilize restrooms throughout and a shower room), Activity Room, TV/Therapy Room, Kitchen, Dining Room, Laundry Room, Medication Room, Closets with storage throughout, and 2 outdoor activity/lounge area. 2nd floor: Multiple Resident Rooms with private 1/2 bath or shared full bath (those without a bath are able to utilize restrooms throughout and 2 common full bath/shower rooms). LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today: Infection Control: Facility has sufficient PPE supplies and the required Infection Control Plan. Operational Requirements: There is an approved fire clearance & facility has the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, multiple residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. The fire extinguishers were observed throughout the facility and are fully charged. No bodies of water or security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested throughout the facility resident private bathrooms and measured within the required range of 105-120 degrees. (Continued on LIC809-C) Staffing & Personnel Records-Training: There appears to be sufficient staffing at all times in the facility. Staff have criminal record clearance, current First-Aid/CPR/AED training along with other required training's documented in personnel files. LPA reviewed 5 staff files with no issues observed. Administrator Gemma Deoso's Administrator Certificate expires on 4/6/2027. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 9 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone landline and the required posters such as, Residents Rights, Complaint Poster, and Ombudsman are posted throughout the facility. Planned Activities: Facility provides scheduled activities with a monthly calendar and the required full-time staff that conduct and evaluate planned activities. There is sufficient space both indoor and outdoor for activities. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored and are in their original containers. LPA reviewed 9 residents medications with no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. The last drill was conducted on 11/19/25. Residents with Special Health Needs: Facility admits residents with hospice services and staff files reviewed today all have required training documented. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held, a copy of the report and appeal rights will be emailed to Administrator Gemma Deoso at gdeoso@trucarecommunity.comthe state’s words, verbatim · CDSS document, Jan 6, 2026

Allegation investigated: Staff did not adequately address residents’ inappropriate behaviors. Staff spoke to resident in an inappropriate manner.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit regarding the above allegation. LPA met with Khrysta Margaros (Assistant Administrator) and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of the staff/residnet rosters, and conducted interviews with 8 Residents (R1-R8) and 6 Staff (S1-S6). (Continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff did not adequately address residents’ inappropriate behaviors. It is alleged that R1’s roommate has been threatening and harassing R1 and the staff are not doing anything about it. LPA interviewed 6 staff and each denied the allegation, stating that R1 has been transferred to 6 different rooms with different roommates and each time there have been issues that begin with R1. Interviews with S1 and S2 revealed that there are no single rooms available to accommodate R1 and they have tried to assist R1 the best they can by separating R1 from roommates they don’t get along with. S2 stated that they are working with R1 to try and relocate them to a sister facility and R1 has been interested in this and is doing a tour of the sister facility tomorrow. LPA spoke with R1 and it was confirmed that staff are trying to assist them and will be touring the sister facility tomorrow. LPA interviewed R1’s current roommate R2 and R2 denied the allegation and stated that they are not harassing R1 and have never threatened R1 but agreed that the 2 do not get along well, R2 stated staff have spoken to them about the house rules and getting along with residents and has agreed to not engage in arguments with R1. LPA interviewed a total of 8 residents and 7 out of 8 residents denied the allegation, interviews with R2,R4 and R5 revealed that they have had altercations with R1, however, staff intervened, have addressed the issues and things appear to have progressed. Allegation: Staff spoke to resident in an inappropriate manner. It is alleged that S1 yelled at R1 when R1 was trying to explain to S1 what was happening with their new roommate. LPA interviewed 6 staff and each denied the allegation stating that they have never yelled at any of the residents or seen another staff yell at any residents. S1 stated that they did not yell at R1 but do recall having a conversation with R1 in which R1 had their TV on loudly and refused to turn it down causing S1 to speak loudly but they denied ever yelling at the resident. LPA interviewed 8 residents and 7 out of 8 residents denied the allegation stating that they have never been yelled at by staff and have never witnessed staff yelling at other residents. Based on statements and interviews conducted with staff and residents, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 23, 2025 · control 28-AS-20251020162944

