Aegis Assisted Living of Aptos.

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a case management - incident visit. LPA met with General Manager (GM) JP Rollet. LPA stated the purpose of the visit. Medication Error 7/25/2025 The purpose of the visit was to address 2 medication errors that occurred on 7/25/2025 and 4/16/2026. On 7/30/2025, the Department received an incident report regarding a medication error on 07/25/2025 involving Staff S1 giving resident R1 another resident's medication. The incident report states S1 "accidentally gave the medication to another resident." S1 reported the medication error to management, and 911 was called. R1 was taken for observation to the hospital, and returned back to the facility the same day with no injuries. The reports states R1 was monitored by staff for changes in condition after the medication error, and R1's family and primary care physician were notified. On 9/19/2025, a Case Management visit was conducted. During visit, LPA requested copies of the following documents: Disciplinary Notice, In-Service Training Records, physician's reports, Service Plans, Centrally Stored Medication and Destruction Records, and Medication Administration Records (MAR). Medication Error 4/16/2026 On 4/21/2026 the Department received an incident report regarding a medication error on 4/16/2026, involving Staff S2 giving Resident R2, an incorrect dose of medication. Page 1 of 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The incident report states "Wellness nurse administered the medication but immediately realized that a double dose of the medication was administered. Wellness Nurse admitted to not completely reading the medication order thereby committing the mistake." The incident report notes R2 was observed, vitals were taken and R2 monitored for side effects. During today's visit, LPA interviewed 3 Staff (S1 to S3), 2 Residents (R1 to R2), and 1 Witness (W1). Based on investigation on 4/23/2026, S1 and S2 reported the medication errors to facility management when the errors occurred. Documents were obtained to include S1 and S2 training records, S1 and S2's written disciplinary action, and R1 and R2 physician's reports and care plans. LPA Tarin also conducted a safety check on R1 and R2. LPA observed R1 watching tv in his/her room. R1 did not respond to LPA's questions due to cognitive impairment. LPA observed R2 sleeping in his/her room. LPA observed R2 had a private companion. A civil penalty is being assessed for the amount of $250 for a repeat violation for CCR 8 7411(a) . A previous licensing report issued on 3/16/2026 cited the same deficiency. Please see LIC421FC. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. A Deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. An exit interview was conducted with GM JP Rollet and a copy of the report and appeal rights were provided.

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced annual inspection and met with General Manager (GM) J.P. Rollet. LPA stated the purpose of the visit. LPA toured the interior and exterior of the facility with GM to include the kitchen, resident rooms, dining room, bathrooms, back and front of the facility. All exit and passageways were free and clear of obstruction. LPA observed the facility to be clean, safe, sanitary and in good repair. LPA toured the kitchen area and observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA observed the refrigerator temperature at 30 F and Freezer at 0 F. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. The facility was equipped with smoke and carbon monoxide detectors. The facility fire alarm system was inspected by a third party vendor on 9/9/2025 and passed inspection. Fire extinguishers were last serviced on 10/20/2025. The facility emergency drill log was reviewed. The facility's last drill was on 12/20/2025. Page 1 of 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA toured 10 resident bedrooms, residents have a bed, functioning lights, dresser/table, bedding and space for personal belongings. LPA toured 10 resident bathrooms. All 10 bathrooms had hand soap, paper towels, functioning lights, and covered trash bins. LPA measured water temperature with a range of 109.2 F to 113.5 F. During inspection of Resident R1's bathroom, LPA observed inside an unlocked bathroom cabinet above the toilet, a clear plastic bag with oval shaped capsules. LPA observed the pills were half blue and half red in color. LPA also observed a small white prescription pill bottle on the second shelf. To the right of the small white prescription bottle, LPA observed 5 yellow capsules inside a clear plastic storage bin. GM stated R1 could manage his/her medications. Review of R1's physician's report dated 10/2/2023, R1 cannot manage or store his/her medications. R1 also has neurocognitive impairment, with confusion and disorientation. A deficiency is being cited today. LPA reviewed 4 resident records. LPA reviewed 4 resident’s Centrally Stored Medication and Destruction Records (CSMDR’s). LPA reviewed 4 staff records. A deficiency was cited during today's visit per California Code of Regulations Title 22, see LIC809D for more information. An exit interview was conducted with GM J.P. Rollet and a signed copy of this report and appeal rights were provided. Page 2 of 2 END OF REPORT

