Carson Senior Assisted Living.

The investigation revealed the following: Regarding the allegation that staff are not properly addressing a bed bug infestation in the facility: Interviews revealed the following: interviews conducted with ten (10) staff members (S1-S10) denied knowledge of an active bed bug infestation within the facility. Resident interviews conducted with eleven (11) residents (R1-R11) did not corroborate the presence of bed bugs. LPA’s observations revealed the following: On 05/13/2026, LPA did not observe bed bugs within the television room or common areas. On 06/30/2026 LPA did not observe live bed bugs or visible signs of bed bug activity, including insects consistent with bed bugs, fecal spotting, blood spots, shed skins, eggs, or other visible evidence. Records reviewed revealed the following: pest control invoices and treatment records documenting ongoing extermination services conducted on multiple dates, including March 18, March 25, April 1, April 8, April 15, and May 6, 2026. Records documented treatment and monitoring for various pests, including bed bugs, and indicated continued pest control maintenance services were being provided. Based on the evidence gathered, interviews conducted, observations made, and records reviewed, although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated. No deficiencies were cited regarding this allegation. An exit interview was conducted, and a copy of this report was provided to the Assistant Administrator.

Observations revealed: kitchen staff plating and serving food to residents during lunchtime. Food menu for 05/13/2026 confirmed the lunch items that were observed. Based on the evidence gathered, interviews conducted, observations made, and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated. Regarding the allegation that staff are leaving residents in soiled briefs, staff interviews conducted with (10) Staff (S1-S10) stated incontinent residents are checked and changed routinely approximately every one to two hours or as needed. Interviews with (11) Residents (R1-R11) did not agree with being left in soiled briefs for extended periods. No odors or unattended incontinent residents, or conditions indicating residents were being left in soiled briefs were observed. A review of resident monitoring and incontinence care logs dated 05/08/2026 documented routine resident checks, repositioning, toileting assistance, and monitoring conducted throughout (AM-PM), and graveyard shifts. Based on the evidence gathered, interviews conducted, observations made, and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated. Regarding the allegation that staff are sleeping in a resident’s room while on duty, interviews conducted with (10) Staff (S1-S10) and (11) Residents (R1-R11) did not agree or report any knowledge of the allegation. Staff members (S8-S9) denied sleeping in resident rooms while on duty. Additional staff interviews indicated (S8-S9) were not assigned to the memory care unit and had not worked in that unit for several months. Based on the evidence gathered, interviews conducted, observations made, and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated. No deficiencies were cited on this visit. A copy of this report and exit interview were provided to the Assistant Administrator.

Investigation Revealed the Following: Allegation: Facility staff do not ensure to provide adequate supervision to residents in care. The details of the complaint alleged that facility staff are not providing adequate supervision to residents because they are using their cell phones On April 14, 2026, at approximately 10:00 a.m., during the records review, the Department observed a copy of the facility’s Staff Memorandum of Understanding dated March 20, 2020. The Department noted that the memorandum states the following policies are to be followed: no personal calls are permitted while on duty, and all telephones in the facility are for business use only. The memorandum further states that no local or long-distance personal calls are to be made on facility phones at any time. On April 14, 2026, during an interview with the facility administrator (A#1), (A#1) stated that staff are permitted to have their personal cell phones in their pockets while on duty because the facility uses a work-related group chat for communication. In addition, (A#1) noted that staff utilize walkie-talkies for communication within the facility. When asked about measures in place to ensure staff provide adequate supervision to residents, (A#1) explained that the resident care coordinator and (A#1) regularly monitor staff performance. Finally, when questioned about any concerns or past incidents involving staff members using their personal cell phones in a manner that affected resident supervision, (A#1) stated, "Not at all." On April 14, 2026, during interviews with residents in care (R#1 through R#8), (8) out of (8) residents stated that staff check on them regularly and that they feel supervised and supported while in the common areas. All residents interviewed stated they have not noticed staff using their personal cell phones while supervising or assisting residents. Additionally, (8) of (8) residents reported feeling safe and well-supervised in the facility and had no concerns about staff attentiveness. Evaluation Report continues LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On April 14, 2026, during interviews with facility staff (S#1 through S#5), (5) out of (5) facility staff stated that their responsibilities related to resident supervision responsibilities as ensuring residents are clean and dry, assisting with dressing, preparing residents for meals, and escorting them to activities. Staff stated that the facility policy prohibits personal use of cell phones but allows work-related communication via group chat. In addition, (5) out of (5) facility staff denied any instances where personal cell phone use interfered with resident supervision. During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Ginger Enriquez/ Facility Administrator

This report supersedes the report created 12/5/25 and the findings will remain unchanged. Investigation Revealed the Following: Allegation: Staff did not prevent a resident from sexually abusing another resident The details of the complaint alleged that (R#1) was sexually assaulted by (R#2). On December 11, 2025, at approximately 12:00 p.m., during a review of records, Licensing Program Analyst (LPA) Iniguez observed Resident #1’s (R#1) Physician’s Report for Residential Care Facilities for the Elderly (LIC 602A), dated June 25, 2025. The report indicates that (R#1) has been diagnosed with a mental health condition that may influence their thought processes and belief system. Additionally, the LIC 602A form notes that (R#1) is confused and disoriented. LPA Iniguez also reviewed (R#1)’s current medication list, which includes a prescription for Haloperidol 50 mg to be administered every morning. This medication is associated with the management of (R#1)’s diagnosed mental health condition. Furthermore, LPA Iniguez reviewed (R#1)’s Appraisal/Needs and Services Plan (LIC 625), dated September 24, 2025, which states that the facility is responsible for monitoring R#1 throughout the day for any physical or mental changes. On December 11, 2025, during an interview, the facility administrator (A#1) she stated that upon being notified of (R#1)’s allegation of sexual abuse by their mental health case manager, the facility took immediate action by assessing (R#1) and offering to relocate them to a different room once one becomes available. (A#1) also indicated that the Long-Term Care Ombudsman would be informed of the incident. To ensure (R#1)’s safety, the facility implemented a two-hour wellness check protocol, with staff monitoring (R#1) throughout the day and night for any physical or mental changes. In addition, (A#1) stated that in response to the allegation, the facility followed its internal abuse protocols by interviewing relevant parties, documenting the incident, and notifying Licensing, the Ombudsman, the mental health case manager, and (R#1)’s psychiatrist. The facility does not utilize in-room surveillance cameras due to resident privacy rights, which align with regulatory standards. Evaluation Report continues LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 This report supersedes the report created 12/5/25 and the findings will remain unchanged. On December 11, 2025, at approximately 1:00 p.m., (W#1) stated that when a program client reports abuse, the department follows a protocol to ensure the client’s safety. This includes providing immediate access to medical and mental health support, formally reporting the incident to authorities. On January 20, 2026, (W#1) reported via email that after receiving the client’s report, they consulted their supervisor and the on-site clinician to confirm the facility was aware of the incident. That afternoon, (W#1) reported the incident to Adult Protective Services (APS) and was instructed to contact the Long-Term Care Ombudsman hotline. (W#1) then completed a SOC 431 form and emailed it to the Long-Term Care Ombudsman and Community Care Licensing. (W#1) also indicated that, to their knowledge, no investigation was initiated by them. On December 11, 2025, at approximately 11:00 am, during an interview with (R#1), they stated that the alleged incidents occurred approximately 15 times over a period of three months. When asked whether the incidents were reported to facility staff immediately after they occurred, (R#1) stated that they did not report them at the time because they believed the behavior would stop on its own. In addition, (R#1) stated that since the report was made, (R#1) indicated that the facility has “placed a camera in their room” to monitor their safety. When asked if they currently feel safe living at the facility, (R#1) responded affirmatively, stating that they do feel safe now. On December 11, 2025, at approximately 11:20 am, during an interview with (R#2), they stated that they do not engage in conversation with (R#1) and simply share the room for sleeping purposes. Also, (R#2) reported no knowledge of any concerns or complaints made against them by either their roommate (R#1) or facility staff. In addition, in response to the allegation of inappropriate physical contact involving (R#1), (R#2) firmly stated that they have never touched (R#1) in a sexual or harmful way and that they always maintain respectful and appropriate behavior toward them. When asked whether they feel safe living at the facility, the individual responded affirmatively. Evaluation Report continues LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 This report supersedes the report created 12/5/25 and the findings will remain unchanged. On December 11, 2025, at approximately 11:30 am, during interviews with residents (R#3-R#10), (8) out of (8) stated that the facility consistently responds in a positive manner when asked about the facility’s response to resident concerns regarding safety, privacy, or personal well-being and, they affirmed that staff respond appropriately to both serious concerns and minor requests for assistance, based on their personal observations. In addition, (8) out of (8) residents stated that they have not observed or heard of any concerning incidents involving (R#1) and their roommate (R#2), and they feel safe living here. During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Julian Villanueva/Resident Coordinator.

