Atria el Camino Gardens.

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Executive Director (ED), Dana Stansel, to conduct a case management visit in relation to a separate inspection conducted on today’s date, November 4, 2025. LPA reviewed resident (R1's) documentation. The facility provided R1's progress notes indicating that R1 was sent to the hospital on January 14, 2025, due to increased confusion and hallucinations. R1 was reassessed by the facility on January 22, 2025, which indicated that R1 required assistance three (3) times per day for orientation "mild/moderate impairment of memory, disorientation, and may display anxiety with memory difficulties. May be perceived as oriented, but memory deficits seen over time. Requires some prompting and encouragement 1 to 3 times per day". R1's previous assessment conducted on March 28, 2024 did not indicate that resident required assistance. R1's Physician's Report LIC602A dated January 6, 2022 indicated that R1 had mild cognitive impairment and did not exhibit confusion/disorientation. R1's Physician's Report LIC602A dated January 21, 2025 indicated that R1 had a primary diagnosis of Dementia and exhibits confusion/disorientation. Interview with ED indicated that R1 required additional care due to progression of Dementia diagnosis. The facility implemented additional care for R1. According to R1's Identification and Emergency Information LIC601, R1 is their own responsible party for financial affairs, payment for care, and their own legal guardian. R1's LIC601 also included family members to notify in an emergency. Email correspondence indicated that the facility was aware that R1's family member was attempting to gain Durable Power of Attorney (DPOA) in order to assist R1. According to invoices provided by the facility, R1 was on an automatic payment plan. The automatic payment did not go ************************************************Continued on LIC809-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 through on February 5, 2025 and was returned on February 8, 2025. R1's automatic payments continued to be returned until April 10, 2025. Due to non-payment, the facility began the 30-day eviction process sending notification to R1 via certified mail on April 28, 2025. The facility did not provide LPA a signed certified mail proof of service for this date. An additional 30-day notice to pay or quit was sent to R1 via certified mail on May 7, 2025 and the certified mail received was signed by R1 on May 13, 2025. The facility filed an unlawful detainer complaint with the Superior Court of California County of Sacramento on July 22, 2025. According to Proof of Service of Summons, R1 was personally served a copy of the summons, complaint, civil case cover sheet, and plaintiff's mandatory cover sheet and supplemental allegations unlawful detainer on July 24, 2025. The Proof of Service of Summons indicated that R1 was served at their home as "a competent member of the household (at least 18 years of age) at the dwelling house or usual place of abode of the party. I informed him or her of the general nature of the papers". R1 has a Dementia diagnosis as of the LIC692A dated January 21, 2025 with confusion/disorientation and also had a family member in the process of obtaining DPOA status who was not sent the 30-day notice or unlawful detainer complaint documentation. Interview with R1 indicated that they do not check their mail frequently and that they have been receiving documents that they do not understand. R1 indicated that they received documents saying they owe something. R1 believed it was for furniture purchased in the 1970s when their spouse was living and expressed they were afraid they could go to jail. R1 indicated that they have not purchased any furniture recently and that their spouse has passed away. Observation of R1 indicated that they were exhibiting confusion. The facility provided LPA with all court documentation pertaining to the unlawful detainer complaint and there were no indication that the court was notified of R1's current primary diagnosis. R1's progress notes indicated that they were sent to the hospital on September 19, 2025 due to increased confusion and strong urine odor. Progress notes also indicated that on September 21, 2025 R1 was noted to have a urinary tract infection and prescription medication was ordered. Interview with ED indicated that the facility had a meeting regarding over reporting and indicated that this incident was not reported to CCLD. CCLD does not have record of the September 19, 2025 incident. LPA had a conversation with ED regarding reporting requirements and ED agreed that the facility will begin reporting all hospitalization incidents to CCLD. As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are listed on 809-D pages. Exit interview was conducted. A copy of this report and appeal rights were provided.

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced and met with the Executive Director, Dana Stansel, to conduct a Required-1 Year Inspection. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. LPA observed five (5) bedrooms in assisted living, two (2) bedrooms in memory care, and seven (7) common area bathrooms. LPA observed apartments to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. The hot water temperature was observed to be 112.7 degrees F in building A and memory care, 118.3 degrees F in building B, and 110.5 degrees F in building C. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke and carbon monoxide detectors are operational. Fire extinguishers and first aid kits are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed six (6) resident files and also reviewed six (6) staff files. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report provided.

