Silverado Senior Living - Belmont Hills

On March 24, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case-management visit in relation to two incidents that occurred at the facility. LPA met with Administrator, Robert Snee and explained the purpose of the visit. The Licensee reported on 3/8/26 at around 8:00pm, Resident 1 (R1) and Resident 2 (R2) were found together in a room. Both residents were observed half undressed. R1 was observed behind R2 but was not observed touching R2. R1 and R2 were immediately separated and redirected back to their rooms. There were no signs of intimacy or injuries. Licensee implemented 30 minute status checks, reminded staff to redirect and encourage both residents to join activities. All required parties were notified On 3/12/26 at around 6:40pm, the Licensee reported, R1 and R2 were found undressed and involved in an intimate act in a room. Both residents were separated and required parties were notified. Status checks were implemented for every During the visit, LPA reviewed R1 and R2's files, discussed incident with staff, and reviewed the facility's policy regarding resident relationships. According to R1 and R2's file, both residents have Alzheimer's dementia diagnosis and this was the first incident with R1 and R2 being half undressed and being intimate with each other. R1 and R2's service plan was observed to be updated to address these incidents. According to the Assistant Director of Health Services observed R1 and R2 walking around in the courtyard at around 6pm. Administrator and Assistant Director of Health Services indicated that R1 was moved to a different neighborhood and since these incidents, there has not been any new incidents and they have not been observed together. No citations are issued during the visit. Report is reviewed with Assistant Director of Health Services and a copy is provided.

On January 5, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit to deliver a copy of amended report that was originally delivered on 2/25/25. LPA met with amended administrator, Robert Snee and explained the purpose of the visit. During the visit, LPA delivered an amended copy of LIC9099 and LIC9099D that was issued on February 25, 2025. Report was reviewed with Administrator, Robert Snee and a copy is provided.

On December 29, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced annual inspection. LPA met with Director of Health Services, Amyda Astrero and explained the purpose of the visit. LPA toured the facility inside and outside but not limited to, five resident neighborhoods; maple, cedar, bay, twin pines and oak, one main administrative office, library, and kitchen. No accessible bodies of water or fire safety hazards observed. This is a locked perimeter facility. LPA toured resident neighborhoods and observed a dining room in each neighborhood. Hallways and resident rooms were observed to be clean, odor-free and free from tripping hazards. Nurses/wellness office was observed in Oak and Maple neighborhood. Medications were observed to be locked and inaccessible to residents. Chemicals and sharps were locked and inaccessible from residents. Water temperature throughout the facility measured between 105-117 degrees F. Communal bathrooms were observed to be clean and odor-free. Kitchen was observed two day perishables and seven day non-perishables. A comfortable temperature is maintained and lighting is sufficient for comfort. Fire extinguishers were serviced in 10/2025. Emergency drills are logged and done every three months. LPA reviewed 5 resident files and 5 staff files. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No citations are issued during the visit. Report is reviewed with Director of Health Services and a copy is provided.

On December 29, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case-management visit to follow up on an incident that occurred on 12/3/25. LPA met with Director of Health Services, Amyda Astrero and explained the purpose of the visit. The Licensee reported on 12/3/25, Staff 1 (S1) was assisting Resident 1 (R1) with care when R1 suddenly became agitated and aggressive towards S1. Resident 2 (R2) entered the room and observed R1 being aggressive towards S1. R2 kicked R1's leg and R1 slapped R2's leg. Both residents were immediately separated, assessed for injuries and were placed on behavior mapping. During the visit, LPA observed R1 and R2, discussed the incident with Director of Health Services and Assistant Director of Health Services, and reviewed both residents' files. Based on R1 and R2's file reviewed, both residents have a dementia diagnosis. Based on R1's file reviewed, R1 has a behavior of aggression/agitation and it's towards staff during care. Based on R2's file, he/she had a history of aggressive behavior, however it has improved. During the visit, LPA observed R1 walking around the community and R2 in the dining hall. According to the Director of Health Services and Assistant Director of Health Services, R2 hit R1 because he/she was trying to protect S1 from R1's aggressive behaviors. No residents had injuries noted. No citations are issued during the visit. Report is reviewed with Director of Health Services and a copy is provided.

On October 8, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit in relation to an incident that occurred on 9/26/25. LPA met with Administrator, Robert Snee and explained the purpose of the visit. On 9/26/25, the Licensee reported Resident 1 (R1) was standing in the dining room when Resident 2 (R2) came up to R1 and leaned his/her head over R1's shoulder. It was observed that R1 punched R2 on the left side of his/her face. Both residents were immediately separated. According to R1, R2 punched him/her first. During the investigation, LPA reviewed R1 and R2's file, observed both residents, and reviewed care plans. Based on both resident's files, R1 and R2 have a diagnosis of dementia. Based on records reviewed, this is the second altercation incident between R1 and R2. According to staff interviewed, verbal training was conducted to ensure both residents are seated separately/ are separated at all times. R2 was seen by his/her physician and there was a medication adjustment. LPA observed both R2 walking around in the courtyard and R1 was observed participating in activities. No citations are issued during the visit. Report is reviewed with Administrator and a copy is provided.

