Arcadia Gardens Retirement Hotel.

In regard to the allegation “Staff is refusing to provide the residents' family with residents' facility file”, it is alleged that facility will not release file records to R1’s family. During interviews with Executive Director and staff all three stated they do not remember R1. R2 stated that he/she received email correspondence and was looking for file for R1 but could not find them. Executive Director informed LPA that there were able to find a handwritten face sheet for R1 with emergency contact information. Executive Director contacted the POA and was told that R1 resided at facility in 2018 for no more than 6 months. LPA was able to confirm dates of R1’s stay with W1. LPA obtained a copy of face sheet dated 09/13/2018. Per section 87506(e) Resident Records Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. Based on interviews conducted and records reviewed, there is insufficient evidence to support the 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. An exit interview was conducted, and a copy of this report was given to Pamela Parsons.

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. LPA met with Director of Nursing Suzana Zadourian. Nursing director assisted LPA with the visit and facility tour. Administrator, Pamela Parsons, arrived shortly after and assisted with the facility tour. The facility is licensed and has Fire clearance approval to serve for a capacity of 175 non- ambulatory residents including 25 bedridden residents, ages 60 and above. The facility has an approved Hospice Waiver on file for twenty-three (23) residents. Eighteen (18) residents currently on Hospice. Facility has an approved Dementia Care Plan in their plan of operation and accept residents with dementia. Facility does not handle residents’ monies. During the visit, a tour of the facility, review records and interviews with staff and residents’ consisted of the following: 1. Infection Control: Infection control practices were observed. Infection control plan is on file. 2. Physical Plant/Environment Safety: The facility is in a residential neighborhood, consists of three floors and has 189 resident bedrooms and 189 resident bathrooms. Level 1 has resident bedrooms, memory care unit, recreation/activity rooms, beauty shop, storage rooms, employee lounge, library, and laundry rooms. 2nd level is memory care, reception/lounge area, resident bedrooms, dining room, kitchen, multiple offices, recreation/activity rooms and laundry rooms. 3rd level consists of resident bedrooms, nurse's office, medication room, penthouse, recreation/activity rooms and laundry rooms. CONTINUED ON 809C.................. 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 A physical tour was conducted. LPA randomly toured resident rooms on each floor in building sections A, B, C, D, E and F. Residents’ rooms were well furnished and in compliance. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 105.0 – 120.0 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. The resident rooms are equipped with a signal system located in each restroom and facility phones to call the front desk. Facility had central air and heating accommodations in the common areas. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable at the memory care unit at the lower level. Interior and exterior space is available to permit residents to walk in safe and comfortable environments. 3. Operational Requirements: The Program Design was reviewed. Fire clearance approved for 175 non- ambulatory residents, 25 bedridden residents, ages 60 and over. Floor of bldg. F & second floor of bldg. F cleared for dementia wings/ with delayed egress. Each dementia unit consisting of 11 rooms. May retain twenty-three (23) Hospice residents. Eighteen (18) residents currently on Hospice. Care and supervision to meet the residents’ needs was observed. Liability insurance expires 02/28/2026. 4. Staffing: One hundred and two (102) full-time staff and twenty nine (29) part-time staff members provide care and supervision to the residents. 5. Personnel Records/Staff Training: Five (5) staff files were reviewed for criminal background clearance and training. All Five (5) staff records reviewed have a health screening with a Tuberculosis clearance, and five (5) staff have First Aid/CPR training that are active. Administrator certificate is current and expires on 07/31/2026. 6. Incident Medical and Dental: All residents have an Appraisal/Needs and Services Plan on file. Staff training was on file. CONTINUED ON 809C...................... 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 7. Resident Rights/Information : Physician orders were reviewed for five six (6) resident files. Medications were also reviewed for six (6) residents. Medications are centrally stored and locked in the nurse's office on the third floor. First aid kit is fully stocked. Mandated documents and signages are posted in common areas. Resident records are stored in a locked cabinet and inaccessible to residents. 8. Resident Records/Incident Reports: Six (6) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Resident records are stored in a locked cabinet and inaccessible to residents. 9. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Staff is adhering to residents' meal plans as per physicians orders for mechanical/ diabetic diets Sufficient food supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Food is stored in covered containers at the appropriate temperatures. Pesticides or poisons are not stored in the food areas, stored in separate closet inaccessible to residents. Freezer and refrigerator has required temperatures, which was within Title 22 Regulation guidelines. 10. Disaster Preparedness: Emergency and Disaster Plan (LIC610E) was found in the facility. The last Fire/Emergency Drill are conducted quarterly on by third-party company on 11/08/25 PM and NOC shift. 11/10/2025 AM shift safety drills were conducted. Smoke and carbon monoxide detectors are operable and in compliance. Fire extinguishers were last serviced on 02/06/26 are fully charged and in compliance. 11. Planned Activities: Sufficient Space is provided to accommodate both indoor and outdoor activities. Sufficient equipment and supplies are provided to meet the requirements of the activity program. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. Outside grounds were toured and pool/spa area with self-latching fenced gate was observed. The outdoor activity area has a shaded patio with ample seating. 12. Residents with Special Health Care Needs: Eighteen (18) residents are receiving hospice services. There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit interview was held with Administrator and a copy of annual facility inspection report was provided.