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Tena Herrera made an unannounced Case Management visit to the facility. LPA met with Administrator Gemma Deoso and explained the reason for the visit. On 9/23/25 the department received an Incident Report date 9/20/25 revealing that on 9/20/25 at approximately 4:50pm the facility had a small fire in the back patio, staff observed a small fire in the bushes near the tree that was quickly controlled by staff using a water hose. 911 was called and the fire department arrived at approximately 5:05pm and cleared the fire. Although there is no proof that the fire was started by residents smoking in the area it is believed that this is how the fire ignited as there were 2 residents who are smokers that were in that area just before the fire started. During todays visit LPA conducted a health and safety check, a tour of the back patio was conducted and LPA observed newly installed standing ash trays (a total of 4) within the designated smoking area, no smoking signs around the large tree, the bushes that were around the tree have been removed and the tree had minor burn marks on the stump. Interview with S1 revealed that the smoking rules and areas were reminded to all residents, staff have been instructed to keep a look out and make more rounds throughout the day and there were no injures due to the fire. There were no safety concerns observed and no deficiencies observed during today's visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 7, 2025

Allegation investigated: Staff disposed of resident's personal belongings.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit regarding the above allegation. LPA met with Gemma Deoso (Administrator) and explained the reason for the visit. The investigation consisted of the following: On 3/27/25 LPA conducted an initial visit and obtained copies of the staff and client roster and LPA interviewed Administrator. During todays visit LPA obtained copies of client/staff rosters, copy of Resident #1's (R1's) Resident Inventory Sheet, a tour of storage areas and R1's room was conducted and LPA interviewed 3 staff and 8 residents. (Continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff disposed of resident's personal belongings. It is alleged that staff have thrown away a few R1’s personal belongings such as a drum, paintings, binoculars, shoes, and a box of CDs. LPA reviewed R1’s Resident Inventory Sheet dated 10/28/18 and all items that have allegedly been stolen (except for shoes) were not listed on inventory sheet. LPA toured R1’s room, paintings, drum, and shoes were observed in the room. LPA interviewed R1 and it was stated that the Inventory Sheet was not updated with the mentioned missing items as they were unaware that was offered/needed, R1 stated that their paintings and drum have been returned as they were in storage, however, the other items are still missing. LPA toured the facilities storage sheds and storage room located on the 2nd floor and observed multiple items that were explained to be stored for residents to create space as their rooms cannot fit large items. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation. S3 stated that although they have seen staff throw items away, they have only observed it to be spoiled food and have never seen personal items being thrown away. LPA interviewed 8 Residents and 6 out of 8 Residents denied the above allegation, although some residents confirmed that some personal items have gone missing, they cannot confirm that it was staff who took them or threw their items away. Based on statements and interviews conducted with staff/residents, tour or R1's room and LPA's observations, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 3, 2025 · control 28-AS-20250324101322

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Gemma Deoso and explained the purpose for today’s visit. The facility is licensed to serve 88 Residents ages 60 and over (20 Ambulatory / 68 Non-Ambulatory), with a Hospice waiver for 8 Residents. Facility currently has 83 residents (4 of which are receiving hospice services). The Facility is a 2 story building located in Bellflower, CA. A tour of the facility included: 1st floor: Multiple resident rooms with private 1/2 bath or shared full bath (those without a bath are able to utilize restrooms throughout and a shower room), Activity Room, TV/Therapy Room, Kitchen, Dining Room, Laundry Room, Medication Room, Closets with storage throughout, and 2 outdoor activity/lounge area. 2nd floor: Multiple Resident Rooms with private 1/2 bath or shared full bath (those without a bath are able to utilize restrooms throughout and 2 common full bath/shower rooms). LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today: Infection Control: Facility has sufficient PPE supplies and the required Infection Control Plan. Operational Requirements: There is an approved fire clearance & facility has the required liability insurance. Physical Plant & Environment Safety: LPA toured facility, multiple residents’ bedrooms/units were checked and had the required closet/drawer space to accommodate each resident comfortably. There are smoke detectors, carbon monoxide detectors and an emergency sprinkler system throughout the facility that are operable and in compliance. The fire extinguishers were observed throughout the facility and are fully charged. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested throughout the facility resident private bathrooms and measured below the required range of 105-120 degrees, citation will be issued with details on the LIC809-D page. There are shaded patio areas available for residents. (Continued on LIC809-C) Staffing: There appears to be sufficient staffing at all times in the facility. With night staff that is trained and able to assist in care and supervision of the residents in the case of an emergency. Personnel Records-Training: Staff have criminal record clearance, current First-Aid/CPR/AED training along with other required training's documented in personnel files. LPA reviewed 5 staff files with no issues observed. Administrator Gemma Deoso's Administrator Certificate expires on 4/6/2025. Resident Records-Incident Reports: Resident files are kept in a secure location and have the following documents in their files - Pre-admission appraisal/Appraisal Needs & Services Plan, Admission Agreements, Identification & Emergency Information and current Physician's Report. LPA reviewed 9 Resident Files with no issues observed. Residents Rights-Information: Residents are provided with telephone landline at the facility and the required posters such as, Residents Rights, Complaint Poster, and Ombudsman are posted throughout the facility.. Planned Activities: Facility provides scheduled activities with a monthly calendar and the required full-time staff that conduct and evaluate planned activities. There is sufficient space both indoor and outdoor for activities. Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. Incidental Medical & Dental: Medication is properly labeled and are centrally stored and are in their original containers. LPA reviewed 8 residents medications with no issues observed. Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. The last drill was conducted on 12/31/2024. Fire drills were being tested by Fire Alarm Company during visit and was observed to be operable. Residents with Special Health Needs: Facility admits residents with hospice services and staff files reviewed today all have required training documented. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit will be cited on the 809D. Exit interview held, a copy of the report and appeal rights will be emailed to Administrator Gemma Deoso at gdeoso@trucarecommunity.comthe state’s words, verbatim · CDSS document, Jan 30, 2025