Investigation Revealed the Following: Allegation: Staff did not prevent a resident from sexually abusing another resident The details of the complaint alleged that (R#1) was sexually assaulted by (R#2). On December 11, 2025, at approximately 12:00 p.m., during a review of records, Licensing Program Analyst (LPA) Iniguez observed Resident #1’s (R#1) Physician’s Report for Residential Care Facilities for the Elderly (LIC 602A), dated June 25, 2025. The report indicates that (R#1) has been diagnosed with a mental health condition that may influence their thought processes and belief system. Additionally, the LIC 602A form notes that (R#1) is confused and disoriented. LPA Iniguez also reviewed (R#1)’s current medication list, which includes a prescription for Haloperidol 50 mg to be administered every morning. This medication is associated with the management of (R#1)’s diagnosed mental health condition. Furthermore, LPA Iniguez reviewed (R#1)’s Appraisal/Needs and Services Plan (LIC 625), dated September 24, 2025, which states that the facility is responsible for monitoring R#1 throughout the day for any physical or mental changes. On December 11, 2025, during an interview, the facility administrator (A#1) she stated that upon being notified of (R#1)’s allegation of sexual abuse by their mental health case manager, the facility took immediate action by assessing (R#1) and offering to relocate them to a different room once one becomes available. (A#1) also indicated that the Long-Term Care Ombudsman would be informed of the incident. To ensure (R#1)’s safety, the facility implemented a two-hour wellness check protocol, with staff monitoring (R#1) throughout the day and night for any physical or mental changes. In addition, (A#1) stated that in response to the allegation, the facility followed its internal abuse protocols by interviewing relevant parties, documenting the incident, and notifying Licensing, the Ombudsman, the mental health case manager, and (R#1)’s psychiatrist. The facility does not utilize in-room surveillance cameras due to resident privacy rights, which align with regulatory standards. Evaluation Report continues LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On December 11, 2025, at approximately 1:00 pm, during an interview with (W#1), (W#1) explained that when a report of sexual abuse is made by a client participating in the program, the department follows a specific protocol to ensure the client's safety and well-being. This includes offering immediate access to medical care and mental health support services tailored to the client's needs. (W#1) further stated that the department is responsible for formally reporting the incident to the appropriate authorities and initiating a thorough investigation to determine the facts and ensure accountability. These steps are taken to protect the client and uphold the program's integrity. On December 11, 2025, at approximately 11:00 am, during an interview with (R#1), they stated that the alleged incidents occurred approximately 15 times over a period of three months. When asked whether the incidents were reported to facility staff immediately after they occurred, (R#1) stated that they did not report them at the time because they believed the behavior would stop on its own. In addition, (R#1) stated that since the report was made, (R#1) indicated that the facility has “placed a camera in their room” to monitor their safety. When asked if they currently feel safe living at the facility, (R#1) responded affirmatively, stating that they do feel safe now. On December 11, 2025, at approximately 11:20 am, during an interview with (R#2), they stated that they do not engage in conversation with (R#1) and simply share the room for sleeping purposes. Also, (R#2) reported no knowledge of any concerns or complaints made against them by either their roommate (R#1) or facility staff. In addition, in response to the allegation of inappropriate physical contact involving (R#1), (R#2) firmly stated that they have never touched (R#1) in a sexual or harmful way and that they always maintain respectful and appropriate behavior toward them. When asked whether they feel safe living at the facility, the individual responded affirmatively. Evaluation Report continues LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On December 11, 2025, at approximately 11:30 am, during interviews with residents (R#3-R#10), (8) out of (8) stated that the facility consistently responds in a positive manner when asked about the facility’s response to resident concerns regarding safety, privacy, or personal well-being and, they affirmed that staff respond appropriately to both serious concerns and minor requests for assistance, based on their personal observations. In addition, (8) out of (8) residents stated that they have not observed or heard of any concerning incidents involving (R#1) and their roommate (R#2), and they feel safe living here. During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Ginger Enriquez/ Facility Administrator.

INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff did not seek medical attention for resident in a timely manner. The complaint alleges that facility staff failed to promptly seek medical attention for Resident #1 (R1). Reports indicated that (R1) was very sick, yet the staff did not take any action to treat the illness. (R1) is experiencing cold symptoms and, although other residents are also ill, suspects it may be COVID-19, which raises concerns given (R1's) other underlying health issues. No additional information regarding this situation was provided. On October 03, 2025, and October 21, 2025, between 09:50 AM and 03:45 PM, the Department interviewed staff members identified as Staff #1 through Staff #4. Four (4) out of the four (4) staff members could not support the allegation. Each of them confirmed that no COVID-19 cases had been reported among the facility's residents or staff. Staff members (S1-S4) stated that the facility continues to take proactive measures to stay up to date on COVID-19 vaccinations, practice good hygiene, wear masks, maintain distance from individuals who are ill, and isolate those individuals when necessary. According to the information from (S1-S4), (R1) is independent and capable of self-care with no requirement of assistance with activities of daily living, leave the facility every day, and do not have any mental health conditions. (R1) only requires assistance with daily medication administration. (S1-S4) confirmed that (R1) exhibited no symptoms of cold or flu, and no symptoms were ever observed that would require immediate medical attention. (S1-S3) reported the residents are actively monitored for cold or flu symptoms. When symptoms are observed, primary physicians are promptly notified. Should these symptoms persist for multiple days, hospitalization may be necessary, as recommended by the physician. On October 03, 2025, and October 21, 2025, between 9:35 AM and 03:45 PM, the Department interviewed resident members identified Resident #1 through Resident #10 (R1-R10). Nine (9) out of the ten (10) resident members could not corroborate this allegation. Eight (8) out of the ten (10) confirmed that they receive adequate medical attention and that staff are responsive to their medical needs. (R2), who shares a room with (R1), denied claims that (R1) is ill or showing symptoms of a cold or flu. (R2) stated that (R2) would generally be aware of (R1)'s health condition, given our close living quarters, and that (R2) would report to staff immediately if either of them was ill. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (R1) mentioned that (R1) experienced a minor cough a few weeks ago, which did not require medical treatment. Although it persisted for several days, (R1) did not have any COVID-19-related symptoms. (R1) stated that (R1) continues to receive daily assistance with medication administration from the staff and is satisfied with the care services provided. (R1) stated to be independent and have no mental condition and can freely advocate for self. The Department reviewed (R1’s) Resident Face Sheet (dated 10/03/23), Identification and Emergency Information LIC 601 (dated 10/10/23), Admissions Agreement (dated 10/03/23), and Consent for Emergency Medical Treatment LIC 627C (dated 10/10/10/23). Further review of the Physician’s Report LIC 624 (dated 03/27/25), Preplacement Appraisal Information LIC 603 (dated 08/26/23), and Medication Administration Record (dated 10/01/25 to 10/31/25) verified (R1) is capable of self-care with no mental health conditions and requires only assistance with medication. During visits on October 3, 2025, and October 21, 2025, the Department did not observe any residents or staff displaying symptoms of illness. The Department observed the facility's infection control practices with screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. The Department observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated infection control posters were posted. Additionally, the facility had not reported any COVID-related cases to Community Care Licensing. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated . No deficiencies issued. An exit interview was conducted with Ginger Enriquez, and copies of the reports were provided.

Continued LIC9099-C page 2 and Unusual Incident Reports (dated 07/18/2025 - 09/02/2025). On 09/25/2025, at 11:40 A.M. - 4:00 p.m., LPA Bunker interviewed Staff members #1-#4 (S1-S4) and residents #1-#8 (S1-S8). The investigation revealed the following: Allegation: Staff wrongfully evicted a resident. It has been alleged that staff wrongfully evicted a resident. On September 3, 2025, and September 25, 2025, LPA Bunker interviewed staff members #1 through #4 (S1–S4). LPA asked whether any resident was being wrongfully evicted. All four staff members interviewed (4 out of 4) answered no. They stated that R1 is still a resident and did not receive a three-day eviction notice. LPA Bunker reviewed R1’s Admission Agreement, which was dated and signed on October 24, 2023. On the same date, R1 also signed the House Rules. LPA Bunker reviewed Unusual Incident Reports dated between July 18, 2025, and September 2, 2025, and observed 14 incidents involving R1’s ongoing aggressive behavior toward staff and residents, including combative actions and harassment. S1-S4 stated that the 30-day eviction notice and the Special Incident Reports were submitted to CCLD in a timely manner. LPA also reviewed the Los Angeles Sheriff’s report dated August 20, 2025, and a 30-day eviction notice dated August 20, 2025. There is no record on file indicating that the facility provided R1 with a three-day eviction notice or that staff wrongfully evicted resident #1. Staff members #1 through #4 (S1–S4) denied the allegation. LPA interviewed residents #1 through #8 (R1–R8). Residents interviewed (7 out of 8) answered no when asked if a resident was being wrongfully evicted. R1 stated that staff provided a 30-day eviction notice dated August 20, 2025, and confirmed that they never received a three eviction notice and no hard copy of a three-day notice was provided. Seven out of eight residents denied the allegation. See Continued LIC9099-C page 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued LIC9099-C page 3 Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099 and LIC9099-C was provided to the facility Med Tech/Resident Coordinator Julie Villanueva. There were no deficiencies cited. An exit interview was conducted.