9099C-1.. Allegation: Staff inappropriately handled resident resulting in resident sustaining fracture. The allegation states after resident (R1) vomited in the dining room, staff (S1) came to assist and grabbed (R1's) arm and yanked it and (R1) has had pain in their arm since this incident. (R1) requested to be sent to the hospital on 3/12/2025 due to experiencing weakness, pain in their right hand and a cold. Documentation reviewed shows (R1) was sent to the Emergency Room on 3/12/25 for the chief complaint of weakness and right hand pain. An x-ray revealed (R1) had a possible distal and radial ulnar fractures. Facility records, specifically the physician's report, showed that resident had a prior diagnosis of rheumatoid arthritis and osteoporosis. (R1) indicated they threw up in the dining room, but the Department was not provided with a specific date for this incident. The Administrator stated this incident occurred late January or early February 2025. (R1) stated that staff (S1) "responded to assist resident and grabbed their arm, ignoring resident's request to let go due to it causing them pain. (S1) denied grabbing or pulling on resident's arm, or physically abusing (R1) at any time,insisting she only "lightly touched" (R1's) hand. (S1) stated she was about to wipe resident's hand when (R1) told her to stop and she let go. The Administrator indicated (S1) went to get some wipes to assist (R1) and her touch was "very mild" when wiping (R1's) hand. Another resident (R2), witnessed the incident, and her statements corroborated with (S1's) statements. Additionally (R2) stated they did not feel (R1) was physically abused or mistreated. The Executive Director/Administrator confirmed that staff (S1) did not have any prior complaints from other residents or staff. The Administrator explained that resident (R1) also did not report the suspected physical abuse until a month had passed and it was reported following a separate incident between (S1) and (R1) where (R1) felt (S1) had offended them by a comment she made. It was unknown how or when (R1) sustained the injury. Based on information obtained, the allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. *cont on 9099C-2.. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 9099C -2... During the interview process of the investigation, the Department received the following additional information that is unrelated to the allegation in this report, as follows: Resident (R1) reported that staff, (S3) and (S4) were verbally abusive to them and staff (S4) grabbed their right arm. No other details provided. LPA interviewed staff (S3) and (S4) who stated that they would both assist (R1) with repositioning in their bed. Both staff stated that (R1) would sometimes refuse assistance and staff would not force (R1) since it's right to refuse. One staff stated they would let (R1) take their time and assist when they were ready for staff to help Both staff denied being verbally abusive to (R1) and said (R1) had moments where they "would be irritated" with staff and observed (R1) to be rude to many other staff. Both staff indicated they never grabbed (R1's) arm or saw any other staff do so. Based on information obtained, there was insufficient evidence to prove by a preponderance that this occurred. Resident, (R3), stated client (R4's) clothing and jewelry have been stolen. No details or dates of missing items were provided, but the incidents were allegedly reported to an unidentified facility staff but nothing has been done about it. (R3) indicated that (R4's) health has declined over the last 3 years and was not sure if this was related to the missing items. The Administrator stated on 8/21/25 that (R4) reported a missing shell sweater to her and that she found the missing item in (R4's) closet, which was stuffed, and took a picture and showed (R4). The Administrator was not aware of any other items belonging to (R4) that were reported missing. Staff (S3) stated that (R4) resides in a different building than where she or (S4) is assigned. The administrator confirmed the facility is following their theft and loss policy and logging items when they are reported missing. Based on information obtained, there was insufficient evidence to prove by a preponderance that this occurred.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection to follow up on a recent incident report (LIC624) submitted to the Department on March 23, 2025. LPA met with Administrator, Dana Stansel, and stated the reason for today's inspection. LPA and Administrator discussed the incident when resident (R1) was not found in their apartment at approximately 8:30 pm on March 22, 2025. Staff had been checking on resident frequently all afternoon due to them showing agitation following a visit from family. Staff immediately contacted the facility management and resident's responsible person when resident was not located inside the community. An exterior search was then conducted and resident was found walking down the street at approximately 8:55 pm. Resident stated they just wanted to take a walk and returned to the community with staff but remained agitated and displayed signs of paranoia. Resident met with emergency medical services upon returning to the community and "exhibited clear cognition" while refusing medical treatment. Resident's responsible person decided to take resident to their home and provide 1:1 care/supervision to await physician guidance and later informed the facility resident was admitted to the hospital on March 24, 2025, for reasons unrelated to the incident. The Administrator stated (R1) moved in non-ambulatory on March 13, 2025 and was very cognizant. LPA reviewed a cognitive test taken on March 12, 2025 showing resident scored 27/30, which is in the "normal" range. Resident's physician's report (also dated 3/12/25) notes (R1) has Mild Cognitive Impairment (MCI), Trimalleolor fracture on the right lower leg, is not confused/disoriented, does not show inappropriate, aggressive or wandering behavior, and is able to follow instructions/communicate needs. It appears, the physician completed additional boxes related to a diagnosis of Dementia and not MCI. Based on documentation reviewed, it appears resident had cognitive functioning within normal limits. There is not a citation issued in this report. Exit interview. Copy of report provided.