Allegation investigated: Staff did not obtain residents permission to change residents medical provider. Staff financially abused resident in care.

Licensing Program Analyst's (LPAs) Tena Herrera and Daniel Konishi conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPAs met with Jesus "Jessie" Chavez who allowed enterance to the office, shortly after Assistant Administrator Khrysta Margaros and Administrator Gemma Deoso arrived to assist, the reason for the visit was explained. The investigation consisted of the following: LPAs obtained copies of Resident and Staff Rosters and copies from Resident #1 (R1) file. LPAs interviewed 3 Staff, and LPA Konishi interviewed 8 residents. (Continued on LIC9099-C) Unsubstantiated The investigation revealed the following: Allegation: Staff did not obtain residents permission to change residents medical provider. It is alleged that staff dis-enrolled R1 from their primary care physician and made changes for R1 to have a new care provider without R1's consent. LPA Herrera reviewed R1's file and there were no indications that the provider was ever changed and the same provider appeared to be listed throughout R1's admission at facility. LPAs interviewed 3 staff, all of which denied the above allegation. Staff stated that they are are not authorized to make such changes and only residents have the authority to do so. Staff #2 (S2) stated that they will assist residents (if needed) when they are looking for care providers, however, only the residents are able to make the changes. All 3 staff stated that R1's care provider was the same from enrollment until their departure from facility. LPA Konishi interviewed 8 Residents and 8 out of 8 residents denied the above allegation, and stated that staff have never changed their health care provider at any point. Allegation: Staff financially abused resident in care. It is alleged that S3 stole $10 from R1 on 12/30/2023 for medications that R1 needed to pay a co-pay for. LPA Herrera reviewed R1's file and all fund deposits and withdrawals were documented and signed for by R1 on the Record of Resident's Safeguarded Cash Resources Form (LIC405). LPA also reviewed a Narrative Charting with the communication log between staff and R1 on reminders of funds needed to purchase medication, as there was a co-pay due, resident refused to pay for medication. LPAs interviewed 3 staff, all of which denied the above allegation. During interview with S3, staff stated that they have never stolen money from a resident, they do not handle resident funds and only administer medication. Interviews with S1 and S2 revealed that R1 was self responsible and handled their own funds, the only reason for the LIC405 was because R1 would write personal checks to facility for facility to exchange for cash, staff stated that they are the only staff with access to resident funds and document each time residents deposit/withdraw funds. Interviews with 3 staff also revealed that law enforcement investigated allegation, however, it was dismissed and no police report was generated. LPA Konishi interviewed 8 Residents, 6 out of 8 residents denied the above allegation, 2 out of 8 stated that they have lost belongings but have never had proof to report a stolen item/money as they have a foggy memory of what may have occurred. Based on statements and interviews conducted with staff and residents, and review of R1's file, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided to Administrator Gemma Deoso.the state’s words, verbatim · CDSS document, Aug 29, 2024 · control 28-AS-20240822111712