Allegation: Staff physically assaulted resident causing injury . The complaint alleges that the staff " verbally and physically abused the resident, resulting in bruises, scratches, on left knee and left wrist" On July 7, 2025, between 9:20 AM and 10:45 AM, the LPA interviewed five staff members (S1-S5), all of whom denied the allegation and stated that no staff member has ever hit or verbally abused a resident in their care. Later, on the same day, from 11:00 AM to 01:00 PM, LPA Richard interviewed eight residents (R2-R9). Seven out of eight residents denied the allegation, affirming that the staff never verbally abused or physically hit them or witnessed staff hitting any residents. However, they reported having observed residents fighting among themselves, with staff intervening to separate them. At 12:10 PM on July 7, 2025, LPA Richard called and spoke with the Client Wellness Program Manager (CWPM) from DHS. The CWPM denied the allegation and mentioned that they are collaborating with the Medical Case Worker (MCW) from DHS to transfer Resident #1 (R1) to a different facility, as R1 requires a higher level of care. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Additionally, LPA reviewed incident reports and photos of R1, dated July 1, 2025, which showed no bruises or scratches on R1's left wrist or arms. LPA was unable to interview R1 because the resident was in the hospital. Based on the information collected, there is no evidence to support the allegations made. Based on information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the LPA found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of the report was provided to the Assisted Living Administrator Ginger Enriquez.

On 04/23/2025 at 1:40pm , LPA Zina Brown conducted an unannounced continuation annual visit using the CARE Inspection Tool. LPA met with the Administrator Ginger Enriquez. and the purpose of today’s visit was explained. During the initial unannounced annual inspection on 4/14/2025, b etween the hours of 11:30am - 3:15 pm, LPA conducted a records review of (11) resident records. LPA conducted a records review for (2) is on hospice care plan, and out of the eleven (11) residents records reviewed from the initial unannounced annual inspection: (1) is on home health care and (3) residents have Personal & Incidental Today on 04/23/2025, between the hours of 1:45pm - 3:00pm, LPA conducted a records review for: (1) Home health resident record (2) Hospice care plan resident records (3) LIC405: Record of Clients/Residents Safeguarded Cash Resources (Personal & Incidental) Staff training (for the year of 2024 from January - December) All client records were complete & all staff records were incomplete and LPA do not observe any discrepancies at the time of visit.No deficiencies were cited during the time of visit. An exit interview conducted with Ginger Enriquez and a copy of the report is provided.

On 04/14/2025 at 9:30am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced annual required visit using the CARE Inspection Tool. At 10:15 am, LPA met with Administrator Ginger Enriquez. LPA Brown explained the purpose of today’s visit. The facility is licensed to operate for (230) non-ambulatory residents ago 60 and above with an approved hospice waive for (10) residents and dementia special program - facility has a delay egress unit for 68 residents. Currently, the facility has a total of 158 residents of which (53) are non-ambulatory residents, (105) are ambulatory residents. Also, the facility has (43) residents on home health, (2) on hospice care, (43) residents diagnosed with dementia , (33) residents are incontinent, (19) of the residents are in assisted living and (14) are in memory care The facility annual need are current. The facility has liability insurance with Notting Hill Risk Retention Grp (NAIC #17052): Policy Number ANH0000205-00 with effective dates 10/16/2024 - 10/16/2025. The facility is a two story structure located in a commercial neighborhood which consists of the following: (27) resident bedrooms in Arbor Unit and (119) resident bedrooms in Assisted Living. Each room has a bathroom in the unit, an activity room, a dining area, a kitchen, and outside patio area. Between the hours 10:23 am - 11:30am of LPA and administrator toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. The resident rooms inspected: in memory care room #4, #9, #10, #13, #24 and in room #36, #148, #163, and #206 in assisted living. All call buttons were in working condition. Bathrooms were operational with water temperature measured at 106.9 – 120 degrees F. Report continues 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 Between the hours of 11:30am - 3:15 pm, LPA conducted a records review of (11) resident records, (11) staff records, (11) Client Medication Administration Records and reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit and did not observed any discrepancies at the time of visit. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. On 11/14/2024, the fire department conducted an inspection for the alarm, smoke detectors and the fire extinguishers were charged and operable in each resident's room. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. Due to time constraints LPA will continue the annual inspection at a later date. No deficiencies were cited during the time of visit, but deficiencies maybe issued at a later date. An exit interview conducted with Ginger Enriquez and a copy of the report is provided.

INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff did not prevent residents from engaging in physical altercation. The details of this complaint alleged that due to a lack of facility supervision residents engaged in an altercation.  It is reported that Resident #1 (R1) is being repeatedly hit on the back of the head by Resident #2 (R2) while both are in the dining room. The administrator has been informed of the incidents and (R1) has been ignored. Further details indicated that there have been no injuries. On 03/21/24 between 09:50 am – 12:20 pm, the Department interviewed (10) out (10) resident #1 - #10 were unable to corroborate the allegation.  Eight (8) out (10) residents #2 - #10 (R2-R10) revealed themselves unable to verify these incidents, and no one observed any act of aggression on a resident. (R2-R10) stated that staff are responsive and will not tolerate inappropriate behavior from residents. (R1) was interviewed and was unwilling to provide a statement. (R1) claimed there is no issue with (R2). (R2) was interviewed and stated engagements with (R1) are friendly. (R2) described an incident last week where (R1) inappropriately addressed other residents in the dining hall. (R2) had enough of (R1’s) behavior and confronted (R1) and made (R1) aware of the improper verbal actions. (R2) claimed there was no physical altercation and that the administrator consulted (R1) and (R2) about the incident. (R2) indicated and (R1) are in kind terms. On 03/21/24 between 10:10 am – 11:20 am, the Department interviewed (3) out of (3) staff #1-#3 (S1-S3) who denied an altercation between (R1) and (R2). (S1) claimed last week, (S1) was made aware of verbal exchanges between (R1) and (R2). Both residents were consulted for their actions and given a verbal warning. (S1-S3) have experienced or witnessed (R1) have made offensive comments about other residents. (R1) has been consulted repeatedly and informed that this behavior is unacceptable according to (S1-S3). On 03/21/24 between 11:04 am – 11:22 am, the Department interviewed a family representative of (R1) witness #1 (W1). (W1) claimed to be unaware of any incident involving (R1) and (R2). (W1) described (R1) as being a strong head, and if (R1) did not want to volunteer a statement or stated to disregard it, it is mostly likely that (R1) was at fault. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (W1) claimed that (R1) does not have a pattern of engaging in improper verbal attacks on others, unless (R1) has been provoked. (W1) verified that the administrator has reached out to (W1) for (R1) insensitive comments towards other residents. Based on the gathered information, there is no evidence to support the allegations mentioned above. Based on information collected, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with Ginger Enriquez, and copies of the reports were provided.

INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Resident sustained unexplained bruising while in care. The details of the complaint alleged resident #1 (R1) had sustained unexplained bruising while in care at this facility. (R1) was found with suspicious bruises. The report did not provide any further details. Investigation revealed resident #1 (R1) was admitted at Carson Senior Assisted Living (CSAL) on 08/20/21 according to Identification and Emergency Information (dated: 08/20/21). (R1) voluntarily terminated residency from (CSAL) on 06/30/24. Physician’s Report (dated: 03/27/24) and Preplacement Appraisal Information (date: 08/17/21) identified (R1) can self-care is independent and requires assistance only with dispensing medications. Records indicated (R1) had no history of skin condition or breakdown. On 06/06/24 at 05:30 pm, (R1) was hospitalized at Harbor UCLA Medical Center (HUCLAMC) due to abdominal pain on the left side and general weakness per Incident Report LIC (dated: 06/06/24). (HUCLAMC) medical records (date: 06/08/24) revealed (R1) was treated for UTI/Pyelo with possible colitis. On 08/13/24 between 10:10 am - 02:45 pm, the Department interviewed (4) out of (4) staff #1-#4 (S1-S4) who reported knowing a bruise on (R1’s) left hand/wrist. (S1-S4) explained they were aware of the bruised hand/wrist as it was documented by (S3) on the facility’s Body Assessment Chart (dated: 06/29/24). Written remarks indicated (R1) was showered. No scratches the body is clear and clean. Bruise on left hand indicated by (S3) on 06/29/24. (S1-S4) described (R1) is diagnosed with mental deterioration but is independent and can self-care. (R1) was not on home health or hospice care. (S1-S4) claimed that (R1) is non-ambulatory and requires assistance with assistive devices. (S1-S4) stated that (R1) was not on any required medical restraint while in care. (R1) had no accidents or falls or physical wrangles. As being independent (R1), to have minimal social interactions with other residents or staff. Interactions were defined with family representatives who came to visit or take (R1) out in the community. (S1) was being examined monthly by (R1’s) internal primary physician. SeniorDoc Medical Notes (dated: 06/26/24) verified (R1) was examined and no signs of falls, wounds, bruises, or skin breakdowns in the last six months. (Evaluation Report continues on LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On 08/13/24 between 10:30 am -01:16 pm, the Department interviewed (10) out of (11) residents #2-#11 (R2-R11) who are unable to corroborate this allegation. (R2-R11) claimed they have never experienced or known a resident who has sustained bodily bruises while in care. As a result of the Department reviewing (R1) Physician Report LIC 602A (dated: 03/27/24), Preplacement Appraisal Information LIC 623 (dated: 08/17/21); Unusual Incident Report LIC 624 (dated: 06/24/24 and 06/30/24); Harbor UCLA Medical Records (dated: 06/08/24); Facility’s Body Assessment Chart (dated: 06/08/24 and 06/29/24); Southern California Hospital Medical Records (dated: 07/03/24), SeniorDoc Medical Notes (dated: 01/31/24 -06/26/24), revealed while hospitalized, (R1) was administered Intravenous (IV) between (06/06/24-06/07/24); (R1) was on medical restraint devices between 06/30/24 – 07/07/24. Medication Administration Record (dated:06/01/24-06/30/24) revealed (R1) is on twenty (20) routine medications. Eleven (11) out of twenty (20) prescribed medications have side effects related to unusual bleeding and bruising according to the National Institute of Health (ref: NIH). Based on the gathered information, there is no evidence to support the allegation mentioned above. Allegation #2: Facility staff did not seek medical attention in a timely manner. The details of the complaint alleged facility staff did not seek medical attention for resident #1 (R1) in a timely manner. It was reported that (R1) required immediate medical attention and the facility staff refused to assist on 06/30/29. The report did not provide any further details. On 08/13/24 between 10:10 am - 02:45 pm, the Department interviewed (4) out of (4) staff #1-#4 (S1-S4) who reported were aware that (R1) was sent out for further medical evaluation at a local hospital on 06/30/24. (S2) indicated family representatives came for a visit on 06/30/24 and felt a concern for (R1’s) requiring immediate 911 (EMS) medical attention. (S2) did not contact Emergency Medical Services (EMS) as (R1) was not having a life-threatening condition. (S2) described that (R1) was not badly hurt, in danger, distressed, fainted, collapsed, persistent chest pain or difficulty breathing was the reason (S2) refused to contact 911 (EMS). Instead, (S2) contacted a regular ambulance to transport (R1) to Southern California Hospital for further medical evaluation on 06/30/24 at 5:35 pm. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (S1-S4) claimed that (R1) was medically evaluated by a monthly internal medical physician. (R1) was observed daily for vital signs and monitored hourly by staff. Assessments were conducted on the body. (S1-S4) claimed that (R1) was medically evaluated by a monthly internal medical physician. (R1) was observed daily for vital signs and monitored hourly by staff. Assessments were conducted on the body. A change of condition was recorded and notified to (R1's) physician. (S1-S4) refuted the allegation the staff did not seek medical attention is untrue. On 08/13/24 between 10:30 am -01:16 pm, the Department interviewed (10) out of (11) residents #2-#11 (R2-R11) who are unable to support this allegation. (R2-R11) claimed they are medically assisted by the facility’s internal medical physicians or their external primary physicians in a timely manner. On 08/13/24 between 09:45 am -03:30 pm, the Department interviewed family representatives (1) out of (4) witnesses #1-#4 (W#1-W#4) who had observed a bruise and concerned for (R1) not feeling well during the visit on 06/30/24. (W1) was one of the individuals who felt that immediate medical attention was necessary. (W1) verified that an ambulance was dispatched to transport (R1) to the hospital. (W2-W4) claimed to have no issues with residents seeking medical attention as medical assistance is provided internally by the medical physicians. (W2-W4) stated they are notified by the facility staff if there’s any change in the resident’s condition. As a result of the Department reviewing (R1) Physician Report LIC 602A (dated: 03/27/24), Preplacement Appraisal Information LIC 623 (dated: 08/17/21); Unusual Incident Report LIC 624 (dated: 06/24/24 and 06/30/24); Facility’s Body Assessment Chart (dated: 06/08/24 and 06/29/24); SeniorDoc Medical Notes (dated: 01/31/24 -06/26/24), Medication Administration Record (dated:06/01/24-06/30/24); Change of Condition Notification Chart (dated: 06/18/24 and 06/23/24); Arbor Hall Resident 1 Hour Monitoring (dated: 06/01/24 – 06/30/24); Hospital List Char 01/01/24 - 06/30/24); Monthly Weight Record (dated: 01/04/24 – 06/05/24), revealed (R1) was monitored daily for any change of condition, and notifications were sent to (R1’s) primary care physician promptly. Based on the gathered information, there is no evidence to support the allegation mentioned above. Allegation #3: Facility staff did not allow resident visitation. The details of the complaint alleged the facility staff did not allow resident #1 (R1) visitors. The report indicated (R1) was denied visitors during 06/16/24 – 06/30/24. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On 08/13/24 between 10:10 am - 02:45 pm, the Department interviewed (4) out of (4) staff #1-#4 (S1-S4) and stated this allegation is untrue. (S1-S4) claimed that (R1) was often seen with visitors at the facility. It was common for family representatives to conduct visits outside or inside the facility. (S1) indicated there were some occasions when (R1) did not want to go outside and family did not want to visit inside and another time when (R1) did not welcome a visit and only wanted a phone conversation with family. . On 08/13/24 between 10:30 am -01:16 pm, the Department interviewed (10) out of (11) residents #2-#11 (R2-R11) who are unable to validate this allegation. (R2-R11) said visitors are welcome, and they have no knowledge of or experience with visitors not receiving access. On 08/13/24 between 09:45 am -03:30 pm, the Department interviewed family representatives (4) out of (4) witnesses #1-#4 (W#1-W#4) claimed they were unable to support this claim. (W1) stated (W1) was never denied visits with (R1). The Department reviewed the facility’s Visitation Records (dated: 06/01/24 – 06/30/24), and records revealed (R1) had routine visits on 06/10/24, 06/11/24, 06/16/24, and 06/30/24. Based on the gathered information, there is no evidence to support the allegation mentioned above. Between 08/05/24 - 08/13/24, the Department made several attempts to interview resident #1 (R1) by telephone who is now recovering at St. Francis Hospital. (R1) was unwilling and unable to communicate in full conversation. Between 08/06/24 – 08/14/24, the Department attempted to interview family representatives of (R1) witnesses #5-#7 (W5-W7) by telephone who were unavailable for statements. Based on information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit inte