***Report Continued from 9099...... Allegation- Staff are not mitigating the spread of infectious outbreaks in the facility. The Department conducted record review and interviewed three staff and three residents regarding this allegation. Complaint alleged that staff were not following infection control guidelines to mitigate the spread of outbreaks at the facility around Thanksgiving 2024. Three staff interviews indicated that there were 3-5 residents who got sick with stomach bug in November 2024 in Assisted Living but there were no confirmed cases of Norovirus outbreak for residents. It was learnt that facility reported all those cases to Department per requirement and sought appropriate medical care for those residents who were sick. Staff interviews indicated that they were following infection control guidelines per facility’s policy and there were no concerns in that area. Department interviewed three out of five residents who were sick with stomach bug, and they all stated that facility provided the necessary care and services to them and did not express any concerns. Department was unable to interview two other residents who were sick at that time as one had moved out from facility on 12/31/24 and other one was not available for interview. Based on this information, it has been evaluated that facility staff followed infection control guidelines regarding this matter and there were no concerns, therefore this allegation was found to be UNFOUNDED. Based on information obtained, LPA finds the allegation to be UNFOUNDED -means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted, and a copy of the report was provided.

On 10/30/2024, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required annual inspection utilizing the care tool. LPA met with Executive Director and explained the purpose of the visit. Today's census is 191 residents in care with eight residents on hospice services, facility is licensed for 325, hospice waiver of 20. During today's inspection, LPA and Executive Director conducted a tour of the interior of the facility to ensure health and safety of residents in care. LPA and Executive Director conducted an inspection of facility kitchen, salon, theater room, laundry rooms, library, medication rooms, ten residents room, and the common areas. LPA observed facility to be at a comfortable temperature of 73*. LPA observed facility to have the required posters in the hallway by the common area. LPA observed facility to be clean and sanitary. File review conducted for 12 residents records and 10 personnel records. LPA reviewed Facility's Emergency Disaster Plan 2024 and Elopement and Fire Drills. LPA observed documentation of quarterly drills conducted for 2024. At this time, LPA is requesting a copy of facility's liability insurance to be emailed to LPA by Friday November 8. During room inspections, LPA and Executive Director observed sharps in R1's room. Additionally, LPA was informed if residents in care does not have mild cognitive impairment and/or dementia they are able to store own detergents. This matter will be under review. No deficiencies cited. Exit interview and a copy of the report was provided.

On 10/30/2024, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct a case management follow-up visit in regards to the visit conducted on 9/20/2024. LPA met with Executive Director, Natasha Georges and explained the purpose of the visit. During today's visit, LPA and Executive Director discussed the closure of the death report visit as R1 was found unresponsive during a meal check as facility has a policy of checking on residents in care if a meal was missed. LPA observed R1 to have POLST with "do not resuscitate". No deficiencies observed. Exit interview and a copy of the report was provided.

On 9/20/2024, Licensing Program Analysts (LPAs) Cassie Yang and Cassie Mikkelson arrived at the facility to conduct a case management visit regarding a death report the Department received on 09/19/2024. LPAs met with Executive Director, Natasha Georges and explained the purpose of the visit. During this visit, LPAs conducted a file review of R1's file and obtained a copy of the following: R1's LIC 602 R1's Needs and Assessment R1's Preplacement Assessment R1's POLST R1's Emergency Contact R1's Skilled Nursing Discharged Report At this time, LPAs are requesting a copy of the following to be emailed to LPA Yang by Monday 09/23/2024: Staff schedule with contact information for 9/17/2024 and 9/18/2024 The following incident is still under review by the Department. Exit interview and a copy of the report was provided.