Allegation investigated: Resident was physically assaulted while in care which resulted in injuries

On 3/4/2024 at 8:17 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced follow up visit to this facility to deliver findings on the investigation conducted by Investigator / Sonia Sandoval. Upon arriving at the facility, LPA met with Med Tech who contacted the Administrator. At 8:45 a.m., the Administrator Gemma Deoso arrived, and LPA explained the reason for the visit. Prior visits were conducted at this facility on 10/25/2023 in reference to the allegation listed above, consisting of a physical plant tour of the interior and exterior was conducted. During the tour LPA did not observe any health and safety concerns. LPA obtained the staff roster, resident roster, unusual incident report dated 10/25/2023 and 10/28/2023, SOC 341, and Inmate Information Center document dated 10/25/2023. LPA conducted file review and obtained all the following documents pertaining to R1: Basic fact sheet, Resident face sheet, Transfer discharge report, Medication administration record, Emergency and Identification Information, Physician’s Report, Discharge paperwork, and Resident assessment form. LPA obtained all the following documents pertaining to R2: Basic fact sheet, Identification and Emergency Information, Physician’s Report, Medication administration record, and Resident assessment form. Report continued on 9099c Unsubstantiated Based on interviews conducted and records reviewed, it was discovered that residents R1 and R2 were able to ambulate inside and outside the facility independently. Additionally, staff confirmed residents could be in the patio area unsupervised. The review of the surveillance footage revealed R1 assaulted R2 with an object (ashtray pole) on 10/21/2023 at 0851 hours. The review of the EMS and 911 audio all revealed Los Angeles County Fire Department was dispatched to the facility at 0859 hours, approximately eight minutes after the incident. The facility staff interviewed revealed R1 had not displayed aggressive behavior towards staff/residents and had no prior incidents. The interview of facility staff confirmed R2 and R1 were separated and assessed. Emergency medical services were requested, and law enforcement was notified of the incident. Based on interviews, and file review the investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with Gemma Deoso and a copy of this record provided.the state’s words, verbatim · CDSS document, Mar 4, 2024 · control 28-AS-20231024150648

Allegation investigated: Staff disposed of resident's personal belongings. Staff did not keep facility free of bed bugs.

Licensing Program Analyst (LPA) Bennette Pena conducted an initial complaint visit to investigate the above allegations. LPA met with Khyrysta Margaros, Assistant Administrator and explained the purpose of the visit. Administrator, Gemma Deoso is out of the facility today. The investigation consisted of the following: LPA obtained a copy of the Staff roster, Resident roster, Professional Exterminator inspection reports & Invoices (October 2023-Feb 2024), Notification memo to residents regarding treatment of bed bugs (dated 10/24/2023) and R1 Acknowledgement of Room Safety Inspection (signed by R1 on 08/27/2021). LPA also conducted a facility tour, inspected random residents rooms (Room #s:123, 126, 240, 241, 242 and 243) and interviewed Staff #1 (S1) – Staff #5 (S5), Resident #1 (R1) – Resident #10 (R10). In regards to the allegation: “Staff disposed of resident's personal belongings.” It was reported that the staff throws away something special of resident’s belongings like brand new clothes, hats, love doll, and new lounge chair due to the facility having bed bugs. Interviewed staff stated that R1 understood and ****CONTINUED ON LIC9099-C***** Unsubstantiated gave the staff permission to throw away some of his belongings due to bed bugs. Interviewed staff indicated that R1 and Administrator agreed to have some of R1's personal belongings discarded to avoid the spread of bed bugs. Staff interviews revealed that staff are not entering residents’ rooms and disposing of residents’ personal belongings without their permission. Staff interviews revealed that staff have not received any complaints regarding this matter. Resident interviews revealed that staff are not entering residents’ rooms and disposing of residents’ personal belongings without their permission. Resident interviews revealed that they have not heard anyone complaining about this matter. Residents and staff interviews do not corroborate this allegation. In regards to the allegation: “Staff did not keep facility free of bed bugs.", it is alleged that on 02/07/24, and 02/08/24, the staff started spraying for bed bugs. No other details provided. During the visit, LPA toured the common areas of the facility and inspected random residents’ bedrooms (Room #s: 123, 126, 240, 241, 242 and 243). LPA did not observe any bed bugs in the inspected rooms. S1 stated that they are aware of the presence of bed bugs in some rooms and for this reason, the Administrator, contacted a professional exterminator for inspection, prevention, and treatment. Interviews conducted with staff members revealed that inspection, preventive spraying, and treatment are done every month, sometimes 2x a month on a regular basis. S1 provided LPA with pest control inspection reports and invoices for the last 4 months (Oct. 2023 - Feb 2024), as well as a plan of treatment for February 2024. 3 out of the 10 residents interviewed indicated that they have seen a few insects and bugs in the facility, however they do not consider it to be an issue. LPA also reviewed an incident report dated 02/02/2024 regarding discovery of bed bugs to which immediate action was taken by the facility. Therefore, there was insufficient evidence to corroborate this allegation. Based on statements and interviews conducted with staff, residents, and review of facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided to Khrysta Margaros, Assistant Administrator.the state’s words, verbatim · CDSS document, Feb 13, 2024 · control 28-AS-20240209085941