Investigation Revealed the Following: Allegation: Staff do not allow resident to manage own funds. The details of the complaint alleged that facility staff did not allow resident to manage their own funds. During the records review, LPA Iniguez reviewed (R#1)’s Physician’s Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A. It is written that (R#1) is not confused or disoriented, but the physician completing the form marked “A084” as an extra notation in this field. Also, (R#1) can manage its cash resources. In addition, LPA reviewed (R#1)’s Preplacement Appraisal Information or LIC 603, and it is written that (R#1) is confused. Furthermore, LPA reviewed a copy of the Social Security Administration Retirement, Survivor and Disability Insurance dated 8/4/2024; it is written that Social Security Has chosen the facility Carson Retirement Center as the representative payee for (R#1)’s monthly check. Also, the letter states that as the payee for (R#1), the facility needs to keep track of how they will use the money they send for (R#1); each year, they will ask to report on how they used it. Furthermore, LPA reviewed (R#1)’s admissions agreement. (R#1) was admitted to the facility on 2/19/2020. However, during the interview with LPA Iniguez, (R#1) stated that all these allegations happened eight years ago, back in 2016, and (R#1) was not living at that time at this facility. During an Interview with the Administrator (A#1), she stated that (R#1) used to manage their funds until Social Security deemed that the facility would manage (R#1) 's funds starting 8/4/23. The facility became (R#1) 's payee from Social Security Administration Retirement, Survivors, and Disability Insurance Services, and since the facility manages some residents' finances, they do have a Surety Bond. Also, (A#1) stated that she has not known of heard about (R#1)’s wallet being stolen or (R#1) getting physically attacked while living at the facility. Evaluation Report continues LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 This report serves as an amendment to clarify finding. It does not supersedes the complaint investigation findings reflected on report created 8/13/24 During an interview with resident 1 (R#1), they stated that they had been here for eight years; the facility administrator manages their finances, but the administrator is taking their money from their bank account. LPA asked (R#1) how they knew the administrator was taking money from them; they said the bank told them the administrator had taken their money. LPA asked (R#1) if they had something in writing about that. (R#1) said no, all my money is under the administrators. During interviews with residents (R#2-R#10), (5) out of (10) residents stated that the facility manages their finances and P&I; those funds are from Social Security. Also, (3) out of (10) residents indicated that their families and conservator manage their finances, and (2) out of (10) residents manage their finances. In addition, (9) out of (10) residents stated that they fee safe living here. During interviews with staff (S#1-S#3), (3) out (3) facility staff stated that they do not know if (A#1) has taken money from (R#1)’s bank account and they don’t think (A#1) is not allowing (R#1) to manage their finances, they said Social Security made the facility the payee for (R#1)’s monthly check. Also, (3) out of (3) facility staff stated that they had not heard about (R#1)’s wallet being stolen or (R#1) getting physically attacked while living at the facility. Allegation: Staff did not safeguard resident's finances. The details of the complaint alleged that facility staff did not safeguard resident’s finances. During the records review, LPA Iniguez reviewed (R#1)’s Record of the Client’s/Resident’s Safeguarded Cash Resources or LIC 405 from August 2023 until August 2024; the ledger shows the amount (R#1) gets from Social Security to pay for their rent. In addition, the facility keeps a record of the leftover money as P&I for (R#1) every time they give some (R#1) signs for it. Furthermore, LPA reviewed (R#1)’s admissions agreement. (R#1) was admitted to the facility on 2/19/2020. However, during the interview with LPA Iniguez, (R#1) stated that all these allegatio ns happened eight years ago, back in 2016, and (R#1) was not living at that time at this facility. Evaluation Report continues LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 During an Interview with the Administrator (A#1), she stated that the facility safeguards (R#1) 's finances and the other residents; the facility uses the Record of the Client's/Resident's Safeguarded Cash Resources or LIC 405 to record the resident's finances. In addition, (A#1) stated that she has not taken money from (R#1) 's bank account, and (R#1) has not had their wallet stolen or been physically attacked while living here. During an interview with resident 1 (R#1), they stated that they had been here for eight years; the facility administrator manages their finances, but the administrator is taking their money from their bank account. LPA asked (R#1) how they knew the administrator was taking money from them; they said the bank told them the administrator had taken their money. LPA asked (R#1) if they had something in writing about that. (R#1) said no, all my money is under the administrators. LPA asked (R#1) if they felt safe living here, and they stated that no, I got hit five times in the face. Also, (R#1) stated that someone stole their wallet eight years ago. During interviews with residents (R#2-R#10), (5) out of (10) residents stated that the facility manages their finances and P&I; they feel the facility does a good job. Also, (3) out of (10) residents indicated that their families and conservator manage their finances, and (2) out of (10) residents manage their finances. During interviews with staff (S#1-S#3), (3) out (3) facility staff stated that the facility keeps a ledger or a Record of the Client’s/Resident’s Safeguarded Cash Resources or LIC 405 for the residents that received Social Security benefits. Evaluation Report continues LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Ginger Enriquez /Administrator.

Two-Hour Incontinent Check Log (dated: 05/01/23-07/10/23), Daily Body Check Log (dated: 02/02/22 - 07/10/23), and Medication Administration Records (dated 05/01/23 - 07/31/23) for Resident #1. A review of Harbor UCLA Medical Center (HUCLAMC) hospital records (dated 07/14/23) and Providence Hospice, Inc. Communication Log (dated: 12/11/22 – 07/19/23), Dental Records, Home Health Records. Interviews of family representatives (W2-W9), home health agency administrator (W1) facility staff (A1, S1-S3), and residents (R2-R10). INVESTIGATION REVEALED THE FOLLOWING: According to Identification and Emergency Information LIC 601 (dated: 03/11/21) and Admission Agreement (dated: 03/11/21) Resident #1 (R1) was a former Driftwood Nursing Center resident who was admitted to Carson Senior Assisted Living on 03/11/21. (R1) was in the care of Concise Home Health Service from (03/03/21 through 12/10/22) and Providence Hospice, Inc. from (12/11/22 through 07/19/23). The Certificate of Death (dated: 04/10/24) indicated the cause of death was Cardiorespiratory Arrest on 07/25/23. Allegation #1: Staff did not ensure residents dentures were cleaned. In the complaint, the facility staff is accused of not having resident #1 (R1)'s denture cleaned. A detailed explanation of this issue was not provided by the complainant. On 04/04/24 between 10:30 am to 03:00 pm, the Department interviewed (R1)’s family representative (W2) and reported concerns that (R1)’s dentures were always missing or lost. (W2) explained that (R1) had partial dentures as it was probably not cleaned regularly as it has gone missing. On 04/04/24 between 8:30 am to 03:30 pm, the Department interviewed (A1) and staff# 1 -#3 (S1-S3) denied the allegation. (A1 and S1) reported that (R1) wore partial dentures that were cleaned whenever they were not missing. (S1-S3) have reported there were occasions when (R1)’s dentures were discovered wrapped in tissue and disposed in (R1)’s wastebasket. (S3) claimed to have found it a couple of times in the wastebasket mistakenly disposed of by (R1). (A1-S1) claimed the facility had On-Site Dental Care to perform oral hygiene care on (R1) as indicated on progress notes (07/13/22; 08/22/22; 09/22/22,10/27/22; 12/06/22; 02/16/23). (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 According to Providence Hospice, Inc. Communication Log (dated: 12/11/22 – 07/19/23), notes indicated on 01/21/23, the hospice team spoke with (W3) and requested dentures for (R1). (W3) indicated (R1) lost denture two years back. Hospice scheduled (R1) for an oral X-ray on 02/16/23 was incomplete due to (R1) not willing to cooperate and (W3) was notified. On 04/04/24 between 09:00 am to 02:22 pm, the Department interviewed (9) out of (9) residents #2 - #10 (R2-R10) who had no issues with oral dental care. (R2-R10) confirmed that the facility provided residents who had no dental coverage on-site dental care. On 04/04/24 between 10:30 am to 03:00 pm, the Department interviewed family representatives (6) out of (6) witnesses #4 - #9 (W4-W9) claimed to have no issues with this matter. (W4-W9) were aware that on-site dental care was provided by the facility and found the service to be adequate and convenient for the residents in care. Based on the information collected, there is not enough evidence to corroborate the allegation mentioned above. Allegation #2: Staff did not ensure residents clothes were clean. Allegation #4: Staff did not safeguard residents’ personal property. It is alleged that resident #1 (R1) was seen often in dirty clothes and that (R1) was seen not in clothes that (R1) had ownership of. The complainant reported (R1) was seen often in dirty clothes and clothes that did not belong to (R1). The complainant claimed (R1)'s own clothes had (R1)’s name on them but (R1) was often seen in clothes that did not belong to (R1). The complainant did not have further details on these allegations. On 04/04/24 between 8:30 am to 03:30 pm, the Department interviewed (A1) and staff# 1 -#3 (S1-S3) all refuted these allegations. (A1 and S1) stated that (R1) was seen by a hospice aide twice weekly for dressing and grooming a part of (R1)’s daily routine. Maintaining good personal hygiene is vital to preventing ill health. (A1) and (S1-S3) expressed that (R1) required daily changes as (R1) was incontinent and would often soil clothing. (S1-S3) claimed that (R1) was only provided three outfits that would only last a few days. While clothing supplied by family members was laundered, (R1) will often be seen in donated clothing pieces. (S1-S3) claimed the clothing never appeared dirty and that donated clothing or recycled garments can never replace the appearance of new clothing. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On 04/04/24 between 10:00 am to 10:30 am, the Department interviewed hospice administrator witness #1 (W1) reported that (R1) was never seen in dirty clothing. (W1) claimed that a hospice aide assisted with dressing and grooming needs for (R1) twice a week. (W1) stated that her hospice team is mandated reporters, and if an act of neglect is observe it would be reported. On 04/04/24 between 09:00 am to 02:22 pm, the Department interviewed (9) out of (9) residents #2 - #10 (R2-R10) all claimed not to have concerns with their clothing appearance nor had issues with clothing not being safeguarded by staff. On 04/04/24 between 10:30 am to 03:00 pm, the Department interviewed family representatives (6) out of (6) witnesses #4 - #9 (W4-W9) reported to have no issues or concerns and that residents were found in presentable conditions and appearance in clothing when visits were conducted at the facility. A review of Providence Inc. Communication Log (dated: 12/11/22 – 07/19/23) revealed hospice aides assisted weekly with (R1)’s dressing and grooming. A review of facilities Caregiver Notes (dated: 04/04/23 – 07/10/23), One Hour Monitoring Log (dated: 04/01/23 - 07/10/23), Daily Body Check Log (dated: 02/02/22 – 07/10/23), Two Hour Incontinent Check Log (dated: 05/01/23 – 007/10/23) and Personal Care Log (dated: 05/24/23 -07/10/23) revealed (R1) is be assisted daily by staff self-care needs accordingly. Based on the information gathered, there is not enough sufficient evidence to corroborate the allegations mentioned above. Allegation #3: Due to staff neglect resident sustained pressure injuries. The complainant alleged due to facility staff negligence resident #1 (R1) sustained pressure injuries. The complainant indicated (R1) was receiving wound care and was uncertain about what stage of the wound. The staff failed to change the bandages promptly, resulting in further pressure injuries. Hospital records from Harbor UCLA Medical Center (dated: 07/14/23) indicated (R1) was admitted for general weakness and unresponsive. Medical records revealed (R1) sustained Coccyx Stage 3 pressure injury 3.5cm x 1.5 cm x 0.2 cm. Investigation revealed (R1) was admitted to Carson Assisted Living from Driftwood Nursing Center on 03/11/21. (R1) was under home health care with multiple home health agencies from (03/03/21 through 12/10/22) with a wound plan. (R1) continued wound care under Providence Hospice, Inc. from (12/11/22 through 07/19/23). (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Providence Hospice, Inc. Communication Logs (dated: 12/11/22 – 07/19/23) revealed (R1) received continued wound care as noted in the progress notes. On 07/06/23, a wound assessment and treatment of Coccyx pressure ulcer wound is now a Staged 3. The treatment plan included three (3) times a week gauze and Hydrocolloid dressing or as needed or soiled was communicated. On 04/04/24 between 8:30 am to 03:30 pm, the Department interviewed (A1) and staff# 1 -#3 (S1-S3) all contested negligence played a role in (R1)’s care. (A1 and S1) stated when it came to (R1)'s wounds were treated by hospice medical professionals. (A1-S1) claimed the facility staff was only responsible for (R1)’s non-medical care since the facility is a non-medical care facility. (A1 and S1-S3) all stated that although they are not trained medical professionals, the facility staff is trained to take care of the residents and supervise them. (A1) stated bandages that are wet or soiled are changed by hospice only. (S1-S3) claimed Daily Body Checks, Two-Hour Incontinent Checks, and One-Hour Monitoring Checks were performed on (R1).  (S1-S3) reported Caregiver Notes and Personal Care Logs as a means of communicating with staff regarding the resident's conditions verified that (R1) was receiving adequate care daily. On 04/04/24 between 10:00 am to 10:30 am, the Department interviewed hospice administrator witness #1 (W1) who reported that (R1) was under a wound care plan. Wound care treatment services continued with Providence Hospice, Inc. even after (R1) was discharged from (HUCLAMC) and was admitted to Rosecrans Care Center on 07/15/23.  (W1) claimed the Carson Senior staff were not neglectful in (R1)’s care. (W1) found the facility staff was diligent, attentive, and responsive when it came to (R1)’s health care needs. On 04/04/24 between 09:00 am to 02:22 pm, the Department interviewed (9) out of (9) residents #2 - #10 (R2-R10) and reported the facility would act accordingly and immediately attend to the resident’s needs. On 04/04/24 between 10:30 am to 03:00 pm, the Department interviewed family representatives (6) out of (6) witnesses #4 - #9 (W4-W9) observed the facility staff to provide the appropriate level of care for residents and denied neglect or lack of care of residents. A review of Providence Inc. Communication Log (dated: 12/11/22 – 07/19/23), Concise Home Health Services Records (date: 03/12

