Wyngate Villa Gardens

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced case management visit to this facility to follow up on the Fire Safety Order received by CCL on 08/12/26. LPA met with Licensee Representative Nieva Ruiz and explained the reason for the visit. LPA conducted physical plant tour at 10:06 AM and requested copies of facility documents relevant to the purpose of the visit. LPA also interviewed the Licensee Representative and Fire Inspector. LPA observed that the physical plant part of the Fire Safety Order were cleared by the facility. LPA's interview with the Licensee Representative revealed that they have already applied for the renewal for the Permit at the LAFD. Fire Inspection as required was done on 08/13/26. There is no health and safety issues observed during this visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 19, 2026

Allegation investigated: Resident was not allowed to communicate with POA/friend by phone. Resident did not have an access to the SSI check. Resident wrongfully was placed on hospice

Licensing Program Analyst (LPA) Michael Cava conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA met with the Business Office Manager (BOM), Nieva Ruiz and explained the reason for the visit. The administrator, Alma Epinal, was advised over the phone. The initial visit to this complaint was made on 01/29/26. During today’s visit LPA conducted a tour of the facility between 10:30am and 11:30am, interviewed administrator and two (2) staff between 11:30am to 12:30pm and interviewed ten 10) residents between 12:30pm and 1:30pm. LPA also reviewed and requested copies of the following documents (between 1:30pm to 2:30pm): Resident 1’s (R1) Information Sheet, R1’s Admission Agreement, R1’s Identification and Emergency Contact Information, Consent Forms, Appraisals, and Physician’s Report. Regarding allegation: Resident was not allowed to communicate with POA/friend by phone, it was reported that facility staff isolated R1 and prevented R1 from reaching out to their POA/friend, often turning off Unsubstantiated R1's cell phone. R1 no longer resides at the facility. The reporting party is unable to confirm if this allegation occurred at this facility, or the most recent facility where R1 is now. Interview with administrator and staff deny the allegation stating R1 had their own personal cell phone, and would call their friend or family, or have their friend or family visit them at least twice per week. LPA was able to obtain R1's contact information and made contact with R1, who stated this allegation is towards current location where R1 is at. R1 had no issues while residing at Wyngate, but opted to move into a community more related to R1's ethnicity. R1 confirmed they were able to use their personal cell phone to communicate with their friend or POA. In addition to interviewing R1, LPA interviewed ten residents, of which the majority had no complaints or issues with making contact with their friends and family. Based on the information obtained, there was insufficient evidence to prove that Resident was not allowed to communicate with POA/friend by phone. Therefore, the allegation is deemed Unsubstantiated at this time. Regarding allegation: Resident did not have an access to their SSI check, it was reported that From October 2023 through January 2025, R1 was at two different Board & Care facilities and R1 never saw their Social Security checks. Interviews with administrator and staff deny the allegation, stating R1 managed their own finances during their stay at this facility. R1's Security Check was mailed to them during their stay here, and R1 made their monthly payments on time. Rent was $1420 a month. Interview with R1 confirm that they manage their own finances and their Social Security check was received during their stay at facility. LPA also interviewed ten residents, of which the majority had no issues with receiving their mail or Social Security checks. Based on the information obtained, there was insufficient evidence to prove that R1 did not have an access to their SSI check. Therefore, the allegation is deemed Unsubstantiated at this time. Regarding allegation: Resident wrongfully was placed on hospice, it was reported that R1 was placed fraudulently under hospice care. Interviews with administrator and staff deny R1 being on hospice or being placed on hospice while at facility. Interview with R1 also confirm that they are not receiving hospice care. Based on the information obtained, there was insufficient evidence to prove that R1 was wrongfully placed on hospice. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Jul 17, 2026 · control 31-AS-20260122141516

Allegation investigated: Facility does not have hot water Facility is in disrepair Staff does not provide adequate care to prevent resident falls