Licensing Program Analyst (LPA) Vaid conducted an unannounced annual inspection visit. LPA met with Administrator, Pamela Parsons, and Director of Nursing Suzana Zadourian. Nursing director assisted LPA with the visit. The facility is licensed to serve for a capacity of 175 non- ambulatory residents including 25 bedridden residents, ages 60 and above. The facility has an approved Hospice Waiver on file for twenty-three (23) residents. Twenty -two (22) residents currently on Hospice. Facility has an approved Dementia Care Plan in their plan of operation and accept residents with dementia. Facility does not handle residents’ monies. Administrator certificate is current and expires on 07/31/2026. During the visit, a tour of the facility was conducted, food supply and medications were reviewed. The facility is located in a residential neighborhood, consists of three floors and has 186 resident bedrooms and bathrooms. Level 1 has resident bedrooms, memory care unit, recreation/activity rooms, beauty shop, storage rooms, employee lounge, library, and laundry rooms. 2nd level is memory care, reception/lounge area, resident bedrooms, dining room, kitchen, multiple offices, recreation/activity rooms and laundry rooms. 3rd level consists of resident bedrooms, nurse's office, penthouse, recreation/activity rooms and laundry rooms. A physical tour was conducted. LPA randomly toured resident rooms on each floor in building sections A, B, C, D, E and F. Residents’ rooms were well furnished and in compliance. Bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 105.0 – 120.0 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. The resident rooms are equipped with a signal system located in each restroom and facility phones to call the front desk. The signal system was tested in various resident's room on each level and are operable. Average time for caregivers to assist residents is 2-4 minutes. (-continued in LIC 809 C-) 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 Facility had central air and heating accommodations in the common areas. Facility maintained a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable at the memory care unit at the lower level. Interior and exterior space is available to permit residents to walk in safe and comfortable environment. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Food is stored in covered containers at the appropriate temperatures. No pesticides or poisons are stored in the food areas. The last Fire/Emergency Drill is conducted on 02/10/2025 and 02/11/2025, PM shift and NOC shift. Smoke and carbon monoxide detectors are operable and in compliance. Fire extinguishers were last serviced on 02/06/25 are fully charged and in compliance. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. Outside grounds were toured and pool/spa area with self-latching fenced gate was observed. The outdoor activity area has a shaded patio with ample seating. Medications are centrally stored and locked in the nurse's office on the third floor. First aid kit is fully stocked. Mandated documents and signages are posted in common areas. Resident records are stored in a locked cabinet and inaccessible to residents. Toxic substances are inaccessible to residents. No deficiencies were observed as per California Code of Regulations, Title 22. Exit interview was conducted and copy of this report was provided to facility Administrator, Pamela Parsons.