Regarding Allegation #1 : Staff neglected resident. This complaint alleged that staff neglected R1. A1 states that no staff would ever neglect a resident in care. A1 states no staff would ever refuse to call 911. LPA Calderon interviewed S1-S3. 3 out of 3 staff state that they would never neglect a resident in care. 3 out of 3 staff state that staff member would not refuse to call 911 if needed or have words with a resident in care. LPA Calderon interviewed R1-R10. R1 states that staff refused to call 911 for R1 and staff called R1 names. R1 states that staff have neglected R1 care. 9 out of 10 resident states that staff do not neglect their care and they have no issues with staff. W1 states that W1 was aware of R1 calling 911 and staff refused to call 911. W1 states that unknown staff called R1 words that were hurtful. On 05/15/2024 LPA Calderon reviewed the following: Reviewed the Physician report (date 03/21/2024), R1 has health issues. Reviewed incident report (date 05/10/2024) R1 was having chest pain and staff called 911. Regarding Allegation #2 : Staff withheld residents’ medication. This complaint alleged that staff withheld medication from R1. A1 states that at no time would any staff member refuse or withhold R1 or any medication from a resident in care. A1 states that accurate records are kept for any resident that takes medications. 3 out of 3 staff state that no staff would refuse or withhold any medication for R1 or any resident in care. 3 out of 3 staff state that accurate records are kept for each resident that takes medications. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA Calderon interviewed R1-R10. R1states that staff refused to give medication to R1. 9 out of 10 residents state that no staff member has refused or withhold any medication. LPA interviewed W1 who states that facility staff refused to give medication to R1. LPA Calderon reviewed the MAR for (April, May 2024) for R1. LPA Could not find any errors for R1 MAR. Regarding Allegation #3 : Staff did not respond to resident’s call assistance button in a timely manner. This complaint alleged that staff did not respond to R1 call button in a timely manner. A1 states that on average it takes 5 to 10 minutes for staff to answer resident call button. A1 states that every time a resident presses the call button the front desk answers and staff are sent to the resident’s room. 3 out of 3 staff state that it takes 5 to 10 minutes for staff to respond to a call button push. R1 states that R1 has pressed the call button and no staff responds. 9 out of 10 residents state that it takes 5 minutes for staff to respond to a call button. W1 states that W1 has noted no staff has responded to R1 call button push. LPA Calderon toured the facility and LPA pushed the call button for rooms 163, 273, 274 and 275. On average it took 5 minutes for staff to show up to the resident room and every time the call button was pushed the front desk answered. LPA Calderon noted 3 staff answered the call. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Based on interviews, observations and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegation of “staff neglected resident” “staff withheld residents’ medication” “staff did not respond to resident’s call assistance button in a timely manner” is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of the Complaint Report were provided to the Administrator Ginger Enriquez (A1).

INVESTIGATION REVEALED THE FOLLOWING: Allegation: Illegal Eviction. A review of (R1’s) Identification and Emergency Information LIC 601 (dated: 11/22/23), (R1) was admitted to Carson Senior Assisted Living on 11/22/23. According to facility Incident Reports LIC 624 (dated: 03/04/24 – 03/06/24), (R1) had three consecutive incidents involving staff on 03/04/24, 03/05/24, and 03/06/24, which led to (R1) being admitted at Harbor UCLA Medical Center, Exodus Recovery, Inc. Urgent Care Center and Southern California Hospital at Culver City. On 04/15/24, between 12:07 pm – and 12:57 pm the Department interviewed (2) out of (2) administrator #1 (A1) and staff #1 both denied the allegation. (A1) stated that she never issued a formal eviction notice to (R1). (A1) claimed (R1) remained a resident and that no personal belongings were removed from (R1’s) room. (A1 and S1) stated that (R1) has not been denied access inside the facility and continues to benefit from services provided by the facility. (A1) stated (R1) has received consultation on house rules. The administrator stated (C1) had three consecutive incidents on 03/04/24, 03/05/24, and 03/06/24, which would have warrant a formal eviction notice. (A1) added that if a formal eviction was implemented, (A1) would adhere to Title 22 regulations and notify Community Care Licensing in writing. In an interview with (S1), who was the staff involved in the incident on 03/06/24 with (R1), contacted 9-1-1. (S1) reported the Carson Sheriff's Department arrived at the facility and detained (R1). Later the Carson Sheriff escorted (R1) to Harbor UCLA Medical Center on 03/06/24 for medical evaluation. (A1) stated it was (R1’s) Laterman Petris Short Act (LPS) Social Worker and California State Public Guardian/Conservator who notified (R1) was transferred to Southern California Hospital at Culver City for further observation. (A1) claimed that a telephone discussion with (LPS) and the Public Guardian/Conservator about the possibility of relocating (R1) to another facility as (R1’s) needs and services may require a higher level of care. However, there have been no updates or fruition on the matter. On 04/15/24, between 01:12 pm – 01:22 pm, the Department conducted a telephone interview with (R1) who does not recall incidents that happened on 03/04/05, 03/05/25, and 03/06/24. (R1) claimed that no one at the facility has notified (R1) of an eviction and that no one has served (R1) with formal eviction in writing. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On 04/15/24, between 01:34 pm – 01:44 pm, the Department interviewed resident #2 (R2) a former roommate of (R1). (R2) claimed there is a reason that they are no longer roommates as (R1) does not adhere to the house rules. (R2) claimed not to have any knowledge of an eviction for (R1) but (R2) added it would not be a surprised as (R1) would be evicted, as (R1) does not follow the facility rules. On 04/15/24 at 01:23 pm – 01:33 pm, the Department interviewed California State Public Guardian/Conservator witness #1 (W1) for resident #1. (W1) confirmed that a conversation with (A1) discussed the possibility of transferring (R1) to another facility due to the incidents that occurred in March 2024 and that (R1) may require a higher level of care. (W1) stated there were no agreements of evicting the (R1) that came out of the discussion on 03/06/24. On 04/18/24 at 08:01 am – 08:23 am the Department interviewed (LPS) Social Worker witness #2 (W2) for resident #1. (W2) verified that a discussion of (R1) is being observed at Southern California Hospital at Culver City and the possibility of (R1) needing a higher level of care. (W2) claimed there were no arrangements for evicting the (R1) that came out of the discussion on 03/06/24. During the investigation on 04/15/24 and 04/18/24, the Department observed (R1) is included in the resident roster. The Department observed (R1's) personal possessions in (R1's) room. Based on the information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. Although the allegation may have happened or is valid, there is not enough preponderance of evidence to evidence the alleged allegation is valid did or did not occur, therefore the allegation is "Unsubstantiated". An exit interview was conducted with Ginger Enriquez, and a hard copy was provided.