Licensing Program Analyst (LPA) conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA initially met staff Jaqueline Montoya who called the Administrator Oscar Chavez and explained the reason for the visit. Mr. Chavez is indisposed at this time. LPA conducted physical plant tour at 9:31 AM, requested copies of facility documents relevant to the investigation at 10:00 AM, reviewed documents between 10:00 AM to 11:00 AM and interviewed staff and residents between 11:00 AM to 1:00 PM. Regarding the allegation that the Facility does not have hot water, LPA's observation during visit on 01/13 26, hot water temperature at building # 1 measured at 107.2°F, building #2 at 114.6°F, building #3 at 118.1°F, building #4 at 112.5°F and building #5 at 111.3°F. During today's visit, hot water temperature at building # 1 measured at 106.7°F, building #2 at 113.0°F, building #3 at 116.2°F, building #4 at 118.8°F and building #5 at 108.2°F. All were within the required range. LPA's interview with five (5) residents today or 10% of the current census revealed that five (5) out of five (5) residents interviewed stated that they always have hot water in their building. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Facility is in disrepair, it was alleged that overhead roof falling and electricity attached to it in an illegal and/or hazardous way, LPA's observation on prior and today's visit revealed that the facility's bathroom and kitchen are generally clean and in good repair, no machine or equipment was observed to be broken or in disrepair. Further, the roof and ceiling on each building were observed to be intact and in good repair, LPA did not observe any exposed electrical wire anywhere in the facility. LPA's interview with the maintenance manager on 01/13/26 at 12:45 PM revealed that the only exposed wire was telephone wire which was no longer in use which was covered immediately. Regarding the allegation that Staff does not provide adequate care to prevent resident falls, LPA records review today between 10:00 AM to 11:00 AM revealed that there was no resident who fell at the facility in 2025 up to May of 2026. LPA's interview with five (5) residents today or 10% of the current census revealed that five (5) out of five (5) residents interviewed stated that the facility has enough staff to care for them. Based on the information gathered during this and prior visit, these allegation are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jun 2, 2026 · control 31-AS-20260106085440

Allegation investigated: Staff do not ensure residents have grooming supplies. Staff are mismanaging residents' mail.

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegations. LPA met with Co-Administrator Alma Espinal and explained the reason for the visit. LPA conducted a physical plant tour at 9:43 AM, requested copies of facility documents relevant to the investigation at 10:18 AM and interviewed staff and residents between 10:30 AM and 1:00 PM. Regarding the allegation that Staff do not ensure residents have grooming supplies, it was alleged that toiletries were not provided for residents both men and women. LPA's observation during visit revealed that the facility has sufficient stock of toiletries from shampoo, razors and shaving cream, bath soap, toothpaste, etc. LPA's interview with five (5) residents or 10% of the current census between 10:30 AM to 1:00 PM revealed that five (5) out of five (5) residents both male and female get their toiletries supplies regularly and were not refused when they ask the staff for toiletries. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation Staff are mismanaging residents' mail. It was alleged that social security cards and state identification cards were missing when checks were expected via mail route. LPA's interview with the Administrator and staff between 10:30 AM to 12:30 PM, revealed that they distribute on the same day regularly during dinner time at the dining area and for non-ambulatory residents, the medication technician brings the mail during medication pass. Further interview with the Administrator also revealed that there was no missing mail reported to the office for the last two (2) years. LPA's interview with five (5) residents or 10% of the current census between 10:30 AM to 12:30 PM, revealed that five (5) out of five (5) residents stated that they get their mail regularly and did not have any mail missing. Based on the information gathered during this and prior visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 21, 2026 · control 31-AS-20250905101430