Licensing Program Analyst (LPA) Alberto Lopez made an unannounced case management visit regarding an incident on the relocation of 1 resident from Con Carino Braeburn (Woodland Hills South (RO) due to mandatory evacuation orders from the Fire Advisory. LPA met with Administrator, Pamela Parsons, and explained the reason for the visit. During the visit today, LPA Lopez conducted a health and safety check at Arcadia Gardens Retirement Hotel, and no concerns were observed. LPA obtained a copy of the client and staff roster for Arcadia Gardens Retirement Hotel. Per interview with the administrator, there are zero (0) resident(s) that has been relocated from Con Carino Braeburn (Woodland Hills south RO) The resident in question was admitted on 01/06/2025 at Arcadia Gardens Retirement Hotel. Which is before the fires. Facility has sufficient staffing to meet the needs of the residents. Food and hygiene supplies are available to accommodate a total of 162 residents. After further investigation, administrator stated they have one (1) resident placed by licensing due to the fire. Resident was at Pasadena Convention Center. LPA spoke with resident and resident stated resident was at resident's private residence before the fires. LPA asked facility Administrator to send incident report to department if they do receive any residents displaced by fire. An exit interview was held, and a copy of this report was given to the Administrator.

Allegation: Staff are prohibiting resident from having visits. The complaint alleges that approximately 4 to 5 weeks ago a person went to the facility to visit resident (R1) and Administrator asked the visitor to wait in the conference room. Administrator then wheeled in the non-ambulatory resident and shortly after the 2 family members entered the conference room. The visitor/former resident (R12) stated they always give advance notice to facility staff of visit plan. It was reported that Administrator allowed R1’s family members to yell and tell the visitor that they are not allowed to visit the resident and was asked to leave the facility. The complaint alleges there is no court order, restraining order, or conservatorship that stipulates resident (R1) shall not be allowed contact with the visitor. A total of three (3) staff were interviewed. Based on interviews conducted, staff stated that the visitor was a previous resident at the facility. Resident (R1's) Power of Attorney's have expressed concern to staff about R1's safety due to cognitive impairment. According to interviews, visitor's conduct i.e. touching of R1's body parts and gift giving is of concern because R1 is cognitively impaired and may be easily influenced by visitor. Staff reported that in the past R1 has stated they feel uncomfortable when they meet with visitor. Staff met with R1 and their POAs on several occasions, which resulted in R1 signing "Resident's Visitor Restriction Forms", that state that they restrict all visits from aforementioned visitor. However, staff reported that due to R1's short and long term memory deficit, sometimes R1 does agree to meet with visitor. The facility visitation hours are from 8AM - 6 PM, with after hour flexibility if needed. Resident (R1) stated that the visitor is a good friend, and is "alright" with the person visiting. The resident stated that staff have not infringed upon their visitation rights. A total of 11 residents were interviewed, none reported visitation issues, and stated their visitors are allowed to visit in the common areas and in their rooms. One (1) family member was interviewed. They stated there are no issues with facility visitation policy and is able to visit anytime. A private caregiver was also interviewed and expressed no concern about facility visitation protocols. Both staff and resident (R1) confirmed visitor is still allowed to visit the resident. Based on record review, the findings indicate R1 requires total care and has cognitive impairment but is able to communicate needs. Former resident (R12)/visitor is also cognitively impaired. There is insufficient evidence to corroborate the 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 . An exit interview was conducted and a copy of this report was discussed and provided to facility Executive Director Pamela Parsons.

The investigation revealed the following: In regards to the allegation that "Staff did not abide to admission agreement," it is alleged that R1 had been admitted into Arcadia Gardens Retirement Hotel with acknowledgements from staff, including processing the payment of the community fee and being provided arrangement paperwork for R1's move into the facility, however the family of R1 was later told that Arcadia Gardens Retirement Hotel backed out of the agreement and would not be accepting R1 into the facility. During interviews with the residents, eleven (11) out of eleven (11) did not corroborate the allegation that the facility has not been abiding to the admission agreements that they signed. One resident interviewed stated that all services that are described in the admissions agreement are being provided by the staff members. Another resident interviewed stated that all of their needs are being met, and stated that all services they require are being offered by the facility staff members. During interviews with the staff, four (4) out of four (4) interviewed denied the allegation. One of the staff interviewed stated that they were initially not informed that R1 had a prohibited health condition when they were planning to admit R1, however once this diagnosis was discovered and along with the fact that R1 was not receiving hospice care either, the facility determined that they were not able to admit the resident. Another staff member stated that they had received incomplete information from the Skilled Nursing Facility (SNF) that R1 was residing at, and was not aware that they had a prohibited health condition when they initially considered R1 for admission into the facility the facility, and remained unaware of this until the facility nurse conducted a body check on R1 at the SNF they were residing at, which revealed the prohibited health condition. During record review, LPA determined that the community fee that R1's family had paid was refunded on 10/9/2024 in its full amount. It was also determined that R1 had never signed an admission agreement with the facility. Based on statements and interviews conducted with staff, clients, review of client 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 held, and a copy of this report was provided.