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent visit for annual continuation. LPA met with Administrator, Gemma Deoso, who assisted with the inspection. The initial required-1 yr inspection was conducted on 01/29/2024. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools today for the remaining domains and observed the following: Personnel Records-Training: Six (6) staff files were reviewed. Proof of staff training, health clearance, vaccinations, food handling certificates, and 1st Aid/CPR training are current. Administrator's certificate expired on 04/06/2023, but proof was presented to LPA showing that renewal was submitted in March 2023.Resident Rights-Information: Resident personal rights, complaint hotline information and visitors policy posters are posted in the 1st floor hallway and by the main entrance. Per Administrator, facility provides internet services to all residents and have access to the facility phone. Planned Activities: There is sufficient space to accommodate both indoor and outdoor activities. LPA observed sufficient equipment and supplies to accommodate residents with special needs to meet the requirements of the activity program. Monthly activity calendar is posted by the dining room. The facility has a Resident Council and council members/residents meet on a monthly basis. Food Service: Sufficient food supply is stored in the kitchen and (2) pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are on file. Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Incident Medical and Dental: A total of eight (8) centrally stored resident medications were reviewed; containing 30-day supply of medications. LPA observed that the medications administered on 1/29/2024 to (1) resident (Resident #1/R1) were not properly documented/logged on the Medication Administration Record (MAR). A complete first aid kit is maintained in the medication room. Medical and dental transportation is provided. Resident Records/Incident Reports: A total of nine (9) resident files were reviewed. They contained Admission Agreements, Physician's Reports, Pre Placement Appraisal, TB clearance, Functional Capability Assessment, Physician's Orders, Medical Consent, Medication Records, and P & I Money Records. The Incident report binder was reviewed. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place, and evacuation chair at each stairway is in place. Records of resident Appraisal and Needs services plans are part of Emergency training. Residents with Special Health Needs: Eleven (11) residents are receiving home health services. Three (3) residents receive hospice care. Physician orders for postural support are on file. LPA observed half bed rails for mobility assistance in some resident beds. There are no residents with prohibited health conditions. Residents who are using oxygen have "No smoking In Use" signs posted on the residents doors. Per California Code of Regulations, Title 22, deficiency was cited. Exit interview conducted and a copy of the report and appeal rights were provided to Gemma Deoso, Administrator.the state’s words, verbatim · CDSS document, Jan 30, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by Administrator Gemma Deoso and explained the purposed of the visit. There are currently (73) residents, 60 years and older residing in the facility, of which (5) are bedridden and (3) are under hospice care. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance lobby. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Staff are trained on the emergency infection control plan and following hand hygiene techniques. Emergency and disaster plan was completed and up to date. Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. The facility does not have a Dementia Waiver in place. A Hospice Waiver for 8 is approved. A fire clearance for 20 ambulatory and 68 non-ambulatory residents is in place. Facility is approved for (8) hospice residents. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 03/01/2024. Surety bond of $10,000.00 is current. Fire drill is conducted on a quarterly basis and a simulated fire drill was last conducted on 01/19/2024. Physical Plant/Environment Safety: The facility is a 2-story building located in a residential community. The facility consists of: First floor: Lobby, Administrative offices, Medication room, Laundry room, (1) Elevator, Large Dining area, Kitchen, 2 Pantries, Activity patio, TV room, Storage room, Boiler room, (2) enclosed Patios by the main entrance, (2) Courtyard areas, Backyard patio/smoking area, and (30) resident bedrooms. Second floor: (18) resident bedrooms, Electrical room, Break room, (2) bathrooms with shower. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. Between 11:00am-12noon, LPA tested hot water temperature in twelve (12) random resident rooms (Rooms #104, #106, #107, #118, #119, #121, #232, #235, #238, #240, #242 and #245) in the first & second floors. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. The facility has eight (8) fully charged fire extinguishers, last serviced on 11/20/2023. *****CONTINUED ON LIC809-C***** Staffing: A total of (31) staff members provide care and supervision to the residents, including the Administrator. LPA reviewed a total of (6) staff files. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Administrator's certificate expired on 04/06/2023, but proof was presented showing that renewal was submitted in March 2023. Personnel Records-Training: Resident Rights-Information: Planned Activities: Food Service: Incident Medical and Dental: Resident Records/Incident Reports: Disaster Preparedness: Residents with Special Health Needs: Due to time constraints, LPA was not able to complete the annual inspection for this facility. LPA will do a continuation of this inspection. Exit interview conducted with Gemma Deoso, Administrator and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jan 29, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Facility has bed bugs throughout the facility