On September 16, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit to follow up on an incident that occurred on 8/26/25. LPA met with Administrator, Robert Snee and explained the purpose of the visit. On 8/26/25, the Licensee reported at approximately 2:30pm, it was found that Resident 1 (R1) left the community was was observed by a caregiver driving to the facility, that R1 was walking on the sidewalk heading towards Notre Dame School. The caregiver immediately parked, approached R1 and brought R1 back to the community. No injuries were noted. Upon investigation, it was noted that the gate failed to lock. During the visit, LPA reviewed R1's file and toured the facility to observe that locks at the facility. Based on R1's file reviewed, R1 has a diagnosis of dementia. R1 has no history of elopements, however does have wandering behaviors. According to administrator and staff interviewed, the locks failed and the gate did not lock properly. Third party vendor, Lockworks Unlimited arrived the same day to fix the locks and checked all other exit gates to ensure the locks did not fail. During the visit, LPA toured the facility and observed all the exit. All gates were locked. According to the administrator, the gates were also re-keyed. No citations are issued during the visit. Report is reviewed with the administrator and a copy is provided.

On August 5, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit. LPA met with Administrator, Robert Snee and explained the purpose of the visit. The purpose of today's visit is to deliver an immediate exclusion letter to exclude Staff #1 (S1) from the facility. The letter was given to the Administrator, Robert Snee. This report is reviewed and discussed with the Administrator and a copy is provided.

Based on photos, facility wound care notes, home health wound care notes, and interviews conducted, R1 returned to the community on 3/7/25 with wounds on both heels. Home health wound nurse came into the facility for wound care 3x a week. On 4/11/25, R1 was admitted to hospice. Regarding the allegation, due to staff neglect, resident was dehydrated, according to the reporting party, R1 was admitted to the hospital on 2/19/25 for dehydration. During the investigation, LPA interviewed staff. According to staff interviewed, the facility was notified that R1 had a history of dehydration. Because the facility is not a skilled nursing facility, they don't log water intake, however since facility staff were aware of the history of dehydration, the facility staff ensured to monitor R1's water intake. Facility staff indicated that a water bottle was also purchased for R1 so that staff are aware how much water R1 is drinking a day. Based on interviews conducted, documents reviewed and information collected, the department has determined that although the above 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 above allegations are UNSUBSTANTIATED. Report is reviewed with the Director of Health Services and a copy is provided.

On July 31, 2025, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced case management visit in relation to an incident that occurred on July 8, 2025. LPA met with Director of Health Services (DHS), Amyda Astrero and explained the purpose of the visit. The Licensee reported, on 7/8/25, a med-tech reported to the DHS that Staff 1 (S1) reported on 7/6/25, Resident 1 (R1) refused to go out of his/her room because he/she was afraid of Staff 2 (S2). The med-tech spoke to R1 and R1 indicated that S2 is rough to R1 and pushed R1 against the wall. DHS conducted an investigation and asked R1 is he/she knew the staff and R1 stated S2's name and stated S2 threw him/her against the wall and left him/her in a bad position. No injuries were notes. S2 was suspended pending investigation. During the investigation, LPA reviewed R1's file, reviewed facility's investigation and attempted to interview S2 and R1. R1 was not interviewable during the visit as he/she was eating lunch. S2 was not working during the time of the visit. Based on R1's file reviewed, R1 has a diagnosis of dementia, however does not have any aggressive or violent behaviors. According to the DHS, this is the first time R1 accused a staff of being aggressive towards him/her. Based on the facility's investigation, the findings went unsubstantiated as no staff member from the PM shift on 7/6/25 witnessed the incident. DHS provided training documents for S2 and will complete an in-service training with all staff on 7/31/25. According to the DHS, S2 is back to work, however is in a different neighborhood from R1. No citations are issued during the visit. Report is reviewed with Director of Health Services and a copy is provided.

On June 4, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit. LPA met with Director of Health Services, Amyda Astrero and explained the purpose of the visit. The purpose of today's visit is to deliver an immediate exclusion letter to exclude an Staff 1 (S1) and Staff 2 (S2) from the facility. The letter was given to the Director of Health Services. This report is reviewed and discussed with the Director of Health Services and a copy is provided.