The investigation revealed the following: In regard to the allegation, lack of care resulted in resident requiring medical treatment, it was alleged staff did not provide care to resident which resulted resident was transferred to a hospital for medical care. Per resident interviews, nine (9) out of nine (9) residents interviewed could not corroborate the allegation. Resident interviews revealed that facility staff had provided care to residents timely which did not lead residents to seek medical treatments. All four (4) out of four (4) staff denied the allegation. Staff interviews revealed that staff would assist residents to meet residents’ care needs. Mostly, residents’ needs for seeking medical treatment were due to residents’ physical conditions. Per LPA’s observation, staff provided care to residents timely as residents called for assistance using the signal systems and when residents requested assistance from the caregivers in person. Therefore, facility staff assisted residents timely to meet residents care needs. In regard to the allegation, resident was neglected while in care at the facility, it was alleged staff failed to check on resident until after resident missed two meals. Per resident interviews, nine (9) out of nine (9) residents interviewed could not corroborate the allegation. Resident interviews revealed that facility staff would check on residents if they did not come to the dining rooms for meals or declined food tray services. All four (4) staff denied the allegation. Staff interviews revealed that staff had to do round in each shift to check on residents, assist residents to meet residents’ care needs and observe residents’ physical conditions. When staff doing round, staff would knock on residents’ room doors, call out residents’ names, wait for residents’ responses if they were in their rooms, and check on residents even if residents declined staff going into their rooms. Per record review, there was an incident report, dated 08/24/23, indicated resident was observed to be weak and need medical attentions while staff was checking on resident. Per LPA’s observation, staff did round to check on residents, responded to residents’ call signals, and asked residents if they needed helps. Thus, facility staff did not neglect residents while in care. In regard to the allegation, resident's responsible party was not provided resident's document, it was alleged the administrator did not provide a signed copy of the resident’s admission agreement to resident’s responsible party upon admission. Per resident interviews, nine (9) out of nine (9) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents and/or responsible parties received a copy of the residents’ admission agreements after admissions. (-continued in LIC 9099 C-) 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 All four (4) staff denied the allegation. Administrator’s interviews revealed that the administrator had to go over the admission agreements with residents and/or responsible parties upon admission. The copies of the admission agreements were provided to them accordingly. Residents who claimed the facility did not provide them copies could had been misplaced or lost the copies instead not provided. Per record review, it revealed the residents’ admission agreements had multiple signature pages (signed and dated) to show residents/responsible parties had received a copy of the admission agreements and records. Thus, facility staff did not fail to provide resident’s admission agreements. In regard to the allegation, resident was not provided services per agreement, it was alleged that staff did not assist resident with the second shower of the week and did not change resident’s clothes. Per resident interviews, nine (9) out of nine (9) residents interviewed could not corroborate the allegation. Resident interviews revealed that staff assisted residents with bathing as scheduled and as needed. Staff would change residents’ clothes after showers and as needed. All four (4) staff denied the allegation. Staff interviews revealed that staff assisted residents with bathing as scheduled; however, residents had rights to decline of being bathed/changed clothes. Staff could not force residents to take baths and/or change clothes if they did not want to. Per LPA’s observation, residents’ clothes looked clean with no foul odor. Thus, facility staff did not fail to provide services per agreement. In regard to the allegation, illegal eviction, it was alleged that the facility’s 30-day notice policy was provided to resident#1 (R1) while resident was in the hospital and may not be able to return within 30 days. Per resident interviews, nine (9) out of nine (9) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents were not aware of any evictions happening at the facility. All four (4) staff denied the allegation. Staff interviews revealed that no eviction notices had even issued and sent to R1. Resident deceased, therefore, no eviction could happen. Thus, facility did not illegally evict resident. In regard to the allegation, facility did not adhere to admission policy, it was alleged that administrator charged resident#1 (R1) for services not received and billed resident for $3,000 more on R1’s final rent statement. Per resident interviews, nine (9) out of nine (9) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents did not observe services charged but not provided on their rent statements. All four (4) staff denied the allegation. Staff interviews revealed that administrator had adjusted the remaining unpaid balance down to $0 upon resident#1’s discharge due to death. The alleged $3,000 service charge was never paid by the resident / responsible party. (-continued in LIC 9099 C-) 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 Per visitor interview, resident#1 (R1)'s final rent statement was adjusted down to $0 and no payment was required. Per record review, resident#1’s final bill, dated 09/19/23, all remaining balance was wrote-off to $0 and the book was closed. Therefore, facility did not fail to adhere to admission policy. In regard to the allegation, staff threatened resident, it was alleged that staff scolded and threatened the resident severely while in care. Per resident interviews, nine (9) out of nine (9) residents interviewed could not corroborate the allegation. Resident interviews revealed that staff did not scold or threaten residents. Since residents may had hearing problems, residents would ask the staff to speak louder, therefore, residents could hear the staff. All four (4) staff denied the allegation. Staff interviews revealed that the facility policy did not allow staff scold or threaten residents. Staff had in-service training on resident’s rights and proper care. Per observation, LPA did not observe staff had talk down, disrespect or threaten residents in care. Therefore, staff did not threaten residents. 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. An exit interview was conducted with Administrator. A hard copy of the report and appeal rights were provided.