On 04/05/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Ginger Enriquez. LPA Dabuet explained the purpose of today’s visit. The facility is licensed to operate for (230) non-ambulatory elderly adults of which (10) may be bedridden ages 60 and above. Currently, the facility has (166) residents and (2) in hospice care. The facility is approved for (10) hospice residents. The facility is a two story structure located in a commercial neighborhood. It consists of the following: (35) resident bedrooms in Arbor Unit and (99) resident bedrooms in Assisted Living. Each room has a bathroom in the unit, an activity room, a dining area, a kitchen, and outside patio area. LPA and administrator toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were stocked during the visit. The resident rooms were inspected: #13, #167, #163, #154, #2, #10,,#11, #17, #24 #213, #205 and #251, #257 and #271. All call buttons were in working condition. Bathrooms were operational with water temperature measured at 105.2 – 115.5 degrees F. A comfortable temperature was maintained in the facility at 72 - 74 degrees F. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Evaluation Report continues 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 Fire extinguishers were charged, and smoke detectors and carbon monoxide were operable in each resident's room. A review of the Medication Records Administration (MAR) was observed to be maintained in order and accurately. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. LPA conducted an audit of resident #1-#8 (R1-R8) service files, and staff #1-#8 (S1-S8) personnel files were in order and complete. The facility is current in CCLD annual fees. The facility has a current administrator certificate for Ginger Enriquez # 6024770740 valid through 03/07/25 and Joe Goldman #6001171740 valid through 05/03/25. No deficiencies during this visit. An exit interview conducted with Ginger Enriquez and a copy of the report is provided.

The investigation consisted of the following: LPA conducted the initial 24-hour visit and requested copies of pertinent documents. The complaint was accepted by CCL IB Investigation Unit and assigned to IB investigator Heidy Bendana. IB investigator Bendana conducted and completed the investigation which included interviews with Assistant Administrator, facility staff, residents, resident R1’s conservator, Social Worker Director at Edgewater Skilled Nursing, and Harbor UCLA Medical Center Clinical Social worker, reviewed Harbor-UCLA Medical Center Medical Records, and resident R1 facility records. Allegation: Resident sustained a fracture while in care It is alleged staff failed to supervise Resident R1 resulting in hospitalization for a fracture. During file record review it was notated R1 is independent. R1’s Physicians Report indicated R1 was “Able to Leave Facility Unassisted,” Able to Bathe, Dress, Groom, and Feed Self,” and did not require assistance with using the restroom or transferring. Appraisal/Needs and Services Plan listed R1 as ambulatory with the capacity to self-care and able to do all ADL’s, there was no indication that R1 was a fall risk. R1 was not feeble or slow and did not require assistance. During interviews with Staff S1-S3, they were asked, by the IB investigator, if R1 required assistance, three (3) out of three (3) stated R1 is independent and did not require assistance. Additionally, Staff (S1-S3) were asked if they were aware of R1 falling, three (3) out of three (3) stated they did not know R1 experienced a fall until R1 reported it to the hospital. During an interview with Staff S2, told the IB investigator, on 04/26/23 R1 was in their rocking chair, their face droopy, their speech was stuttered and not normal, therefore S2 called 911. S2 was informed Continued on LIC9099-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 by the hospital that R1 had a fall on 04/22/23. During an interview with R1’s Responsible Party (W1), conducted by IB investigator, stated they did not believe R1 was a fall risk. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated . Allegation: Staff failed to seek medical attention for resident in a timely manner. It is alleged that staff did not seek medical attention for Resident R1 in a timely manner. It was reported that Resident R1 had a fall on April 22, 2023, that resulted in a left femoral neck hip fracture. During interviews, conducted by IB investigator, with Staff S1-S4, they were asked if they had any knowledge of the fall R1 had, four (4) out of four (4) stated they had no knowledge of R1 having a fall, they did not receive that information until R1 reported to the hospital on April 26, 2023, they had a fall on April 22, 2023. On April 26, 2023, Resident R1 was transferred to the hospital due to R1’s face being droopy, stuttering, and speech not being normal. During an interview with MedTech S2 stated on April 25, 2023, R1 told them they were having leg pain and had given them pain medication, and that in the past, R1 frequently complained of leg pain. Additionally, during an interview S2, stated they did not remember if R1 reported a fall. During interviews, conducted by the IB investigator, with Residents R2 and R3, two (2) out of two (2) stated they receive assistance and medical assistance in a timely manner. 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 During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated . No deficiencies were observed or cited. An exit interview was conducted with Assistant Administrator, Ginger Enriquez, , and a copy of this report was provided.

INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff threatened resident while in care. Allegation #3: Staff did not provide a safe and comfortable environment for residents. The details of this allegation claimed that resident #1 (R1) was threatened by administrator #1 (A1). According to the reporting party (R1) was threatened by (A1) that (R1’s) personal property would be thrown away and that (A1) had threatened (R1) in the past. As a result of feeling threatened (R1) did not feel the facility provided a safe and comfortable environment for (R1) and other residents. On 02/23/24 at 12: 47 pm – 12: 58 pm the Department interviewed (R1) by telephone. (R1) claimed that (R1) had enjoyed living at the facility for (22). However, (R1) was threatened by (A1) who (R1) is unable able to identify by name. (R1) is unable to provide further information such as details on dates, times, and incidents that have occurred with (A1) where (R1) may have felt threatened. (R1) responded, "Yes", "I liked living there and I felt safe" when asked whether this facility provided a comfortable place to live. On 02/23/24 between 09:15 am – 10:30 am, the Department interviewed administrator #1 (A1), and staff #1-#3 (S1-S3) reported (4) out (4) verified that this allegation is untrue. (A1) claimed to have never threatened (R1) since (R1’s) residency at the facility. (S1) has simply followed up with (R1) regarding (R1’s) residency since (R1) had not returned to the facility since (R1’s) hospitalization on 09/12/23. (R1) had not given notice whether (R1) would remain as a resident. The facility continued to retain all of (R1's) personal property safeguarded and protected until (R1) had given notice to terminate residence. (S1-S4) stated that we have installed surveillance cameras, safety devices, smoke detectors, house rules, mandated elder abuse training, and emergency preparedness training to mitigate the risks of an unsafe environment. On 02/23/24 between 9:30 am – 11:50 am, the Department interviewed residents #2-#11 (R2-R11) (10) out (10) who are complimentary of (A1) and staff. (R2-R11) claimed they had not been threatened by (A1) or any of the staff. (R2-R11) all guaranteed they felt the facility has provided a safe and comfortable environment for residents. As a result of the information gathered, there is no evidence to support the allegations mentioned above. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation #2: Staff did not safeguard resident’s personal belongings. The details of this allegation reported that the facility failed to safeguard resident #1 (R1’s) personal belongings. On 02/23/24 at 12: 47 pm – 12: 58 pm the Department interviewed (R1) by telephone. (R1) claimed the facility failed to safeguard her personal property on the day she was transported to Harbor Regional Medical Center on 09/12/23. (R1) claimed to have observed individuals in and out of (R1’s) room and that money that was stored in a portable refrigerator with a lock was stolen. (R1) could not describe the individuals nor unable to determine the roles of the individuals in the facility. On 02/23/24 between 09:15 am – 10:30 am, the Department interviewed administrator #1 (A1), and staff #1-#3 (S1-S3) reported (4) out (4) verified that this allegation is false. (A1 and S1) claimed (R1) has been a resident for 19 years and has never had any issues with property not safeguarded. (A1 and S1) reported when (R1) was admitted to the hospital on 09/12/23, (R1’s) personal belongings remained in the room locked. (A1) unaware of how long (R1) was going to be away from the facility placed all (R1’s) personal items in an unoccupied locked room room #203. The Department verified all the items listed on (R1’s) Resident Personal Property and Valuables LIC 624 which listed (14) personal property items and (14) were accountable. From 10:26 am – 10:29 am, the Department took photographs of the items as evidence. The Department observed a portable refrigerator sealed with a padlock required a key to open. On 02/23/24 between 9:30 am – 11:50 am the Department interviewed residents #2-#11 (R2-R11) (10) out of (10) all confirmed their personal belongings were safeguarded and have not gone missing. On 02/23/24 at 10:10 am, (R1) effectively voluntarily terminated her residency with the facility when (R1) authorized in writing for (R1’s) guardian witness #1 (W1) to retrieve (R1’s) personal property. As indicated in (R1’s) discharge summary, “(W1) went up to the storage room and picked out what (W1) wanted to take with (W1)”. (W1) declined to be interviewed by the Department. As a result of the information gathered, there is no evidence to support the allegation mentioned above. Based on information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Ginger Enriquez, and copies of the reports were provided.