On May 27, 2025, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management in relation to an incident that occurred on 4/27/25. LPA met with Administrator, Robert Snee and explained the purpose of the visit. On 4/27/25, the Licensee reported, the facility's engagement assistant (S1) observed Resident 1's (R1's) 1:1 caregiver sitting outside the door holding the door knob preventing R1 from leaving the room. All required parties were notified. New medications were ordered and 1:1 caregiver was terminated. During the visit today, LPA interviewed staff and reviewed R1's file. Based on file reviewed, R1 has a diagnosis of advanced dementia and a previous history of aggressive behavior, however was on medication to stabilize his/her aggressive behaviors. R1's behavior stabilized so the physician stopped the medication, however R1 started having aggressive behaviors. According to staff interviewed, the 1:1 caregiver was through a third party vendor/agency the facility uses, however the family contracted with the vendor/agency directly. The Director of Health Services indicated, when S1 witnessed 1:1 caregiver sitting outside holding R1's door knob preventing R1 from leaving his/her room, S1 immediately let R1 out of the room and walked him/her around outside. 1:1 caregiver is no longer allowed to come back to the facility and another 1:1 caregiver was hired to assist R1. R1 has a weekly psychiatrist appointments and medication management has been implemented. No citations are issued during the visit. Report is reviewed with the administrator and a copy is provided.

S2 who was on the AM shift admitted that he/she should have called 911 immediately after resident had a fall and complained of pain, however indicated because resident was not in severe pain, S2 did not call 911. S1 who was on shift during the PM shift, indicated he/she was not sure why the facility did not send R1 to the hospital after the fall in the morning. The facility did not send R1 out to the hospital till about 5:30pm when R1 started moaning, complaining of pain, and couldn't move his/her legs. Based on medical records reviewed, due to the fall, R1 sustained a left hip fracture. Based on the investigation, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Failure to correct said deficiencies may result in additional civil penalties. AN IMMEDIATE CIVIL PENALTY OF $500.00 WAS ASSESSED TODAY: $500 FOR THE VIOLATION AS STAFF DID NOT SEEK MEDICAL ATTENTION FOR A RESIDENT. THE ADMINISTRATOR WAS INFORMED THAT AN ADDITIONAL CIVIL PENALTY IS STILL BEING DETERMINED AND MIGHT BE ASSESSED BASED ON HEALTH AND SAFETY CODE §1569.49. 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 According to the administrator and the Director of Health Services, the facility's protocol is to have the shift nurse call responsible parties regarding incidents that occur before they leave their shift. The facility did notify R1's responsible party based on interview conducted with S2, administrator and Director of Health Services. Based on care notes reviewed, it was observed that S2 did contact R1's responsible party. Based on the above information, the Department has found that this allegation to be UNFOUNDED, meaning that this allegation was false, could not have happened and/or is without a reasonable basis. Report is reviewed with the administrator and a copy is provided.

On December 3, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual visit. LPA met with Administrator, Robert Snee and explained the purpose of the visit. LPA toured facility and grounds including but not limited to, five resident neighborhoods; maple, cedar, bay, twin pines and oak, one main administrative office, library, and kitchen. No accessible bodies of water or fire safety hazards observed. LPA toured resident neighborhoods and observed a dining room in each neighborhood. Dining room and hallways were clean and free from any tripping hazards. Resident rooms were observed clean, odor-free, with all required furniture. Nurses station was observed in the Oak and Maple neighborhood. Medications were observed to be locked and inaccessible to residents. First aid kits were observed to be present and complete. Toxins and chemicals were locked and stored away in a storage room. Water temperature throughout the facility measured between 105-115 degrees F. Communal bathrooms were observed to be clean and odor-free. Kitchen was observed two day perishables and seven day non-perishables. Lighting and temperature throughout the facility was sufficient for comfort. Fire extinguishers were mounted and serviced in 10/2024. Emergency drills are logged and done every three months. LPA reviewed 5 resident files and 5 staff files. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. Report is reviewed with Administrator and a copy is provided.

On March 15, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that was reported to CCL. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit. The Licensee reported on March 11, 2024 at approximately 12:05pm, Resident 1 (R1) was found by Resident Care Coordinator outside near the community parking lot in a wooded area. R1 was escorted back into the community and was assessed by the nurse. Based on facility's internal investigation, perimeter gates were all closed, locked and in working order; no evidence of equipment or rocks were visible to indicate gate was propped open. There were no signs of equipment or furniture to indicate that R1 could've climbed the gates. Facility initiated behavior mapping for R1 and conducted rounds to ensure all gates were locked and secure. In addition, on the same day, March 11, 2024 at approximately 6:25pm, while conducted rounds, staff reported that R1 was not in the dining room. Staff immediately started searching for R1. Med-tech found R1 walking around on the other side of the gates near the Bay neighborhood, close to a picnic area. R1 was redirected back into the community, assessment was done by nurse, and a one on one caregiver was assigned to R1. Community perimeters were checked again, all gates were observed locked. Locksworth Unlimited inspected the gates. During the visit, LPA reviewed R1's file, observed R1 eating lunch. R1 is currently residing in Twin Pines neighborhood where there is more staff present. Based on R1's file, R1 has a diagnosis of Alzheimer's Dementia and is unable to leave the facility unassisted. Behavior mapping log was observed. Facility conducted 30-minute status checks after the first incident occurred at 12:05pm. According to Administrator and Director of Health Services, R1 does not have a history of AWOL, however R1's responsible party takes R1 out of the community for several days at a time which; recent outing was hiking from 3/5/2024 - 3/10/2024. Updated service plan was observed. No citations issued during the visit. Report is reviewed with Administrator and a copy is provided.