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint investigation visit on 01/08/2024 and delivered findings. LPA Ramirez was met by Khrystal Margaros- Assistant Administrator and explained the purpose of the visit. The investigation consisted of the following: Initial complaint investigation was conducted on 09/21/2022 by LPA Mora. LPA Ramirez requested and obtained copies of Staff Roster (LIC 500), Resident Roster (LIC 9020), Staff #1 interviews (S1-S4), Resident #1- 6 interviews (R1 – R6), Resident#7 (R7): Face sheet, Admissions Agreement, Physician Report dated 02/10/2022, Special Incident Report (SIR) dated 07/13/2022 & 09/30/2022, Facility menu for the week of 01/07/2024 through 01/13/2024, Facility Meal Entrée Alternative Policy, List of diabetic residents, List of residents with dietary restrictions, List of facility sugar free items available to residents, Orkin Pest Control Service reports dated 10/25/2023 and 12/19/2023 and physical plant tour. SEE 9099-C for continuation of report. Substantiated The investigation revealed the following. Regarding Allegation: Facility has bed bugs- It is alleged the facility has bed bugs. LPA Ramirez toured six (6) resident rooms. Two (2) out of four (4) staff interviewed confirmed this allegation. Five (5) out of the six (6) residents interviewed confirm this allegation. LPA Ramirez observed several brownish-red stains throughout R6’s pillowcase. LPA Ramirez observed Orkin Pest Control service reports dated 10/25/2023 and 12/19/2023, that indicated the facility was treated for bed bugs. Based on observations, records review and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. Deficiency is being cited. Exit interview was conducted and a copy of this report, 9099-D and appeals rights was provided. The investigation revealed the following. Regarding Allegation: Staff exposed resident to hazardous materials- It is alleged staff sprayed insect spray while resident# 7 (R7) was present. Four (4) out of the four (4) staff interviewed deny this allegation. Six (6) out of the six (6) residents interviewed deny this allegation. Due to R7 no longer being in the facility, LPA Ramirez was unable to interview resident or contact resident. LPA Ramirez conducted physical plant tour and did not observe and hazardous materials accessible to residents in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Staff did not accord dignity to a resident in their relationship- It is alleged facility did not treat R7 with dignity and accused R7 of brining insects into the facility. Four (4) out of the four (4) staff interviewed deny this allegation. Six (6) out of the six (6) residents interviewed deny this allegation. Due to R7 no longer being in the facility, LPA Ramirez was unable to interview resident or contact resident. LPA Ramirez observed several staff providing care and supervision. LPA Ramirez did not observe any deficiencies. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Staff do not serve palatable meals- It is alleged the facility is not serving palatable meals to diabetic residents. Four (4) out of the four (4) staff interviewed deny this allegation. Three (3) out of the six (6) residents interviewed revealed that sometimes meals provided by the facility are lacking flavor. Due to R7 no longer being in the facility, LPA Ramirez was unable to interview resident or contact resident. LPA Ramirez toured kitchen while lunch was being prepared. LPA Ramirez observed various spices and seasonings in facility pantry. LPA Ramirez observed facility menu near kitchen entry. LPA Ramirez did not observe and deficiencies in kitchen area. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Staff do not serve alternative foods for diabetic resident. It is alleged the facility does not serve alternative foods for diabetic residents. Four (4) out of the four (4) staff interviewed deny this allegation. Six (6) out of the six (6) residents interviewed deny this allegation. Due to R7 no longer being in the facility, LPA Ramirez was unable to interview resident or contact resident. LPA Ramirez observed facility’s alternate entrée policy near kitchen entrance. Interviews with staff revealed that residents with diabetic restrictions or other dietary restrictions may choose items from this menu. LPA Ramirez observed “Diabetic Residents List” in kitchen area where kitchen staff prepare meals for residents. LPA Ramirez observed sugar-free condiments and food items in facility pantry. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of this report and appeals rights was provided.the state’s words, verbatim · CDSS document, Jan 8, 2024 · control 28-AS-20220912122555