Interview with administrator revealed that letter request for records was received by their accounting department on 5/24/24. Administrator was out of the facility from 5/24/24-5/27/24 and received the letter on 5/28/24. Upon returning administrator reviewed the letter and requested medical records staff to pull records from storage and put the records together to comply with the request. Due to the large amount of documents facility was not able to provide records by due date of 5/29/24. Based on documents reviewed, law firm letter - release of information dated 5/21/24 is stamped 5/24/24 which is when it was received by the facility. Per Health and Safety Code (HSC) facility is to provide records upon requested not exceeding two business days. Due to the holiday weekend facility was to provide records by 5/29/24. During my visit, R1’s records were available for review. However, older records are currently on storage and need to be pulled out. LPA contacted law firm and informed that facility’s administrator will provide records by 5/30/24 end of day. Administrator spoke with a law firm representative, who accorded that mailing the documents by end of day 5/30/24 was acceptable. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview was conducted with Pamela Parsons and a copy of this report was provided.

The investigation revealed the following: Allegation: Staff are prohibiting resident from having visits. It is alleged that staff are prohibiting R1 from having visits with a friend who has previously been able to visit and is now restricted from doing so. LPA reviewed R1's file and observed a Resident's Visitor Restriction form in which R1 has on occasions signed that they do not wish to have visits with this friend. LPA interviewed 4 staff and 4 out of 4 staff deny the above allegation and stated that residents are allowed visitation and are given privacy during visits. Staff interviewed also stated that R1 is given the option when asked if they would like to visit and if R1 says yes R1 will then ask where their visitor is and asks for staff to take them to their visitor. Staff stated that they do not stay present while R1 is having a visit with their friend and allow them to visit with privacy. LPA interviewed R1 and R1 stated that they are able to have visits and mentioned that their friend visited them last week. Interview (via phone) with R1's friend, they stated that they visited R1 last week and have not been back since to visit, they stated they feel that staff will not allow visitation and when LPA asked if they have ever been denied a visit with R1 the friend stated that they have never been denied visitation with R1 by staff. LPA interviewed 8 additional residents and 8 out of 8 residents denied the above allegation and stated that they are able to have visits with friends/family and are given privacy during their visits. Based on statements and interviews conducted with staff and residents, and review of R1 files, there was not enough supportive evidence to concur with the reported allegations. 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 to Pamela Parsons - Executive Director.