On February 16, 2024, Licensing Program Analyst (LPA) Komal Charitra met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero for a Case Management visit to follow up on a substantiated complaint allegation of neglect and lack of supervision resulting in serious bodily injuries. On October 10, 2019, the Department concluded a complaint investigation which alleged that the facility did not provide proper care and supervision which resulted in a resident (R1) sustaining multiple falls including a serious bodily injury. The allegation was substantiated, and the licensee was cited for violating California Code of Regulations (CCR) Title 22, § 87464(f) Basic Services. The investigation revealed the facility failed to do an accurate fall risk assessment after R1 experienced multiple fall incidents at the facility on June 17, 2018, July 15, 2018, October 11, 2018, October 17, 2018, and December 19, 2018. As a result, the facility failed to identify and implement measures and or plan of care changes to minimize further fall incidents for R1. Based on documentation reviewed, according to the facility’s assessment, it was not identified that R1 was a high risk for falls. On March 1, 2019, R1 had another unwitnessed fall and was hospitalized. Based on the investigation, it was revealed that there are three small buildings on this property. There were no caregivers present in R1’s building before or at the time R1 fell. Two caregivers were in another building and a licensed vocational nurse (LVN) was in a med room, but the LVN was not answering their phone. As a result of the improper risk assessment and facility’s failure to identify and implement a proper plan of care to address R1’s fall risk; R1 sustained a right intertrochanteric femur fracture and needed to undergo an operation called femur intramedullary rodding. (Continue to 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 In addition, based on the documents and information collected, the investigation revealed that the facility was aware of R1’s multiple falls, but continued to provide care based on inaccurate fall risk assessments, outdated plan of care, and did not notify the Primary Care Physician (PCP) of the changes until R1’s fall on March 1, 2019. There was no facility report or documentation available for review to indicate facility staff or the administrator had notified the PCP about R1’s fall history or a plan of care necessary to minimize R1’s risk for falls. At the time of the complaint visit on October 10, 2019, an immediate civil penalty of $500 was issued and the licensee was informed that an additional civil penalty was being determined and might be assessed based on Health and Safety Code § 1569.49. The Department has concluded an analysis and has determined that an additional civil penalty is warranted for a violation that resulted in R1 sustaining serious bodily injuries while under the care of this facility. Welfare and Institutions Code § 15610.67, defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility failing to provide the proper care and supervision to R1, knowing that R1 was a fall risk, resulting in R1 falling and sustaining a right intertrochanteric femur fracture, which is serious bodily injury. Today, February 16, 2024, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49 for a violation that the Department constitutes as a serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on October 10, 2019, the amount of the civil penalty issued today will be $9500. A copy of the LIC 421D was given to Administrator, Robert Snee and originals were signed. Exit interview conducted. A copy of the report issued. Appeal rights provided. Administrator, Robert Snee signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.

On January 31, 2024, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual inspection. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit. LPA toured facility and grounds including but not limited to, five resident neighborhoods; maple, cedar, bay, twin pines and oak, one main administrative office, library, and kitchen. No accessible bodies of water or fire safety hazards observed. LPA toured resident neighborhoods and observed a dining room in each neighborhood. Dining room and hallways were clean and clear for hazards. Resident rooms observed had all required furniture and were observed to be clean. Nurses station was observed in the Oak and Maple neighborhood. Medications were observed to be locked. First aid kits were observed to be present and complete. Three laundry rooms and one main laundry room was observed to be locked. Toxins and chemicals were locked and stored away in a storage room. Water temperature throughout the facility measured between 112-118.9 degrees F. Six communal bathrooms were observed to be clean and odor-free. Kitchen was observed to be clean. Kitchen was observed two day perishables and seven day non-perishables. Lighting throughout the facility was sufficient for comfort. A comfortable temperature of 71 degrees F is maintained. Fire extinguishers were mounted and serviced in 10/2023. Emergency drills are logged and done every three months. LPA reviewed 5 resident records and 5 staff records. Resident records are updated, complete and signed. Staff records are complete, with training logs that have met the basic requirement. Medication review was done, and all medications are accounted for, and centrally stored medication records are updated. No citations are observed during the visit. Report is reviewed with the Administrator and Director of Health Services and a copy is provided.