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jan 8, 2024

87303 Maintenance and Operation(a)The facility shall be clean, safe, sanitary and in good repair at all times.Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: Based on observations, interviews and records reviewed, the facility was being treated for bed bugs on 10/25/2023 and 12/19/2023.the state’s words, verbatim · CDSS document, Jan 8, 2024

Plan of correction: *Facility provided proof of pest control service report dated 12/19/2023 for bed bug treatment. No further action required. Administrator advised LPA Ramirez that the facility is in the process of conducting a revised pest control proposal. Licensee will submit to LPA once received.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a Case Management Visit-Deficiencies on 01/08/2024 at 8:30 am, stemming from subsequent complaint investigation conducted on 01/08/2024. LPA Ramirez was greeted by Assistant Administrator Khrysta Margaros. Case Management-Deficiencies findings: · LPA Ramirez toured room 244 and observed several brownish-red stains of different sizes on Resident#6 (R6) pillowcase. Per facility staff, this room is being treated for bed as of 12/19/2023. Per 87307-Personal Accommodations and Services- (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillowcases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. LPA Ramirez will issue deficiency based on observation. · Facility staff could not provide LPA Ramirez with proof of an Unusual Incident/Injury Report (LIC 624), for reporting bed bugs in the facility. Per 87211-Reporting Requirements- (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (D)Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. LPA Ramirez will issue deficiency based on observation. Deficiencies are being cited. Exit interview was conducted. A copy of this report, 809-D and appeals rights was provided.the state’s words, verbatim · CDSS document, Jan 8, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(3)(C) · Plan of correction due date: Jan 8, 2024

87307 Personal Accommodations and Services (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths.the state’s words, verbatim · CDSS document, Jan 8, 2024

Plan of correction: The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. This requirement was not met: LPA Ramirez observed several brownish-red stains of different sizes on Resident#6 (R6) pillowcase. **Facility staff provided clean linen to R6 during visit. No further correction required**

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(D) · Plan of correction due date: Jan 22, 2024

87211 Reporting Requirements-(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: No SIR was was sent to this licensing agency to report bed bugs.the state’s words, verbatim · CDSS document, Jan 8, 2024

Plan of correction: Licensee will retrain staff on this regulation and provide proof of retraining by 01/22/2024, via email. Facility will back date SIR and report bed bugs in facility by 01/22/2024.

Allegation investigated: Insufficient staff to meet the residents needs.

Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegations. On today's visit, LPA met with Administrator Gemma Deoso, who assisted with the visit. Regarding the allegation that there is insufficient staff to meet the residents needs, the investigation consisted of review of resident and staff rosters, including staff schedule, interviews with Resident #1 - Resident #7, Administrator, and Staff #1 - Staff #3. Residents interviewed were unable to corroborate the allegation. Six out of Seven residents interviewed stated that their needs are being met. Administrator and staff interviewed stated that the staff are meeting the residents needs. LPA reviewed staff roster and staff schedule, and observed that the facility appears to have sufficient staff to meet the resident's needs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Unsubstantiated Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted with Ms. Deoso. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 24, 2023 · control 28-AS-20231019153221

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 1, 2023

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not being met as evidenced by: Administrator, staff and residents interviewed confirmed that the facility has bed bugs. LPA observed Orkin inspection report dated 10/2/23, which also confirms that the facility has bed bugs. This poses a health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 24, 2023

Plan of correction: Administrator will send copy of Orkin treatment report for treatment done on 10/25/23 to LPA, by POC due date. Administrator will continue to send reports to LPA until the facility is free of bed bugs.