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced Required One (1) year visit at this facility today. LPA initially met with staff Ricardo Rodriguez who called the administrator and explained the reason for the visit. The co Administrator Alma Espinal arrived twenty (20) minutes later. A tour of the physical plant was conducted at 9:25 AM and the following was noted: The facility consists of five (5) buildings, each house has one main entrance. The facility had submitted and approved Mitigation Plan and Infection Plan on file.. The facility has sufficient stock of PPE in the storage room. The facility has five (5) buildings with a total of (34) shared bedrooms. Each building has their own bathrooms ranging from one (1) at building #3 up to five (5) on building #2. The facility is fire cleared for bedridden in building #2 only. Approved hospice for ten (10) residents. Common areas were inspected. All buildings has its own living room. Activity room is located on building #4 and dining area is located on building #2. Dining area was observed to be neat, clean and in proper order. The facility maintains a comfortable temperature at 74°F. There are carbon monoxide detector installed in the facility. Fire extinguishers are located all throughout the facility and last inspected on 06/20/25. The facility is equipped with emergency pull alarm and sprinkler system. (continued to LIC 809-C) (continued from LIC 809) Laundry room is located adjacent to the kitchen and was observed to be locked. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry room inaccessible to the residents. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents. The residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passage ways are lit. The bathroom was checked for cleanliness and proper operation. LPA observed that there are appropriate grab bars in the showers and toilets. The hot water temperature at building # 1 measured at 129.2°F, building #2 at 134.4°F, building #3 at 118.8°F, building #4 at 145.0°F and building #5 at 108.3°F. There were enough clean linen available in the closets. Medications were kept in a locked medication carts in the medication room. The medications were observed to be locked and inaccessible to residents. Medications were reviewed and inventoried, medication count did not tally with the record. There are multiple complete first aid kits located in the medication room. Facility emergency disaster plan was reviewed. Facility disaster drill was last conducted on 11/10/25. A fire alarm inspection by the LAFD was last performed on 09/23/24 with validity until 03/31/27. There is no body of water in the facility. Back and front yard passageways were observed to be clear from obstruction. There is a shaded area on each building for the residents. In addition to the physical plant inspection, residents and staff records were reviewed, LPA reviewed files of five (5) randomly selected residents. Residents files appear to be complete and updated. Five (5) staff files were also reviewed, staff files appear to be complete and updated. Citation issued. Appeal rights discussed and given. Exit interview conducted. A copy of this report issued.the state’s words, verbatim · CDSS document, Jan 20, 2026

Allegation investigated: Facility has mold/fungus. Staff do not ensure that facility is free of pests.

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegations. LPA met with Administrator Oscar Chavez and explained the reason for the visit. LPA conducted a physical plant tour at 9:10 AM, requested copies of facility documents relevant to the investigation at 9:48 AM and interviewed staff and residents between 10:00 AM to 12:30 PM. Regarding the allegation that the facility has mold/fungus, it was alleged that the bathrooms have mold, fungus, bugs, and dirty towels. LPA's observation during physical plant tour today revealed that all the bathrooms and toilets in buildings 1,2,3,4 & 5 were clean and did not observe anything that may look like fungus and mold in any of the bathrooms. Further, LPA did not see any towels in any of the bathroom. LPA's interview with the administrator revealed that all the toilets are being cleaned every day and re-stocked with toilet paper. LPA's interview with two (2) housekeepers today confirmed that they clean all the toilets on all buildings every day. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff do not ensure that facility is free of pests, it was alleged that the bathrooms have bugs. LPA's observation during physical plant tour today revealed that all the bathrooms and toilets in buildings 1,2,3,4 & 5 were free of bugs and pests. LPA's record review today also revealed that the facility has a contracted pest control company that visits monthly to ensure that there is no infestation at the facility. LPA's interview with five (5) residents or 10% of the current census revealed that five (5) out of five (5) residents did not see any bugs or pests in their bathroom at any time. Based on the information gathered during this visit, these allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 10, 2025 · control 31-AS-20250905101430

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff do not provide a safe environment for resident in care