On December 6, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit to follow up on two incidents that was reported to CCLD. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit. The Licensee reported on 11/7/2023, Resident 1 (R1) was observed holding Resident's 2 (R2's) hand. It was observed by a caregiver that R1 reached over and touched R2's breasts. Caregiver immediately separated R1 and R2. R1 was placed on 30-minute checks, facility called responsible party to request a one-on-one caregiver, and facility called R1's physician to review R1's medications. The Licensee reported on 11/8/2023 around 4:30pm, R1 observed walking by R2 and gilded his/her hang over Resident 3's (R3's) breast area. Caregiver separated both residents at the time. One one one caregiver for R1 was provided at 6:30pm on 11/8/23, physician adjusted R1's medication, behavior mapping is on-going. During the visit, LPA reviewed R1's file, observed R1 and discussed the incidents with Administrator and Director of Health Services. Based on R1's record review, R1 has a diagnosis of Alzheimer's Dementia and does not have any inappropriate or aggressive behaviors. Based on observations, R1 was in the dining room with R1's one-on-one caregiver. According to the administrator and director of health services, R1 has not had any inappropriate incidents since the one-on-one caregiver was assigned and facility will continue to monitor R1. Director of Health Services will set up a meeting with R1's physician and responsible party and conduct a re-assessment for R1. No deficiencies are cited today. Report is reviewed with Administrator and Director of Health Services and a copy is provided.

On September 29, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit. LPA met with Administrator, Robert Snee, Director of Health of Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. The purpose of today's visit is to deliver an immediate exclusion letter to exclude an employee of the facility. The letter was given to the Administrator. This report is reviewed and discussed with the Licensee and a copy is provided.

On September 7, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit at the facility to follow up on an incident that was reported on 8/28/2023. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit. The Licensee reported on 8/25/2023, Staff #1 (S1) reported to Administrator that he/she observed Staff 2 (S2) throw a cup of tea on Resident 1 (R1). In addition, S1 reported that he/she observed S2 on 7/25/2023 make contact with S2's hand to Resident 3 (R3). During the visit, LPA discussed incidents with the administrator and director of health services. According to the interviewed staff, there were not witnesses for the two incidents being reported by S1. S2 was immediately suspended on 8/25/2023 and later terminated on 8/30/2023. Belmont Police, Ombudsman and all required parties were notified. Administrator to send facility's internal investigation records to LPA by 9/8/2023. No deficiencies are cited during visit. LPA to conduct a follow up visit if required. Report is reviewed with Director of Health Services and a copy is provided.

On August 18, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case-management visit to follow up on an incident that was reported to CCLD on 8/17/2023. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit. The Licensee reported on 8/10/2023, Resident 1 (R1) was bitten by a dog. Blood was noted on right middle finger, however R1 denied pain. During the visit, LPA interviewed the administrator, requested copies of the dog's vaccination records, reviewed facility policies and procedures regarding pets, observed blank facility admission agreement and reviewed a copy of resident handbook regarding pets at the facility. According to the administrator and director of health services, there were no prior biting incidents at the facility with this specific dog. The dog was returned back to the adoption center after the incident. LPA reviewed resident handbook and policies and procedures regarding pets at the community. Based on the resident handbook reviewed, it indicated that the community has pets to promote resident's quality of life. In addition, the facility handbook also indicates that residents are welcome to bring their pets as well. Furthermore, LPA reviewed the dog's vaccination record and all shots are up to date. No deficiencies cited during the visit. Report is reviewed with Director of Health Services and Administrator and a copy is provided.

On August 2, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that was reported to CCL on 7/20/2023. LPA met with Administrator, Robert Snee and Director of Health Services, Amyda Astrero and explained the purpose of the visit. The Licensee reporting on 7/18/2023, a staff member (S1) reported 3 separate incidents that occurred between Staff 2 (S2) and 3 different residents. During the visit, LPA collected documentation. No citations are issued at this time. Report is reviewed with administrator and a copy is provided.

On May 3, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that occurred on April 22, 2023. LPA met with Administrator, Robert Snee, Director of Health Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. On May 1, 2023, the Licensee reported that a caregiver heard R1 shouting for help while being in the Maple dining room. According to the Licensee, the caregiver found R2 sitting on R1 with one hand on R1's chest and the other hand between R1's legs. During the visit, LPA discussed the incident with Administrator, Director of Health Services, and Assistant Directors of Health Services and reviewed resident files. According to the Administrator, this incident occurred after dinner when caregivers were assisting put residents to bed. The Director of Health Services indicated that the caregiver immediately responded to R1 as his/her room is near the Maple dining room. Based on R1 and R2's file, both residents have a diagnosis of dementia. According to the Director of Health Services and file reviewed, R2 does not have a history of touching residents, however he/she does have a wandering behavior where he/she wanders in the hallways or other residents rooms. During the visit today, LPA observed a one on one caregiver with R2. In addition, R2's medication dosage was increased. Furthermore, Administrator indicated that R2's room was changed to the Cedar building. No citations issued during this time. Report is reviewed with Robert Snee, Amyda Astrero, and Hazel Yabut and a copy is provided.

On February 3, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced visit and met with the Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. The purpose of today's visit is to deliver an immediate exclusion letter to exclude an employee of the facility. The letter was given to the Assistant Director of Health Services. This report is reviewed and discussed with Assistant Director of Health Services. A copy is provided.