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced case management visit to follow up on an incident where a resident eloped from the facility. LPA met with General Manager (GM) J.P. Rollet. LPA stated the purpose of the visit. On 7/21/2025, the Department received an Incident Report (IR) dated July 18 , 2025, stating Resident R1 had eloped from the facility at approximately 2:50PM. The IR states staff received a report from Staff S7 at approximately 2:50PM, where S7 reported ‘seeing a lady on the street that resembles one our residents.” The facility began a search for R1 and did not locate R1 in his/her room. Staff began a search in the area outside of the facility where S7 reportedly observed R1. R1 was located by facility staff at approximately 3:05PM, sitting on the side of the street across from the local fire station. R1 was being taken by paramedics for assessment due to falling and sustaining an injury to the head. Based on Google Maps search, R1 was located approximately 0.7 miles away from the facility. On 7/22/2025 and 9/11/2025, LPA Tarin interviewed Staff S1 to S6. 3 out of 6 staff did not observe R1 on the day of elopement. S1 and S4 stated he/she saw R1 in the facility between 2:45PM and 2:50PM. S6 states he/she observed R1 between 2:00PM and 2:30PM. 6 out of 6 staff stated R1 has a history of wandering behavior. 2 out of 6 staff stated R1 has eloped from the facility before 7/18/2025. S2 and S4 states R1 eloped in May 2024 but did not provide additional information. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 5 out of 6 staff stated R1 has a history of cutting his/her wanderguard bracelet off. S6 did not provide additional information. LPA interviewed General Manager (GM). GM states the elopement occurred during a shift change, and "a lot of traffic was going through the front, which is the only way in and out of the community." Based on review R1’s physician’s report dated 3/27/2024, lists R1’s diagnosis as neurocognitive disorder. R1’s mental condition is listed as confused/disoriented, has wandering behaviors, and R1 is not able to leave the facility unassisted. R1’s service plans dated 6/27/2024 states R1 has exiting seeking behavior, seeks out, loiters near or attempts to exit through doors and/or windows. R1’s Elopement Risk Assessment dated 7/13/2025 states R1 showing wandering and exit seeking behaviors, verbalize a desire to leave community/to go home, resident has a history of previous elopement. R1’s Elopement Risk Assessment also states “ Resident currently with wanderguard, However, resident have been finding ways to cut wanderguard bracelets…in the meantime will continue to replace wanderguard. LPA reviewed previous incident submitted to the Department for R1 and found an elopement that was reported on 5/17/2024, where R1 eloped from the facility on 5/11/2024 when out on a walk. R1 was returned to the facility unharmed. Based on review of R1’s hospital discharge paperwork dated 7/18/2025, R1 sustained a fractured left wrist and a closed head injury during the elopement. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 An immediate civil penalty of $500.00 is being assessed against the facility today for violation the absence of supervision, which resulted in R1 eloping from the facility. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. This report was reviewed with General Manager J.P. Rollet and a copy of the report was provided. Appeal Rights were provided.

Allegation: Staff do not ensure that residents' showering needs are being met while in care. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if staff did not ensure that residents were being showered while in care based on the information available. Unsubstantiated. Allegation: Resident developed a bladder infection due to staff neglect. Records reviewed for R1 included discharge summaries and notes at the facility including correspondence with the primary care doctor, the record did not identify lack of supervision or neglect as a cause for treatment of R1's bladder infection. Discharge summaries advise follow-up with the primary care physician and hydration. The department was unable to determine if Resident developed a bladder infection due to staff neglect while in care based on the information available. Unsubstantiated. Allegation: Staff do not respond to residents' requests for assistance in a timely manner. Based on records reviewed and observation the facility did respond in a reasonable amount of time during the department unannounced visits. The facility provided residents with assistance that varied also noted is the activated call button announce the call. The department was unable to determine if Staff did not respond to residents' requests for assistance in a timely manner based on the information available. Unsubstantiated. Allegation: Staff do not ensure that residents receive medical attention in a timely manner. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if Staff did not ensure that residents receive medical attention in a timely manner while in care based on the information available. Unsubstantiated. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff do not ensure that there is communication which encourages family/responsible party involvement with the resident in care. Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The facility provides information in three place including a current life enrichment activities sheet. The department was unable to determine if at the time of the complaint that Staff did not ensure that there was communication which encourages family/responsible party involvement with the resident in care based on the information available. Unsubstantiated. Allegation: Facility is understaffed, Based on unannounced visits, records reviewed and observing processes including medication administration, responding to call buttons, meals and resident care the facility was providing care required under basic care with documentation. All interactions provided the residents with outcomes that met the need of each situation. The department was unable to determine if at the time of the complaint the facility was under staffed. Unsubstantiated. Based on this investigation the allegations may have happened or are valid, however, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore these allegations are unsubstantiated.