Licensing Program Analyst (LPA) Tao conducted an unannounced site inspection for the expansion of dementia unit on the 2 nd floor at the facility. LPA met with Administrator, Pamela Parsons, and Chief operations officer , David Chirikian . The capacity remained the same as 200 residents which included 175 non-ambulatory and 25 bedridden, ages 60 and above. The facility had approved twenty-three (23) Hospice Waivers and approved dementia wing on the first floor which has delayed egress that consisted of 11 rooms. Facility has an approved Dementia Care Plan in their plan of operation to accept residents with dementia. Fire clearance: Fire clearance is granted for 200 residents which included 175 non-ambulatory and 25 bedridden on 03/20/24. Structure: The facility is located in a residential neighborhood, consists of three floors/levels and has 186 resident bedrooms and bathrooms. Resident bedrooms, memory care unit, recreation/activity rooms, beauty shop, storage rooms, employee lounge, library and laundry rooms are located at the lower level. Reception/lounge area, resident bedrooms, dining room, kitchen, multiple offices, recreation/activity rooms and laundry room are located at main level. Upper level consists of resident bedrooms, nurse's office, penthouse, recreation/activity rooms and laundry room. Today’s visit is regarding the new expansion of the dementia unit on the 2 nd floor. This unit included 11 residents’ rooms and one dining room with delayed egress. (- continued LIC 809 C -) 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 Bedrooms and Bathrooms for residents: Bedrooms are spacious, accommodated for residents and in compliance with regulation. Bathrooms have grab bars maintained for each toilet, bathtub and shower. Linens & Hygiene Supplies: Sufficient linen/supplies which include pillowcases, mattress pads, blanket and bedspreads are available. Adequate supply of linen, wash clothes and towels are observed. Smoke Detectors/Signal system: Smoke /carbon monoxide detectors are tested and operable which are located in hallways and each bedroom. Signal system is tested and operational. Residents & Staff Files: Locked cabinets for records of staff and residents are installed and available. No resident is currently residing at this new unit. Water Temperature: Water was measured at a range of 110.6 to 112.9 degrees Fahrenheit which was in compliance with Reg Title 22. Fire extinguishers/ delayed egress: Fire extinguisher was fully charged, and last fire inspection was on 3/20/24. Delayed egress was operational. Finding: No issue was observed during today’s visit. Exit conference was conducted with administrator. A copy of this report was provided.

The investigation revealed the following: In regard to the allegation: staff did not respond to resident in a timely manner, it was alleged that staff did not provide assistance to resident timely after resident fell. Ten (10) out of eleven (11) residents who were interviewed could not corroborate the allegation. Resident interviews revealed that facility staff would provide timely care if residents called on the signal button for help. All five (5) staff who were interviewed denied the allegation. Staff interviews revealed that staff would assist residents timely if residents when residents called for help. LPA tested and called the signal button. Staff responded to LPA’s calls in about 2 minutes and staff attended to residents’ rooms to provide care in range of from 3 minutes to 10 minutes. Therefore, there was not preponderance evidence to show staff failed to respond to resident in a timely manner. In regard to the allegation staff are not providing resident with privacy, it was alleged that staff did not provide privacy to residents and visitors during visits and did not allow visitor to go to resident’s room during the visit. Ten (10) out of eleven (11) residents who were interviewed could not corroborate the allegation. Resident interviews revealed that staff provided privacy to residents during visitation and residents could choose where the visitation took place. All five (5) staff who were interviewed denied the allegation. Staff interviews revealed that staff honored residents’ privacy and offered it to residents for visitations. Per record review, residents had personal rights for privacy and visitation. Therefore, the facility staff provided residents and visitors with privacy during visits. In regard to the allegation staff did not safeguard resident's personal belongings, it was alleged that resident’s cell phone was missing while in care. Ten (10) out of eleven (11) residents who were interviewed could not corroborate the allegation. Resident interviews revealed that when their cell phones or personal items were claimed missing, staff would assist to find them and one (1) of eleven (11) residents did not report missing a cell phone. Their items were misplaced and found in the next day. Residents were not aware of any personal items being stolen. All five (5) staff who were interviewed denied the allegation. Staff interviews revealed that staff would search for the missing items and return them to residents when found. Staff stated the claimed missing items were misplaced, not missing. Therefore, the investigation did not reveal facility fail to safeguard residents’ belongings. (-continued in LIC 9099C-) 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 In regard to the allegation staff did not provide a comfortable environment for resident, it was alleged that resident was left in a shivering cold room in the cold day. Ten (10) out of eleven (11) residents who were interviewed could not corroborate the allegation. Resident interviews revealed that residents had never left in a cold room shivering. The staff would check on them and assist as needed. All five (5) staff who were interviewed denied the allegation. Staff would do rounds and respond to call buttons to assist resident if rooms were cold or hot. Per LPA’s observation, resident’s rooms’ temperature were in the range of 70- 75 degree Fahrenheit which was in compliance with Title 22. Therefore, the residents’ rooms had comfortable temperature. 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. An exit interview was conducted with Administrator. A hard copy of the reports were provided.

Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit. LPA met with Administrator, Pamela Parsons. The facility is licensed to serve for a capacity of 200 residents including 175 non-ambulatory and 25 bedridden residents, ages 60 and above. The facility is approved for twenty-three (23) hospice residents and has an approved Dementia Care Plan. Annual licensing fees are current. Administrator certificate is current, and the expiration date is 07/31/24. During the visit, the CARE tool was used, a tour of the facility was conducted, food supply was reviewed, staff/residents were interviewed, facility records were reviewed, and medications were reviewed. The facility is located in a residential neighborhood, consists of three floors/levels and has 186 resident bedrooms and bathrooms. Resident bedrooms, memory care unit, recreation/activity rooms, beauty shop, storage rooms, employee lounge, library and laundry rooms are located at the lower level. Reception/lounge area, resident bedrooms, dining room, kitchen, multiple offices, recreation/activity rooms and laundry room are located at main level. Upper level consists of resident bedrooms, nurse's office, penthouse, recreation/activity rooms and laundry room. (-continued in LIC 809 C-) 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 conducted a physical plant. Residents’ rooms were well furnished and in compliance. The bathrooms inspected were clean, operable, with the required grab bars and non-skid materials in the shower. Hot water temperature was in a range of 106.2 - 110.5 degrees Fahrenheit which was within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies was observed. The resident rooms had signal systems. LPA randomly tested the signal system in different resident's room on each level and they were operable. Staff arrived at residents' rooms to respond the calls in a range of 3 to 5 minutes. The facility phones for residents’ use were located at the front desk and operable. Auditory alarm devices to monitor exits were operable at the memory care unit at the lower level. Sufficient supply of perishable and nonperishable foods were observed. The last Fire/Emergency Drill was conducted on 03/12/24. Smoke detectors and carbon monoxide detectors were operable. Outside grounds were toured and pool/spa area with self-latching fenced gate was observed. The outdoor activity area has a shaded patio with ample seating. Medications were centrally stored and locked in the nurse's office on the upper level. Resident records were stored in a locked cabinet and inaccessible to residents. Toxic substances were inaccessible to residents. No deficiencies were observed and cited per California Code of Regulations, Title 22. An exit interview was conducted. This report is discussed and provided to facility Administrator.

Ten (10) out of ten (10) residents who were interviewed could not corroborate the allegation. Resident interviews revealed that facility staff would provide timely care if residents fell whether residents were injured or not. Staff would notify residents’ responsible parties if residents fell. Four (4) out of four (4) staff denied the allegation. Staff interviews revealed that staff would assist residents timely if residents fell while in care. Therefore, there was not preponderance evidence to show staff failed to provide care to residents and resident sustained injured. In regard to allegation staff are failing to meet resident’s needs, it was alleged that staff did not provide care to resident on changing diapers and assisting with feeding. Ten (10) out of ten (10) residents who were interviewed could not corroborate the allegation. Resident interviews revealed that staff had provided the care they needed such as grooming, cleaning, changing diaper and assistance with feeding. Four (4) out of four (4) staff denied the allegation. Staff interviews revealed that staff would assist residents per residents’ needs. Per record review, resident was scheduled to have a 2-hour check on reposition / diaper change and assisting with feeding. Therefore, staff provided care to meet resident’s needs. In regard to allegation staff leave resident in soiled clothing for extended periods of time, it was alleged that staff left resident in wet soiled clothing for extended periods of time. Ten (10) out of ten (10) residents who were interviewed could not corroborate the allegation. Resident interviews revealed that they had never left in soiled, wet clothing. Staff changed their clothes timely if got soiled. Four (4) out of four (4) staff denied the allegation. Staff interviews revealed that staff would change residents’ clothes as needed. Per observation, residents were observed to be clean, neat and with no foul odor. Therefore, resident was not left in soiled clothing for extended periods of time. In regard to allegation staff failed to safeguard resident’s personal belongings, it was alleged that resident’s cell phone was missing in the facility. Ten (10) out of ten (10) residents who were interviewed could not corroborate the allegation. Resident interviews revealed that staff would help them to find their missing belongings and most of the time, their missing belonging were found in their rooms. Residents were not aware of any personal items being stolen. Four (4) out of four (4) staff denied the allegation. Staff interviews revealed that staff would assist residents to search for the items and return them to residents. In most cases, resident’s items were misplaced in their room. File review revealed resident #1 did not have the said items under resident’s possession. Therefore, investigation did not reveal staff failed to safeguard resident’s belongings. (- continued in LIC 9099C-) 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 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. An exit interview was conducted with Administrator. A hard copy of the report and appeal rights were provided.