On January 27, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced annual infection control inspection. LPA observed the COVID-19 signage posted on the door of the front lobby. LPA was screened at entry point and observed the visitor screening log documentation. LPA met with Director of Health Services (DHS), Amyda Astrero and Administrator, Robert Snee joined shortly thereafter. Administrator was able to provide screening log documentation for staff and residents to LPA. This facility is a locked memory care facility and the central entry point is the front lobby. LPA toured the facility and grounds. No accessible bodies of water or fire safety hazards observed. The facility has a total of four different buildings (Twin Pine, Oak, Bay, Cedar/Maple) for residents based on the level of care required. LPA toured the facility with Administrator and DHS and observed the library room. 30-day PPE supply was located in a closet in the library. All communal bathrooms throughout the facility was observed to be equipped with liquid soap, paper-towels, hand washing signs, and a trash can with a fitted lid. LPA toured all four buildings at the facility and observed it to be clean, odorless and free from any tripping hazards. A comfortable temperature of 70-73 degrees F is maintained and lighting is sufficient for comfort. There are a total of four dining rooms at the facility for residents; no toxins, chemicals, or sharps were observed present. LPA observed resident activities calendar posted in the hallways of the resident buildings. LPA observed two Wellness Centers located at the facility. Wellness Centers had medication locked and stored appropriately and inaccessible to residents. LPA observed the first aid kits in the wellness center to be present and completed. COVID signage was observed to be posted throughout the facility. During the visit, LPA observed staff wearing face masks. LPA observed 4 locked laundry rooms. Toxins and chemicals were observed to be locked and inaccessible to residents. LPA observed additional toxins and chemicals locked outside in the housekeeping storage room. LPA toured and observed the kitchen to be clean and observed 2 day perishable and 7 day non-perishable. There is a locked gate separating the kitchen and the housekeeping storage room from resident buildings. Infection control practices are observed: COVID signage posted throughout the facility, entry procedures, daily monitoring log for staff, residents and visitors, 30-day PPE supply, face coverings for staff, containment strategies, staff training and policies. No citations issued during the visit. Report is reviewed with Director of Health Services and a copy is provided.

On October 10, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that was reported to CCLD on October 3, 2022. LPA met with Director of Health Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. The Licensee reported on September 25, 2022, Resident #1 (R1) and Resident #2 (R2) were found in R2's room. It was indicated R2 was agitated and screaming because R1 touched him/her. According to the Director of Health Services, R1 did not have a one on one caregiver assigned at this time. During the visit, LPA reviewed R1's file and interviewed staff. According to the file reviewed, R1 has a diagnosis of dementia. In addition, R1 has had a prior incident where R1 was found naked in another resident's bed. According to the interviewed staff, R1 has a new Geriatric doctor in which the facility has been in communication with daily, and R1's medications have been adjusted. In addition, Director of Health Services and Assistant Director of Health Services, indicated R1 has an one on one caregiver assigned around the clock and has notified all required parties. The facility had a care team meeting to discuss R1's behaviors and future care plans and has been in touch with R1's responsible party on a daily basis. No citations issued during the visit. LPA reviewed report with Director of Health Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and a copy is provided.

On September 23, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on incidents that were reported to CCLD. LPA met with Director of Health Services, Amyda Astrero and Assistant Director of Health Services, Hazel Yabut and explained the purpose of the visit. The Licensee reported on 9/7/22, Resident #1 (R1) and Resident #2 (R2) were heard yelling. Staff separated the resident and spoke to the residents. According to R1, he/she was hit on the left side of the chest by R2 and according to R2, R1 hit him/her on the arm. During the visit, LPA observed residents files and observed the residents. R1 was observed to be sleeping and R2 was observed to be eating lunch. Based on file reviewed, R1 and R2 has a diagnosis of Dementia. In addition, LPA reviewed R1's and R2's service plan and it indicated that facility is conducting behavior mapping and are keeping both residents apart from each other. The Licensee reported on 9/9/22, Resident #3 (R3's) one on one caregiver reported that R3 hit R2. According to the Licensee, it was indicated that the R3 said something to R2, however R2 did not acknowledge resulting to R3 throwing juice on R2 and punching him/her on the left side of the chest. According to the Director of Health Services, R3's one on one caregiver was also punched by R3. During the visit, LPA observed R3 having lunch and observed a male one on one caregiver present. Based on file reviewed, R3 has a diagnosis of dementia and has been assigned a one on one caregiver since admission based on physician and responsible party due to agitation and wandering behavior. LPA reviewed the needs and service plan for R3 and it indicates that physician adjusted his/her medication and behavior mapping is being conducted. In addition, the facility will ensure that there is a male one on one caregiver assigned to R3 at all times. On 9/11/22, the Licensee reported an unwitnessed incident that Resident #4 (R4) was pulling down his/her pants to urinate. Resident #5 (R5) yelled at R4 resulting to R4 becoming agitated and slapping R5 in the face. During the visit, LPA observed both residents to be eating lunch. Based on file reviewed, both residents have a diagnosis of dementia. According to the Director of Health Services, R4 had a medication adjustment and a urine analysis was done. Behavior mapping is being conducted for both R4 and R5. Report is reviewed with Director of Health Services and Assistant Director of Health Services and a copy is provided. No citations issued during the visit.