The permit was issued by the State of California, Department of Industrial Relations, Division of Occupational Safety & Health. LPAs reviewed a copy of the Disaster Response Procedures: Elevator Failure guidelines. The guidelines state staff should check to see if there is anyone is the elevator, the general manager should notify the elevator company for repair and initiate communication protocol. On 12/26/2024, LPAs interviewed Assisted Living Director (ALD). ALD stated the elevator was in disrepair on 12/18/2024. ALD states the elevator was out of service and was repaired that same day. ALD stated the elevator was stuck on the second floor and maintenance was notified. ALD stated the elevator was repaired and working at 2:30PM. ALD states staff and residents were informed of the elevator being in disrepair on 12/18/2024. LPAs interviewed 5 staff. 2 out of 5 staff state the elevator was in disrepair last week. Staff S2, Maintenance Director, stated the elevator was in disrepair on 12/18/2024 at 9am. S2 states he/she was notified by the facility at 9am on 12/18/2024. S2 states before he/she started repairs he/she made sure no one was inside the elevator. S2 was unable to fix the elevator. S2 states staff, residents and visitors were notified that the elevator was not working. S2 states an elevator repair company was called and the elevator was repaired by 2:30PM that same day. Staff S3 states the elevator was in disrepair on 12/18/2024 and was repaired that same day. 3 out 5 staff stated the elevator has not been in disrepair. LPAs interviewed 6 residents. 4 out of 6 residents state the elevator has not been in disrepair. 2 residents declined to be interviewed. LPAs reviewed the elevator repair invoice from the company contracted to repair the elevator. The invoice is dated 12/18/2024, with an incident time of 9:14AM, arrival time of 1:30PM and completion time of 2:30PM. The invoice states the description of the elevator as "elev passenger unit/not resp/stk on 2nd flr". The invoice states the resolution for the elevator as "top floor spirator." The invoice notes the labor hours as 1 hours and 0 minutes for the repair. See 9099-C Page 2 of 3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPAs reviewed the facility's Disaster and Emergency Manual. Under Emergency Generators, the Manual states that if the facility does not have have a generator, the community will identity at least 2 local rental companies to provide an appropriate generator for the community to rent during an emergency or disaster. LPAs reviewed ALD's file for emergency training. LPAs observed ALD's documentation of Employee Safety Orientation Checklist which includes a training titled "Emergency and Disaster Manual-Location and Contents" which was completed on 1/25/2023. LPAs reviewed the facility's Emergency and Disaster Plan. Under A.) Provisions for Emergency Power, the facility listed 1 generator rental company. During interview, ALD stated the facility does not have a backup generator. ALD stated he/she did not call a generator rental company on 12/14/2024 when the facility experienced a power outage from 6:45 AM to 9:45 PM. ALD stated no attempts were made to restore power on 12/14/2024. ALD stated the electric company was notified about the power outage. ALD states staff conducted extra safety check on residents, meals were delivered to residents, and activities were brought into residents rooms. ALD states all residents were given flashlights and lanterns to use in their rooms. LPAs interviewed 5 staff. 5 out of 5 staff stated the facility has experienced power outages and that the facility does not have a back up generator. 5 staff state when there is a power outage, staff will conduct extra safety checks on residents, assist residents with going upstairs and downstairs, and bring meals to resident rooms. LPAs interviewed 6 residents. 4 out 6 residents stated the facility had a power outage but did not know if the facility had a backup generator. R2 states the facility had one power outage, but did not know the date of the outage. R2 states the power outage did not impact his/her every day routine. R3 states the facility had a power outage about a week and a half ago,and it lasted the whole day. R3 states the staff brought all his/her meals to the room, and had no concerns during the power outage. R6 states the facility has a power outage, but did not remember the date. R6 states he/she has a flashlight and latern in his/her room that was provided by the facility. R6 states he/she uses oxygen, and has back up battery charged oxygen tanks in the event of a power outage. 2 residents declined to be interviewed. See LIC9099-C Page 2 of 3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The Department has investigated the above allegation. Based on interview, record review and observation, the preponderance of evidence standard has been met. Therefore, the above allegation is substantiated. A deficiency was cited per California Code of Regulations Title 22. See LIC9099-D. This report was reviewed with Assisted Living Director, Gloria Escoto, and a signed copy of this report and appeal rights were provided. Page 3 of 3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Based on the interviews conducted with residents, and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegation is unsubstantiated. This report was reviewed with Assisted Living Director, Gloria Escoto, and a signed copy of this report was provided.

Licensing Program Analyst (LPA) Albert Johnson conducted a case management visit on today's date for a health and safety deficiency found during the tour of the facility The following deficiency was observed by staff and LPA: Unlocked toxins under the sink in the memory care unit. The cabinet has a locking devise, however, it is broken and unable to be locked. The toxin were accessible to the four resident seated in the dining area unsupervised. There are 12 resident in the memory care area and two staff working on this date. Deficiency cited on the following 809-D to Title 22 regulations. Exit interview conducted and appeal rights discussed and given. A copy of this report was left with the Lead/