LIC 9099-C Allegation: Staff is not meeting the needs of the residents. The Department conducted interviews regarding the allegation above. Based on interview conducted with Executive Director, it revealed that R1 had an incident in the restroom and R1 thought the pendant was pressed for help. Interview further revealed that in the restroom there is a pull cord that triggers a help signal but R1 did not use it nor did R1 contacted the front desk for assistance via telephone. Executive Director stated a help signal training will be provided for residents in care. Interview further revealed that R1 is not in incontinence care where this was a rare occasion. Interview conducted with R2 revealed R2 has had no issues getting staff assistance. Interview conducted with R3 and R4 both revealed there is no concerns with their needs as staff are helpful. File review revealed that there was no record of R1's pendant was triggered during the time of the incident. File review further revealed that based on the calls triggered by R1's pendant from May 2024 to date of incident, the longest response time was four minutes. File review of R1's LIC 602A PHYSICIAN'S REPORT FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY revealed that R1 has the capability for self care and is able to care for own toileting needs. Based on information obtained, LPA finds the allegation to be UNFOUNDED -means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted, and a copy of the report was provided.

On 5/22/2024, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility unannounced to conduct a required quarterly case management visit in accordance with the Stipulation and Order, effective date 06/01/2022 to 06/01/2024. LPA met with the Executive Director (ED), Natasha Georges, and explained the purpose of the visit. During today's visit, LPA reviewed facility's stipulation binder and reviewed the orders of the stipulation. LPA observed facility audits of emergency call responses, care records and incident reports. LPA observed E-call testings to be completed for residents in care for month of April 2024. LPA observed last reporting of response call exceeding 10 minutes to be sent to Licensing on 5/17/2024. LPA observed in-service training regarding PHB, Valve Shut off- to be conducted on 5/9/2024. LPA observed the signatures of staff present. LPA observed the facility to be clean, safe, sanitary and in good repair at all times. LPA observed the stipulation to be posted in a conspicuous space. LPA and Executive Director discussed the upcoming end of facility's probation term. LPA informed Executive Director once probation has ended, a new facility license will be generated and mailed to the facility. As a result of today's visit, LPA observed the facility to be in compliance to Stipulation and Waiver and Order. Exit interview conducted and a copy of the report was provided.

LIC9099-C Allegation : Illegal eviction The Department conducted interviews and file review of the following allegation. Interview conducted with Assistant Executive Director, it revealed that R1's rent has not been paid for an extensive amount of time. Interview further revealed that R1 had a professional fiduciary as Durable Power of Attorney who conducted financial abuse and neglected to pay R1's monthly rent. File review revealed the last payment made by R1's fiduciary was February 2022. File review further revealed R1 and responsible party was provided a copy of the 30 Day Notice To Pay Or Quit letter in April 2022, September 2022. Notice of Intent To File Unlawful Detainer Action was provided to R1 in November 2022 and Notice of Filing Unlawful Detainer Complaint was filed and provided to R1 in January 2023. File review further revealed Sacramento Sheriff Department provided a Notice to Vacate to R1. Therefore, the allegation is unfounded. Allegation: Staff did not provide resident's responsible party with resident's records. The Department conducted interviews regarding the allegation cited above. Interview conducted with Assistant Executive Director revealed that R1's responsible party had requested for R1's "medical records". Assistant Executive Director stated that the facility does not have access R1's medical records as only the hospital will have the following records. Interview further revealed that Resident Service Supervisor was asked to make copies of R1's LIC 602 Physician Report, original Physician Orders for Life-Sustaining Treatment (POLST) and medication list for R1's repsonaible party. Interview conducted with Resident Service Supervisor revealed that documents request was provided to R1's responsible party "several times". Interview further revealed that the documents provided was R1's LIC 602, medication list, tuberculosis test result. Additionally, in another occasion, LIC 602 was emailed to R1's responsible party. The allegation is unfounded. Based on information obtained, LPA finds the allegation to be UNFOUNDED -means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted, a copy of the report was provided.