On September 12, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that was reported to CCLD on September 9, 2022. LPA met with Assistant Director of Health Services, Hazel Yabut and Administrator, Robert Snee. Director of Health Services, Amyda Astrero joined shortly thereafter. LPA explained the purpose of the visit. The Licensee reported on September 7, 2022, Resident #1 (R1) was observed to have jumped over the facility fence near the activity office using a planter. Staff assisted R1 up, however R1 attempted to run after his wife who had just visited. Staff redirected R1 back to the facility. No injuries were noted. During the visit, LPA observed R1 walking outside with his assigned one on one caregiver. LPA reviewed R1's files and interviewed staff. File reviewed indicates that R1 is a newly admitted resident that has a diagnosis of Parkinson's Dementia and is unable to leave the facility unassisted. According to the Director of Health Services, Amyda Astrero and Assistant Director of Health Services, the facility notified R1's responsible party and R1's physician as required. R1's physician adjusted R1's medications and a one on one caregiver was assigned. Behavior mapping is still being conducted on resident. No citations were issued during today's visit. LPA reviewed report with Director of Health Services and Assistant Director or Health Services and a copy is provided.

On July 18, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on an incident that occurred on July 11, 2022. LPA met with Staffing Coordinator, Maria Miller and Director or Resident and Family Services, Kate Rickard joined shortly thereafter. LPA explained the purpose of the visit. The Licensee reported on July 11, 2022, Resident #1 (R1) was observed by a caregiver (S1) climbing over the facility gate. S1 immediately ran towards R1 and called for help. R1 was already on the other side of the gate by the time S1 got to the gate. R1 was observed outside the community, walking up the hill to the twin pine park. Staff members followed R1 and tried redirecting him/her to the facility, however R1 refused. Medications were administered to R1 and R1 became cooperative and returned back to the community. During the visit, LPA reviewed R1's files and interviewed staff. Files reviewed indicated that R1 has a diagnosis of Alzheimer's Dementia and is unable to leave the facility unassisted. According to the staff interviewed, R1 is a newly admitted resident and has a history of elopement from previous facility. According to R1's file, R1 eloped from a facility by climbing a 10ft wall. The facility notified responsible party and R1's physician. R1's physician adjusted R1's medications and a one on one caregiver was assigned. Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. Report is reviewed with Staffing Coordinator, Maria Miller and Director or Resident and Family Services, Kate Rickard and a copy is provided with appeals rights.

On June 16, 2022, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on incidents that were reported to CCLD. LPA met with Assistant Director of Health Services, Hazel Yabut, and explained the purpose of the visit. The Licensee reported that resident (R1) had three separate incidents; one on 5/27/22 and two on May 30, 2022. On 5/27/22, it was reported that R1 hit an agency caregiver (S1) in the face, causing both R1 and S1 to fall to the floor. In addition, it was indicated that during this incident, a second caregiver (S2) present was knocked to the floor after attempting to redirect R1. On May 30, 2022, it was reported that R1 touched a caregiver (S3) while giving R1 a shower in the morning. Later in the day, it was reported that R1 touched another resident (R2). During the case management, LPA interviewed staff and reviewed R1's file. According to the file reviewed and the interviews conducted, R1 is a newly admitted resident with a diagnosis of Dementia with behavioral disturbances. In addition, LPA reviewed R1's service plan and it indicates that R1's medications were adjusted, facility implemented frequent checks and has assigned R1 with two caregivers to be present when providing care. On 5/26/22, the licensee reported a male resident (R3) walked into a female resident's room (R2); no injuries were reported. During the visit, LPA observed the residents and reviewed R3's file and interviewed staff. According to file reviewed, R3 has a diagnosis of dementia. Interviewed staff indicated that R3 does not have any prior history of unusual behavior. Based on R3's needs and services, the facility implemented frequent checks to prevent this incident from happening again. LPA reviewed this report with the Assistant Director of Health Services, Hazel Yabut; a copy is provided

On May 24, 2022, Licensing Program Analyst (LPA) conducted an unannounced case management visit. L PA met with interim Administrator, Robert Snee, and Director of Health Services, Glynis Marcantel joined shortly thereafter. LPA explained the purpose of the visit. The licensee reported on May 13, 2022, Resident (R1) was observed by the front receptionist to be walking toward the main office. According to R1, it was indicated at first that he/she jumped over the fence, however R1 then stated he/she had walked through the gate. There were no injures noted. During the case management visit, LPA interviewed staff and reviewed R1's files. According to the file reviewed, it indicates that R1 has dementia and is unable to leave the facility unassisted. According to the staff interviewed, it was indicated that the latch on the gate may not have been latched all the way resulting to R1 walking out of the facility. Facility immediately conducted a head count of all residents and checked to ensure all the gates were locked. In addition, the facility had a locksmith company come and perform an inspection of all gates to ensure they were locked and latched properly, however, these precautions were conducted after R1 was able to leave the facility. Section 87411(a) Personnel Requirements, requires that facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary care and supervision to meet resident needs. In the above incident, there was an absence of supervision resulting in a resident leaving the facility. 87411(a) Personnel Requirements- $500 CIVIL PENALTY ASSESSED FOR REPEAT VIOLATION WITHIN 12 MONTHS on 2/24/2022. Deficiency of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 is observed and cited on a following page. Report is reviewed with Robert Snee, and Glynis Marcantel and a copy will be provided with appeals rights.