Licensing Program Analyst (LPA) Jose Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with Administrator Oscar Chavez and explained the reason for the visit. LPA conducted a physical plant tour at 9:08 AM, requested copies of facility documents relevant to the investigation at 9:32 AM and interviewed staff and residents between 10:00 AM to 12:30 PM. Regarding the allegation that Staff do not provide a safe environment for resident in care, it was alleged that Resident #1 (R1) was choked by Resident #2 (R2) after R1 refused to be intimate with R2. LPA's interview with R1 on 05/20/25 at 11:15 AM, revealed that the incident happened at the parking area at around 7:30 AM while they were waiting for transportation going to the Day Program. Further interview also revealed that R1 had a relationship with R2 and tried to break up with R2 during that incident. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with R2 today at 11:33 AM, however, revealed that R1 asked R2 to massage R1 at the back so R2 did but denied choking R1 in any way because it was only massaging R1's nape and not R1's throat. LPA's interview with the Administrator today at 10:30 AM and Assistant Administrator on 05/20/25 revealed that when R1 reported to them the incident R1 stated that the incident happened in R1's room and when they interview R2, R2 denied choking R1. LPA's interview with both R1 & R2 confirmed that there was no one else present in the parking area when the incident occurred. LPA's record review on 05/20/25 also revealed that there was no camera installed at the parking area so there was no record of the alleged choking incident. LPA's interview with two (2) residents that are both living in the same building as R1 and rooms were adjacent to R1 revealed that they did not witness R2 being rough to R1 and coming to R1's room during early morning hours. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Aug 7, 2025 · control 31-AS-20250514160241

Allegation investigated: Staff do not ensure that resident's belongings are safeguarded

On 03/17/2025 at 10:00 am Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegation. LPA was greeted by staff who allowed entry and called Administrator Oscar Chavez, to meet with LPA. Administrator arrived shortly after, and LPA explained the reason for the visit. An entrance interview was conducted. From 10:30 am to 2:00 pm LPA toured the facility with Administrator, interviewed residents and staff, and reviewed facility files. The facility has five (5) buildings with a total of (34) shared bedrooms. The facility is fire cleared for forty six (46) ambulatory and twenty two (22) non-ambulatory residents, ten (10) of which maybe bedridden in building #2 only. LPA requested copies of resident roster, LIC 500, Liability Insurance and Administrator Certificate. LPA requested copies of pertinent information relevant to the investigation including but not limited to admission agreements, resident property inventory sheet, resident medical records, and any information pertaining to residents in care. Continued on LIC9099-C Unsubstantiated Allegation: Staff do not ensure that resident's belongings are safeguarded. It is alleged that staff do not ensure that resident's belongings are safeguarded. Regarding this allegation it is reported that Resident #1 (R1)’s room was broken into and R1’s tablet was broken. Interview with Administrator revealed that R1 did report to staff that the tablet was broken on 03/14/25 however Administrator stated that R1 has a tendency of damaging property and accusing others of stealing but when staff investigate, belongings are left forgotten in common areas by R1 and property that is damaged is caused by R1. Interview with two (2) out of two (2) staff assigned to R1’s building revealed that R1 did not directly report anything to them however staff did express that they are aware of R1’s tablet incident. Staff stated R1 has a tendency of making false allegations due to R1’s mental state, furthermore staff revealed that R1 has the ability to lock the room and does so every day, therefore no other residents would have access to R1’s room. Interview with ten (10) out of (10) residents revealed that they have never had issues with their property being stolen or damaged and that staff make sure that their belongings are safeguarded by being vigilant about residents staying out of other residents’ rooms. LPA reviewed resident records and found a property inventory sheet for R1 that did not reflect a tablet. LPA also reviewed the facility admission agreement that reflects that residents agree that they will self-report and update their own property inventory sheet and that they are responsible for their own belongings. LPA did not find a tablet on R1’s inventory sheet but Administrator did confirm that R1 has a broken tablet. Furthermore, Administrator states that they looked over video footage for 03/14/25 when incident was reported to staff and there was no observation of anyone other than R1 entering and/or leaving R1’s room. Footage is only recorded for seven (7) days and as of today’s date anything outside of seven (7) days is not available. LPA interviewed R1 and R1 states that they do not know how the tablet was broken as they did not witness anyone breaking it, R1 just suspects that it was broken by someone else but cannot state who or when. Therefore, based on observations, file reviews and interviews this allegation is deemed unsubstantiated. Report signed by designee Ricardo Rodriguez as Administrator had to leave before LPA was able to deliver report. No citation issued. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 17, 2025 · control 31-AS-20250312131151