***This licensing report supersedes the original complaint investigation report, dated 06/23/22. The findings remain as Unsubstantiated. *** In regard to allegation "staff is not dispensing resident's medication as prescribed," it was alleged that staff did not administer resident’s medication and/or insulin as prescribed. Per residents’ interview, eleven (11) out of eleven (11) residents could not corroborate the allegation. Residents interview revealed their medication was administered as prescribed. Per the interviews with residents who were on insulin revealed that staff would check their blood sugar prior administer their insulin and provided proper dosages accordingly. Per staff interviews, six (6) out of six (6) staff denial the allegation. Staff interviews revealed staff would follow the resident’s chart to administer residents’ medication and observe residents when taking the medication. Staff / LVNs would check the resident’s blood sugar between 7:30 a.m. to 8:00 a.m. daily. Night shift LVNs would administer the resident’s medication (Insulin) on Fridays and Saturdays. During the weekday, the morning shift LVN would administer residents’ medication (Insulin). Residents’ blood sugar readings were checked daily and posted in the medication administration record (MAR). The MAR recorded the blood sugar to determine whether the resident’s medication (Insulin) administration was needed. Medication was recorded and documented in the medication computerized system which keeps track of the prescribed medication (Insulin). The medication (Insulin) dosage was determined by the resident's physician. Per the review of residents’ Medication Administration Records (MAR) from 09/01/21 to 09/30/21 and from 10/01/21 to 10/08/21, MAR documented residents had received their blood glucose checks at 7:30 a.m. and at 4:30 p.m. and administered their prescribed medication at 8:00 a.m. Per file reviews, the facility’s in-service training records documented the facility offered training on 08/15/21 to facility LVNs presented by facility’s LVN Director regarding the topic: “Insulin Administration”. Therefore, staff is dispensing resident’s medication as prescribed. In regard to allegation "staff are not serving a good quality of food", it was alleged that facility did not provide good quality food to residents. Per residents’ interview, nine (9) out of eleven (11) residents could not corroborate the allegation. Residents’ interview revealed the majority of residents corroborated that the facility’s food service is good and there were no issues with the quality of food service. Two (2) out of eleven (11) residents stated the food was not good because it tasted bland or overdone. Per staff interviews, six (6) out of six (6) staff denial the allegation. Staff interviews revealed staff would provide good quality of food and alternate menu was available to residents. (-continued in LIC 9099C-) 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 ***This licensing report supersedes the original complaint investigation report, dated 06/23/22. The findings remain as Unsubstantiated. *** A virtual tour of the facility’s physical plant was conducted including the kitchen, dining area, food supply; and a review of the facility’s menus showed the facility was all in compliance. During the subsequent visit, LPA/RA Ceniceros conducted a tour with Administrator Parsons to the commercial kitchen, dining room area, and residents’ bedroom to ensure food services were in compliance. LPA Tao toured to the kitchen and observed food were cooked fresh and served hot. Thus, staff is providing good quality food to residents. In regard to allegation “facility has ants", it was alleged that facility had ants in the facility. Per residents’ interview, ten (10) out of eleven (11) residents could not corroborate the allegation and had not seen ants in their rooms. One (1) resident out of eleven (11) residents said only seen ants when food was left out overnight. Residents’ interview revealed the facility did not have ants issues. Per staff interviews, six (6) out of six (6) staff denial the allegation. Staff interviews revealed staff did not see ants in the facility. During the initial visit conducted by LPA Tao, and subsequent visit conducted by LPA/RA Ceniceros, no ants were observed during the physical plant including facility’s commercial kitchen, dining room area, and residents’ bedroom. As a preventive measure, the facility had a monthly contract with a pest control company that conducts services. Therefore, the allegation of the facility has ants is found to be UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Administrator and a hard copy was provided.