On 3/14/2024, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility unannounced to conduct a required quarterly case management visit in accordance with the Stipulation and Order, effective date 06/01/2022 to 06/01/2024. LPA met with the Executive Director (ED), Natasha Georges, and explained the purpose of the visit. During today's visit, LPA observed the common areas to be clean, safe, sanitary and in good repair. LPA reviewed facility's stipulation binder and reviewed the orders of the stipulation. LPA observed an audit of total care staff hours and total care task for month of January 2024, February 2024 and partial of March 2024. LPA observed the facility to conduct daily audits of emergency call response and incident reports for residents if call exceeds ten minutes. LPA observed documentation of facility's staff training conducted in month of January 2024. LPA observed the recent report submitted to LPA, between February 20 - March 4, there was a total of 883 calls made, there was three calls exceeding ten minutes. LPA and Executive Director discussed the facility's current standing of nine days with no response call exceeding ten minutes. As a result of today's visit, LPA observed the facility to be in compliance to Stipulation and Waiver and Order. Exit interview conducted and a copy of the report will be emailed to Executive Director.

Allegation: Facility is not maintaining a comfortable temperature for a resident in care. The Department conducted extensive interviews regarding the allegation cited above. Interview conducted with R1 revealed that facility staff conduct daily checks on residents in care to ensure room are in a comfortable temperature. Interview conducted with R2 revealed that R2's AC unit is in an operable condition. Interview further revealed that facility provides residents in care portal air conditioning units during the summer if needed, and facility provides portal heating units for residents if they request for it. Interview conducted with Executive Director revealed that facility offer residents in care, the option to relocate to the B and C wings if needed as the A wing units' Heating, Ventilation, and Air Conditioning is older. Doc ument review revealed that Executive Director had submitted a request for a replacement for the A wing Heating, Ventilation, and Air Conditioning . Based on interview conducted with Executive Director revealed that a request is to be approved, then a construction permit is needed prior to work getting done. Interview further revealed that facility accommodates to residents' needs if alternative heating and/or air conditioning is needed. Based on information obtained through interviews and file reviewed, the Department finds the allegation found the complaint to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of report and appeal rights will be provided via email to Administrator.

Allegation: Facility staff are not keeping the facility at a comfortable temperature for residents. Allegation: Licensee does not ensure facility AC unit is in working condition The Department conducted extensive interviews regarding the allegation cited above. Interview conducted with R1 revealed that facility staff conduct daily checks on residents in care to ensure room are in a comfortable temperature. Interview conducted with R2 revealed that R2's AC unit is in an operable condition. Interview further revealed that facility provides residents in care portal air conditioning units during the summer if needed, and facility provides portal heating units for residents if they request for it. Interview conducted with Executive Director revealed that facility offer residents in care, the option to relocate to the B and C wings if needed as the A wing units' Heating, Ventilation, and Air Conditioning is older. Document review revealed that Executive Director had submitted a request for a replacement for the A wing Heating, Ventilation, and Air Conditioning. Based on interview conducted with Executive Director revealed that a request is to be approved, then a construction permit is needed prior to work getting done. Interview further revealed that facility accommodates to residents' needs if alternative heating and/or air conditioning is needed. Based on information obtained through interviews and file reviewed, the Department finds the allegation found the complaint to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of report and appeal rights will be provided via email to Administrator.

Allegation: Staff did not follow proper eviction procedures. Based on file review, it revealed R1 has missed the rent payment for the month of October 2023, November 2023, and December 2023. Interview conducted with Administrator revealed R1's Power of Attorney is aware that R1 is out of funds and is unable to pay rent at the facility. Interview with R1 revealed R1 is aware her Power of Attorney has not paid R1's rent for several months. Documents revealed that eviction letter was served on December 22, 2023 with effective date of January 22, 2024, which is 30 days, in compliance of Title 22 Eviction Procedures. Document further revealed eviction letter obtained the required criteria of referral services aid in finding alternative housing, complaint information to Licensing and Long Term Care Ombudsman, and lastly Health and Safety Code Section 1569.683(a)(4) unlawful detainer action. Based on information obtained, LPA finds the allegation to be UNFOUNDED -means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted, and a copy of the report and appeal rights was provided via email.

On 11/30/2023, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to the facility to conduct a case management visit regarding a voicemail LPA received from Executive Director (ED), Kim Hagen. LPA met with Assistant Executive Director (Asst. ED), Cristina Ortez, and explained the purpose of the visit. LPA was informed ED was not in the community. Asst. ED contacted ED, who spoke to LPA on speaker phone. LPA was informed ED is relocating to a new community and Asst. ED will be interim ED for the time being. LPA was informed the required documents will be provided to LPA in a timely manner to appoint new Administrator. ED reported her exit date in the community to be 12/08/2023. LPA and Asst. ED then discussed a current concern regarding family visitation dispute with R1. LPA advised facility to keep documentation and submit incident reports if the events were to reoccur when a resident declined visitation but family members are refusing to leave the premises. As a result of today's visit, no deficiencies observed. Exit interview conducted and a copy of the report was provided.