Type of visit: Case Management - Deficiencies

On 03/17/25 LPA Casillas arrived at facility above to conduct an initial 10-day complaint investigation for complaint # 31-AS-20250312131151. This Case Management is not related to the original complaint visit. During the facility tour LPA observed that cleaning supply cart was left unattended for an extended period of time. This allowed residents to have access to cleaning supplies. LPA asked staff why it was left unattended and staff replied that the cleaning staff was performing another duty. LPA asked staff to please call cleaning staff to return to cart and put away the supplies until they are able to supervise them appropriately. LPA waited for cleaning staff member to return and take charge of cart. LPA explained to Administrator the importance of ensuring that harmful products are not left unattended if outside the locked storage area. LPA explained to Administrator that a citation would be issued for this deficiency. LPA also advised Administrator that there needs to be a training of all staff on the importance of keeping harmful items locked for resident safety. Administrator will email LPA a copy of the training that was provided along with a log of all staff that was in attendance by end of POC date. Report signed by designee Ricardo Rodriguez as Administrator had to leave before LPA was able to deliver report. Citation Issued. Appeal rights discussed and provided. Exit Interview conducted.the state’s words, verbatim · CDSS document, Mar 17, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309(a) · Plan of correction due date: Mar 24, 2025

87309(a)Storage Space and Access ...the licensee shall ensure that disinfectants, cleaning solutions…and other similar items ....are in locked storage and are not left unattended if outside the locked storage. This was not met as evidenced by: Based observation, staff do not ensure that cleaning supplies were inaccessible to residents in care, this poses a potential health and safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 17, 2025

Plan of correction: Supply cart with cleaning supplies was put away in LPA’s presence. Administrator will email LPA a copy of the training that was provided along with a log of all staff that was in attendance by end of POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced Required One (1) year visit at this facility today. LPA initially met with staff Vanessa Rodriguez who called the administrator and explained the reason for the visit. The Assistant Administrator Alma Espinal arrived thirty (30) minutes later. A tour of the physical plant was conducted at 9:35 AM and the following was noted: The facility consists of five (5) buildings, each house has one main entrance. There are required posters posted at each main door and all over the facility. Screening area is located immediately upon entrance. Sign in sheet and hand sanitizer is available. All the staff were observed to be wearing mask. The facility had an approved Mitigation Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has multiple screening stations all through out the facility. The facility has sufficient stock of PPE in the storage room. The facility has five (5) buildings with a total of (34) shared bedrooms. Each building has their own bathrooms ranging from one (1) at building #3 up to five (5) on building #2. The facility is fire cleared for forty six (46) ambulatory and twenty two (22) non-ambulatory residents, ten (10) of which maybe bedridden in building #2 only. Approved hospice for ten (10) residents. Common areas were inspected. All buildings has its own living room. Activity room is located on building #4 and dining area is located on building #2. Dining area was observed to be neat, clean and in proper order. The facility maintains a comfortable temperature at 74°F. There are carbon monoxide detector installed in the facility. Fire extinguishers are located all throughout the facility and last inspected on 04/04/24. The facility is equipped with emergency pull alarm and sprinkler system. (continued to LIC 809-C) (continued from LIC 809) Laundry room is located adjacent to the kitchen and was observed to be locked. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry room inaccessible to the residents. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents. The residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passage ways are lit. The bathroom was checked for cleanliness and proper operation. LPA observed that there are appropriate grab bars in the showers and toilets. The hot water temperature at building # 1 measured at 118.9°F, building #2 at 126.5°F, building #3 at 113.9°F, building #4 at 130.5°F and building #5 at 119.5°F. There were enough clean linen available in the closets. Medications were kept in a locked medication carts in the medication room. The medications were observed to be locked and inaccessible to residents. There are multiple complete first aid kits located in the medication room. Facility emergency disaster plan was reviewed. Facility disaster drill was last conducted on 10/18/24. A fire alarm inspection by the LAFD was last performed on 09/23/24 with validity until 03/31/27. There is no body of water in the facility. Back and front yard passageways were observed to be clear from obstruction. There is a shaded area on each building for the residents. In addition to the physical plant inspection, residents and staff records were reviewed, LPA reviewed files of five (5) randomly selected residents. Residents files appear to be complete and updated. Six (6) staff files were also reviewed, staff files appear to be complete and updated. Citation issued. Appeal rights discussed and given. Exit interview conducted. A copy of this report issued.the state’s words, verbatim · CDSS document, Dec 4, 2024

Allegation investigated: Staff is charging residents to take a shower Staff left residents in a soiled diaper for a long period of time Staff did not administer medications to residents.