In addition, the facility is required to send Licensing a written report within seven days of the occurrence of any of the events indicated in Title 22 Regulation 87211(a)(1), (A) through (D). During the investigation, LPA was not given any proof of the facility reporting the incident between R1 and the private caregiver as required. Nevertheless, the facility failed to notify Licensing with 24 hours of the elder abuse and failed to provide Licensing a written report of the incident within 7 days. Based on the information collected, it was determined that the facility failed to report to Licensing as required. The preponderance of evidence standard has been met; therefore, the above allegation is determined to be Substantiated. Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC 9099D. Failure to correct the deficiencies may result in civil penalties. Report was reviewed with Director of Health Services, Glynis Marcantel and a copy is provided with appeals right.

On November 15, 2021, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced Case Management visit regarding an Incident Report that was received on November 10, 2021. LPA was greeted by the Administrator, Joan Newman and the Director of Health Services, Glynis Marcantel joined shortly thereafter. LPA Charitra explained the purpose of the visit During today's inspection LPA observed the residents. Residents were observed to be in the dining room together at this time. LPA interviewed staff and reviewed resident documents and the admission agreement. According to the admission agreement, the residents are able to remain independent, roam around the facility and actively engage in the community alone. According to the Incident Report, Resident 1 (R1) was observed to be kicking Resident 2 (R2). Residents have a diagnosis of Dementia with Behavioral Disturbances and were left alone in the dining room when the incident occurred. Based on the Administrator and the Director of Health Services, this was a one time altercation between the residents, no prior history of physical abuse. The facility does not provide one on one care to the residents unless stated otherwise. LPA reviewed the Needs and Service Plan for both R1 and R2 and it states residents do not require hands on assistance. Facility informed Ombudsman, Licensing, Physicians, and the resident's Responsible Party regarding this Incident. No deficiencies were issued. Report was reviewed with Administrator

On this day at 1100hrs, Licensing Program Analysts (LPA) Jaime Vado and Komal Charitra conducted an unannounced prelicensing inspection visit. LPAs met with diector of health services Glynis Marcantel and director of plant operations Gary and explained the purpose of today's inspection. LPAs toured the facility's buildings and grounds. Entire facility has hardwired smoke detectors and fire panel. Fire panel last inspected on 11/01/2021 and sprinklers last inspected on 11/02/2021 of which both are in full service. Facility does contain an emergency generator that will power facility for 72 hours. LPAs toured resident buildings. Twin Pines building is inspected. Room 507 was observed and water was tested at 116F. Room is fully furnished with appropriate lighting and furniture. Room is equipped with push button call system. Shower is clean and contains non-skid mat and grab bars. Fire extinguisher in dining room last inspected on 10/2021 and is charged ready for use. Carbon monoxide detector is present. Oak building is inspected. Room 405 and 411 were observed. Water was tested at 117F. Room is fully furnished with appropriate lighting and furniture. Room is equipped with push button call system. Shower is clean and contains non-skid mat and grab bars. Carbon monoxide detector is present. Maple building is inspected. Room 307 was observed and water was tested at 108F. Room is fully furnished with appropriate lighting and furniture. Room is equipped with push button call system. Shower is clean and contains non-skid mat and grab bars. Fire extinguisher in hall was last inspected on 10/2021. This building also contains resident incontinence supplies and some COVID related PPE. Carbon monoxide detector is present. Cedar building is inspected. Room 212 was observed and water was tested at 115F. Room is fully furnished with appropriate lighting and furniture. Room is equipped with push button call system. Shower is clean and contains non-skid mat and grab bars. Carbon monoxide detector is present. Additional COVID related PPE are located in a shed in the exterior area of the facility and in a closet in the library. Kitchen is inspected as well as fresh, frozen foods, and emergency food supplies. All food supplies are in place. Kitchen hood is due for cleaning and service on November 2021 but facility already has this scheduled to be conducted. Kitchen cooking range is due for cleaning as well as it was observed needing service. Cooking range and oven are operating. Facility has two wellness rooms which house the resident medications. These are observed and medications are properly stored and locked inaccessible to residents. Each resident building is equipped with a dining room and supplies are stored in refrigerators for resident use as well as juice and dining supplies. Sharps are not stored in these dining rooms. Facility is in compliance with Title 22 regulations. No citations are issued. Report is reviewed with Glenis.