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On 01/29/2026 at 9:40 AM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported AWOL incident that occurred on 01/09/2026. LPA met with Executive Director (ED), Angeles Sticka, and explained the purpose of the visit. On 01/20/2026, LPA P. Manalo received an incident report that indicated that on 01/09/2026, R1 AWOL’D from the facility. Incident report revealed that facility staff seen R1 down the street. Facility staff conducted a search around the neighborhood for R1 and found R1 at bank nearby. Per incident report, R1 did not sustain any injuries. During the visit, LPA interviewed ED and R1. ED stated that R1 went to the bank so that R1 can pay for R1's rent to the facility. ED stated that a fax report was sent to the physician to follow up on R1's diagnosis. LPA reviewed and obtained documents including but not limited to resident roster, incident report, physician report, resident assessments, physician fax report, resident information form, and a copy of the check's invoice that R1 made to the facility. Physician report dated 11/23/2025 indicated that R1 has intermittent confusion and is not able to leave the facility unsupervised. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiency within a 12-month period may result in civil penalty. Exit interview conducted. Appeal Rights, LIC421FC, and a copy of this report provided.

On 11/05/2025 at 1:00 PM , Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding an incident reported to Community Care Licensing Division (CCLD) on 10/22/2025 . Upon arrival, LPA met with Executive Director (ED) Angeles Sticka and explained the purpose of the visit. LPA obtained the following documents: Resident Roster, Resident Information Sheet, medical assessment dated (07/02/2025), Memory Care Staff schedule (week 10/12/25), In-Service "Elopement Drill" training staff sign-in sheet (dated 10/18/25 and 10/22/25), and Individualized Service Plan (dated 10/28/25). LPA interviewed Staff (S1) who stated that on 10/17/2025 , Resident (R1) eloped from the Memory Care (MC) unit. S1 reported that MC staff on duty did not observe R1 leaving the secured unit. According to S1, R1’s granddaughter was the individual who discovered that R1 was missing from their apartment and could not be located within the MC unit. S1 stated that staff immediately initiated the facility’s elopement protocol , which includes: conducting a search of the MC unit and resident apartments. Checking the Assisted Living (AL) apartments, common areas, and the remainder of the building. Conducting an external neighborhood search. Contacting 911 if the resident cannot be located. LIC809-C Continued... 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 LIC809-C (Page 2) S1 reported that staff contacted the Berkeley Police Department, and shortly thereafter, the facility received a call from Agrodolce Osteria, a local restaurant located on Shattuck Avenue, informing staff that R1 was at their establishment. R1’s daughter retrieved R1 from the restaurant and returned them safely to the facility. S1 further stated that R1 has eloped twice to date, with the 10/17/2025 incident being the most recent occurrence. In response, the facility implemented door alarms on all emergency exits and conducted in-service training with MC staff on 10/18/2025 and 10/22/2025 regarding elopement procedures and resident supervision. S1 also indicated that a 1:1 companion was arranged for R1 for five days following the incident; however, the family declined to continue the service due to the cost. S1 added that R1 was later observed walking on Milvia Street, but staff are still unsure how R1 managed to exit the MC unit and the building. LPA reviewed R1’s Medical Assessment (MA), which indicated that R1 was able to leave the community unsupervised. LPA discussed this MA with S1, who confirmed that the response on the assessment was not accurate and did not reflect R1’s current condition or supervision needs. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided

On 05/05/2025 around 03:00 PM, Licensing Program Analysts (LPA) L. Holmes conducted a Component III for a Pre-licensing inspection on 05/05/25. LPA was greeted and met with Angeles Sticka, Executive Director (ED) and Andrew Moret, VP of Operations. LPA discussed the importance of attending the informational calls, understanding the updated guidelines and printing the provider information notices (PINS) for residents, infection control, and continuous communication with authorized representatives and staff so that the facility maintains awareness and updates for compliancy for the State of California Title 22 regulation, and Health and Safety Codes. -Component III completed. Exit interview conducted and a copy of this report provided to Angeles Sticka, Executive Director (ED).

On 05/12/2025 around 10:00 AM, Licensing Program Analysts (LPA) L. Holmes arrived announced to conduct for a return visit to complete a Pre-licensing Inspection on 05/05/25. Upon arrival, LPA was greeted and met with Angeles Sticka, Executive Director (ED) The facility is approved for a capacity of 138; 134 may be non-ambulatory and 4 bedridden. LPA toured the perimeter of the facility and checked Guardian for personnel association. CORRECTION: -All staff, in addition to corporate members, need to be associated to the facility prior to working at the facility LPA observed that the facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility's license remaining pending and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided to Angeles Sticka, Executive Director.