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegations. LPA met with administrator Oscar Chavez and explained the reason for the visit. LPA conducted physical plant tour at 9:35 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and interviewed staff and residents between 10:30 AM to 12:30 PM. Regarding the allegation that Staff is charging residents to take a shower, it was alleged that Staff #1 (S1) charges residents to give showers. LPA's interview with six (6) residents who needs shower assistance on 08/24/23 between 11:00 AM to 1:45 PM and additional three (3) residents who also needs shower assistance on 01/11/24 between 10:34 AM to 1:00 revealed that nine (9) out of nine (9) residents interviewed denied paying S1 or any of the staff for their showers. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with S1 on 08/24/23 at 11:34 AM revealed that S1 never asked any residents for payment when assisting them with their showers nor witnessed or have knowledge of any staff charges any resident to give them showers. LPA's interview with the administrator today at 12:00 PM also revealed that he did not receive any report of S1 or any staff of charging any resident for showers. Regarding the allegation that Staff left residents in a soiled diaper for a long period of time, it was alleged that residents (no particular resident was identified on the complaint) are left with soiled diapers for four (4) to five (5) hours. LPA's interview with three (3) incontinent residents on 08/24/23 between 11:00 AM to 1:45 PM, one (1) incontinent resident on 01/11/24 between 10:34 AM to 1:00 and three (3) additional incontinent residents today between 10:30 AM to 12:30 PM revealed that all seven (7) incontinent residents interviewed stated that staff always change their diapers on time three (3) to four (4) times a day and staff always come within reasonable time or within (15) minutes or less when they push their call button. Regarding the allegation that Staff did not administer medications to residents, it was alleged that S1 did not give residents their medication. LPA's interview with the administrator today at 12:00 PM revealed S1 or any caregiver do not administer medication to any resident, only the medication technician. LPA's interview with S1 today at 12:30 PM revealed that S1 never once administer or provided any medication to any resident at any time. LPA's interview with six (6) residents today between 10:30 AM to 12:30 PM. revealed that six (6) out of six (6) residents interviewed confirmed that S1 did not administer or gave them any medication at any time. Based on the information gathered during this and prior visits, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Apr 24, 2024 · control 31-AS-20230818155055

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced Required One (1) year visit at this facility today. LPA initially met with staff Vanessa Rodriguez who called the administrator and explained the reason for the visit. The Administrator Oscar Chavez arrived fifteen (15) minutes later. A tour of the physical plant was conducted at 9:25 AM and the following was noted: The facility consists of five (5) buildings, each house has one main entrance. There are required posters posted at each main door and all over the facility. Screening area is located immediately upon entrance. Sign in sheet and hand sanitizer is available. All the staff were observed to be wearing mask. The facility had an approved Mitigation Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has multiple screening stations all through out the facility. The facility has sufficient stock of PPE in the storage room. The facility has five (5) buildings with a total of (34) shared bedrooms. Each building has their own bathrooms ranging from one at building #3 up to five (5) on building #2. The facility is fire cleared for forty six (46) ambulatory and twenty two (22) non-ambulatory residents, ten (10) of which maybe bedridden in building #2 only. Approved hospice for ten (10) residents. Common areas were inspected. All buildings has its own living room. Activity room is located on building #4 and dining area is located on building #2. Dining area was observed to be neat, clean and in proper order. The facility maintains a comfortable temperature at 74°F. There are carbon monoxide detector installed in the facility. Fire extinguishers are located all throughout the facility and last inspected on 04/07/23. The facility is equipped with emergency pull alarm and sprinkler system. (continued to LIC 809-C) (continued from LIC 809) Laundry room is located adjacent to the kitchen and was observed to be locked. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry room inaccessible to the residents. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents. The residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passage ways are lit. The bathroom was checked for cleanliness and proper operation. LPA observed that there are appropriate grab bars in the showers and toilets. The hot water temperature at building # 1 measured at 106.6°F, building #2 at 112.6°F, building #3 at 119.2°F, building #4 at 116.9°F and building #5 at 115.8°F. There were enough clean linen available in the closets. Medications were kept in a locked medication carts in the medication room. The medications were observed to be locked and inaccessible to residents. There are multiple complete first aid kits located in the medication room. Facility emergency disaster plan was reviewed. Facility disaster drill was last conducted on 01/19/24. A fire inspection by the LAFD was last performed on 07/27/22 with validity until 03/31/24. There is no body of water in the facility. Back and front yard passageways were observed to be clear from obstruction. There is a shaded area on each building for the residents. In addition to the physical plant inspection, residents and staff records were reviewed, LPA reviewed files of five (5) randomly selected residents. Residents files appear to be complete and updated. Six (6) staff files were also reviewed, staff files appear to be complete and updated. Exit interview conducted. A copy of this report issued.the state’s words, verbatim · CDSS document, Jan 27, 2024