Allegation investigated: Staff did not administer resident's medication as prescribed. Staff did not provide adequate food service.

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced initial complaint visit to investigate the allegations listed above. LPA met with Gemma Deoso, Administrator and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of Resident & Staff Rosters, weekly menus (Sep 2023), Resident #1 (R1) files such as; AdmissionAgreement, Physician's report, Identification and Emergency Information, Preplacement Appraisal and Appraisal, Special Incident Reports (dated 2/12/2023 & 8/29/2023), Medication list, Medication Administration Record (MARs) for Jul 2023-Sep 2023, Hospital's discharge papers for R1and letter from R1’s physician stating she can manage her own meds. At 12:30pm, LPA conducted a tour of the facility’s common areas, focusing on the kitchen and dining area. LPA observed that the dining area was closed due to the facility under quarantine. However, LPA observed the food served during lunch consisted of whole grains, nuts, fruit and vegetables. At 1:20pm, LPA reviewed R1’s medication list and MARs. Between 1:40pm-2:45pm, LPA interviewed Staff #1 (S1) - Staff #7 (S7), and between 2:45pm-3:45pm, LPA interviewed Resident #1 (R1) – Resident #9 (R9). *****CONTINUED ON LIC9099-C***** Unsubstantiated The investigation revealed the following: In regards to the allegation: " Staff did not administer resident's medication as prescribed.” It is alleged that the facility staff have been mismanaging R1's medication and that the staff are failing to administer it in a timely manner. Facility staff interviewed denied the allegation. Staff stated that resident #1 is medication compliant and staff follow R1's medication directions. Staff stated that R1 is not capable of managing her own medication and being assisted by staff. S3 stated that she received the letter provided by R1 regarding medication administration, however, the letter was incomplete. S3 stated that facility has not received the updated letter that they requested from R1's physician. LPA reviewed Resident #1's medication list and Medication Administration Record (MAR) for Aug-Sep. 2023, and observed that R1's medication has been administered as prescribed. LPA also reviewed R1's Physician's report which stated that R1 is not capable of managing her own medication. (8) out of (9) residents interviewed were unable to corroborate the allegation. Other residents interviewed stated that they are receiving their medication as prescribed and do not have any problems. In regards to the allegation: "Staff did not provide adequate food service.” It is alleged that the staff are failing to provide adequate food service, that on 09/18/2023 R1 did not get any food for dinner. Staff interviewed denied the allegation and stated that residents get their regular meals 3x a day plus snack. And if residents request extra meal, they get it. Staff interviewed also indicated that a resident can easily use the call light in their rooms if they need assistance, whether it's ordering food or other requests. At 12:30PM, LPA conducted a tour of the kitchen and dining area and observed adequate amount of food prepared and packed for lunch. The food was prepared by the cook and the kitchen worker was ready to deliver the food trays (wrapped) to the rooms. Currently, the facility is under quarantine and meals are being delivered to the residents room. The meal included fruit, vegetables, nuts and whole grains. Some meals were labeled to serve residents with dietary preferences. The food is observed to be adequate and sufficient to meet the residents’ nutritional needs. LPA obtained a copy of the weekly menu for the month of Sep. 2023. The menu included different items from each food group and listed alternatives, including snacks on the menu. (8) out of (9) residents interviewed stated that the staff had never missed providing them meals and they do not have problems with the meals being served to them. Other residents stated that they get their meals 3x/day plus snacks. Some residents indicated that they can call a staff by using the call light in their rooms if they want extra food or an alternate menu. LPA also observed the Local Ombudsman contact information posted on the wall in the hallway, next to the elevator and the front office, which was visible to residents in the facility. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview, a copy of this report was provided to the Facility Administrator, Gemma Deoso.the state’s words, verbatim · CDSS document, Sep 28, 2023 · control 28-AS-20230919114700