On 10/20/2023, Licensing Program Analysts (LPAs) Cassie Yang and Cheyenne Ratajczak arrived unannounced to conduct a case management visit regarding the incidents reports the Department received on Tuesday October 17, 2023. LPAs met with Executive Director (ED), Kim Hagen, and explained the purpose of the visit. LPAs and ED discussed the serious/unusual incident report (SIR) submitted for an incident occurring on 9/10/2023 regarding R1’s emotional distress. LPAs discussed the importance of submitting SIRs in a timely manner as Title 22 mandates written reports to be submitting within seven days of occurrence. ED explained the dated of occurrence was inputted incorrectly as the incident occurred on 10/15/2023 not 9/10/2023. Additionally, LPAs and ED discussed the SIR submitted for an incident occurring on 10/16/2023 regarding the incident with medications in R2’s room. LPAs discussed the importance of informing family members that medications are to be locked and secured if resident is able to store own medications. ED informed LPAs R2 is a new resident in care, and is in the Med Program, meaning facility assist with medication administration. ED stated the medications found in the room where over the counter medications which was removed during time of observation. ED informed LPAs the facility notified family members immediately to remind them of facility's protocols. ED also stated primary care physician was notified as all medications need a doctor's order. LPAs and ED then discussed the LIC 624A Death Report received for R3. ED informed LPAs R3 was hospitalized beginning of the month due to a concern home health nurse observed. ED stated R3 was then discharged to a skilled nursing facility and then hospitalized again for the original concerns when R3 was at the facility. ED stated cause of death is unknown as R3 has not been at the facility for a few weeks. Please continue on 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 LIC 809-C... At this time, LPAs requested a copy of R3's LIC 602, Emergency Contact, Needs and Assessment, all 2023 Incident Reports, list of meds, and Power of Attorney documents. LPAs informed ED to submit a copy of R3's Death Certificate once received by the family. This incident will be under review until further notice by the Department. During this visit, no deficiencies cited. Exit interview conducted and a copy of the report was provided to ED.

Allegation: Facility is unsanitary. The Department conducted interviews to investigate this allegation. During interview conducted with S1 on 02/08/2023, S1 informed LPA the bistro is cleaned after each shift and trash are thrown out daily. Based on LPA’s observation on 02/08/2023 and 05/04/2023, LPA observed the bistro to be clean and sanitary. Allegation: Staff do not ensure that the facility is free from pests. The Department conducted interviews to investigate this allegation. During interview conducted with S1 and S2 on 02/08/2023, LPA was informed there is no concerns of cockroach and/or pest in the kitchen. LPA was informed by S1 that during the duration of S1’s employment, S1 has not seen any cockroaches presence in the bistro kitchen. On 2/8/2023 and 5/4/2023, LPA inspected the kitchen space in areas included but not limited to: under the refrigerator, freezer, fryer, and inside storage room, LPA did not observe presence of pests. During this investigation, LPA conducted records review and extensive interviews. LPA found the facility to be compliance with Title 22. Based on interviews conducted, the preponderance of evidence standards have not been met. Based on information obtained during the investigation, LPA finds the allegations to be UNFOUNDED - A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview was conducted with Executive Director and a copy of this report and appeal rights was provided to Executive Director. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff serve residents moldy food. The Department conducted interviews to investigate this allegation. During interview conducted with S1 and S2 on 02/08/2023, LPA was informed that all food are labeled and discarded after the third day. LPA was informed that some sauce are made of herbs, that residents have mistaken it to be green mold. During interview conducted on 05/04/2023 with ED, LPA was informed a resident had complained about her cheese. LPA was informed by ED that the cheese served was blue cheese. Facility staff do not follow proper hand washing procedures. The Department conducted interviews to investigate this allegation. During interview conducted with S1 and S2 on 02/08/2023, S1 and S2 both informed LPA that the kitchen protocol is to wash hands prior to putting on gloves for prepping. During interviews, LPA was informed there are handwashing signs posted in the kitchen and restrooms for staff to follow. Based on interviews conducted, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED . A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted with Executive Director and a copy of this report and appeal rights was provided to Executive Director.