Allegation investigated: Residents are allowed to smoke inside the facility Staff shower resident with only cold water

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent visit to this facility to further investigate the above allegations. LPA met with administrator Oscar Chavez and explained the reason for the visit. LPA conducted physical plant tour at 9:44 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and interviewed residents and staff between 10:34 AM to 1:00 PM. Regarding the allegation that Residents are allowed to smoke inside the facility, it was alleged that some residents smoke inside the facility especially residents in room #9. LPA physical plant tour on prior visit on 08/24/23 at 9:18 AM and today at 9:44 AM revealed that no traces of cigarette smell was observed inside the facility especially surrounding Room #9. LPA's interview with six (6) residents on 08/24/23 between 11:00 AM to 1:45 PM and four (4) residents today between 10:34 AM to 1:00 PM revealed that ten (10) out of ten (10) residents interviewed did not smoke or witnessed anyone smoking inside the facility. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that Staff shower resident with only cold water, it was alleged that a resident is showered with cold water all the time. LPA's interview with six (6) residents on 08/24/23 between 11:00 AM to 1:45 PM and four (4) residents today between 10:34 AM to 1:00 PM revealed that eight (8) out of ten (10) residents interviewed were assisted by the staff to shower and eight (8) out of eight (8) residents interviewed were showered with warm water. The two (2) residents who did not need assistance showering also revealed that they always shower with warm water. Ten (10) out of ten (10) residents interviewed confirmed that the facility always has hot water. Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 11, 2024 · control 31-AS-20230818111812

Allegation investigated: Staff did not prevent a resident from hitting another resident while in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with administrator Oscar Chavez and explained the reason for the visit. LPA conducted physical plant tour at 9:38 AM, requested copies of facility documents relevant to the investigation at 10:02 AM and interviewed staff and residents and witness between 10:10 AM to 1:00 PM. It was alleged that Resident #1 (R1) was punched by Resident #2 (R2) in the shoulder. LPA's record review today at 10:15 AM revealed that both R1 and R2 are independent and attending Adult Health Day Center (ADHC) in Canoga Park. LPA's interview with the administrator today at 10:10 AM revealed that it was reported to him by R1 that the incident happened at the ADHC when R1 and R2 were doing activity in the ADHC and when R1 tried to assist R2 in the game, R2 allegedly hit R1. LPA's interview with the staff of ADHC today at 12:35 PM revealed that the staff did not witness any physical or verbal altercation between R1 and R2 at any time while in the day program. (continued to LIC 9099-C) Unsubstantiated (continued from LIC 9099) Further interview with the ADHC staff also revealed that no staff and/or client witnessed the alleged incident either per the staff's investigation. LPA's interview with another resident which is a common friend of both R1 & R2 confirmed the story of the administrator that the incident did not happen at the facility and also revealed that R1 & R2 had an ongoing relationship. Further interview with the administrator also revealed that there was no reported incident wherein R2 had any physical or verbal altercation with R1 at any time while in the facility. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.the state’s words, verbatim · CDSS document, Oct 5, 2023 · control 31-AS-20231002164728