INVESTIGATION REVEALED THE FOLLOWING: Allegation #3: Facility staff did not observe change in resident's health conditions. Allegation #4: Facility neglected well care checkups for resident in care. The details of the complaint alleged the facility did not observe the change in resident #1 (R1) condition and neglected the wellness care checkup for (R1). The complainant claimed the (R1) was exposed to an infection and had general weakness of muscles. A review of (R1's) service records and medical records revealed, (R1) medical checkups were performed with the in-house physicians. Records indicated physician visits listed: 09/20/18,11/19/18, 12/12/18, 08/28/19, 02/19/20, 12/17/19, 01/17/20, 02/19/20, 08/13/20, 08/17/20, 09/03/20, and 09/13/20. Psychiatric Assessments were conducted monthly from 12/12/18 through 12/31/20. Physician's Report LIC 602A was performed on annually on 11/19/18, 12/17/19, 01/20/20, and 02/19/20. (R1's) Appraisal/Needs and Services Plan LIC 625 were performed on 06/19/1810/16/19, 01/17/20. (R1) records indicated, that (R1) was being observed by staff every (2) hours daily on each shift according to Incontinent 2-hour check logs. On 09/27/23, interviews were conducted between 10:00 am and 3:11 pm with (9) out (9) residents #2 - #10 (R2-R10) were complimentary of staff. (R2-R10) recognized that staff have challenging duties and remain to be attentive and responsive. On 09/27/23, interviews were conducted between 10:37 am and 12:43 pm with (5) out (5) family representatives witness #1-#5 (W1-W5) reported they did not have any concerns for their health and safety and medical assistance was available for residents at all times. (W1-W5) described the care and supervision as sufficient. On 12/01/23, interviews conducted between 11:00 am and 1:00 pm (5) out of (5) staff # 1- #5 (S1-S5) claimed care and supervision for (R1) continuous around-the-clock daily. (S1-S2) claimed, (R1) did present a decline in his health condition. (R1) was being medically assessed in-house by medical professionals, and (R1's) wellness checkups were performed in the facility. Evaluation Report continues LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Several attempts to interview (R1) on 09/27/23 and 11/27/23 were unsuccessful. (R1’s) health condition prevented (R1) from carrying on full conversations. (R1's) Case Workers were not available for an interview. Based on all the information obtained during the investigation, there is no evidence to support the allegations mentioned above. Based on the information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Beverly Malacas, and copies of the reports were provided.

INVESTIGATION REVEALED THE FOLLOWING: Allegation: Facility neglect resulting in resident developing infection. The details of the complaint alleged staff neglected resident #1 (R1's) care, resulting in an infection. The complainant reported that (R1) has not had a wellness care checkup since 2018 which may have caused (R1) to have an inactive Hepatitis B. The complainant did not provide any further information. (R1) was at this facility on 08/27/18 according to (R1’s) Identification and Emergency Information LIC 601 (dated: 08/27/18) (R1) did not have a legal guardian, power of attorney, conservator, or family listed. (R1) was admitted with no history of hepatitis infection. Medical lab test results (date:8/29/18 and 08/14/19) presented no hepatitis. (R1) continued medical checkups with the in-house physicians. Records indicate physician visits as follows: 09/20/18,11/19/18, 12/12/18, 08/28/19, 02/19/20, 12/17/19, 08/13/20, 08/17/20, 09/03/20, and 09/13/20. Psychiatric Assessments were conducted monthly from 12/12/18 through 12/31/20. Medical records for (R1) revealed on 09/03/20 reportedly, the lab work unable to be drawn due to the insurance card not being verified by the lab company. Medical records for (R1) (dated: 04/13/22) enclose a history of chronic hepatitis B, chronic hepatitis C, alcoholism, drug abuse, and TB infection. According to (ref: Mayo Clinic), the Hepatitis virus is passed from person to person through blood, semen, or other body fluids, and unsafe injection or exposure to sharp instruments. The Physician's Report LIC 602 for (R1) states that (R1) is unable to leave the facility unassisted nor had wandering behavior. ( R1)'s medication remained constant during his residency at the facility, and no needle injections were required according to his Medication Administration Records. On 09/27/23, interviews conducted between 10:00 am and 3:11 pm with (9) out (9) residents #2-#10 (R2-R10) claimed they were all healthy and had not acquired any infections due to lack of care. (R2-R10) reported medical assistance is available from their primary physician or the in-house primary physicians and is always accessible. On 09/27/23, interviews conducted between 10:37 am and 12:43 pm with (5) out (5) family representatives witness #1-#5 (W1-W5) stating no concerns for the health care for the residents at this facility. (Evaluation Report continues on LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Several attempts to interview (R1) on 09/27/23 and 11/27/23 were unsuccessful. (R1’s) health condition prevented (R1) from carrying full conversations. On 12/01/23, in interviews conducted between 11:00 am and 1:00 pm (5) out of (5) staff # 1- #5 (S1-S5) did not know how (R1) may have been exposed to an infection. (S3-S5) claimed that (R1) did not engage with others and was not intimate with any residents at the facility. Based on the information provided, it is unclear whether (R1) was exposed to or contracted the infection while in care at the facility. Therefore, based on all the information obtained during the investigation, there is no evidence to corroborate the allegation mentioned above. Allegation #2: Resident fell while in care. The complaint alleged resident #1 (R1) fell due to staff negligence while in care. The complainant (R1) fell off the bed and incurred bruises on the left side of the face. There was no further information provided by the complainant on this matter. A review of an incident report (dated: 03/01/21) revealed (R1) slid out of the wheelchair at 11:00 am on 03/01/21 while watching television in the activity room. The unwitnessed incident indicated (R1) sustained a minor bump on the upper left cheek and an ice pack was applied. There was no indication of an open wound. According to (R1’s) Physician’s Report LIC 602A, (R1), functional capabilities use a walker and a wheelchair unassisted (dated: 01/17/20). There is no indication in any of (R1’s) service records that (R1) was considered a fall risk and required constant supervision nor presented a history of falls. The facility notified the primary physician and Community Care Licensing (CCL) of this incident. A review of (R1) medications listed (R1) on Questiapine 200mg, Cetizine 10 mg, Aripirazole 10mg, and Norvasc 10mg. These medications all have side effects of simple unusual bleeding or bruising according to Mayo Clinic (ref. Mayo Clinic.org). On 09/27/23, interviews were conducted between 10:00 am and 3:11 pm with (9) out (9) residents #2-#10 (R2-R10) all confirmed to have no issue with accidents or falls while in care. (R2-R10) reported the care and supervision were adequate and felt safe while at the facility. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 An interview on 12/01/23 at 9:30 am with staff # (S2) confirmed to have had knowledge of the incident on 03/01/21 documented the necessary information, and later contacted the proper authorities of the incident. (S2) at the time of the incident, (R1) did not have an open wound nor showed signs of bruises. (S2) reported that (R1) is non-ambulatory and can get around with the help of a walker or wheelchair. (S2) stated (R1) only needed assistance transferring in and out of bed. Interviews conducted on 12/01/23 at 11:00 am – 1:00 pm with (4) out (4) staff #1, #3 - #5 (S1-S5) confirmed that (R1) was not a fall risk and did not have a history of falls at the facility. A review of (R1’s) Incontinent 2-hour check logs revealed (R1) was being supervised every 2 hours daily by staff. Several attempts to interview (R1) on 09/27/23 and 11/27/23 were unsuccessful. (R1’s) health condition prevented (R1) from carrying on full conversations. Therefore, based on all the information obtained during the investigation, there is no evidence to corroborate the allegation mentioned above. Based on the information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Ginger Enriquez, and copies of the reports were provided.

INVESTIGATION REVEALED THE FOLLOWING: Allegation: Facility has pests. The details of the complaint reported the facility has pests. The complainant reported the facility has "multiple cockroaches on the wall". The complainant did not provide further information on who was involved, where in the facility or when it took place. A full inspection of the entire facility was conducted by the Department, including the dining room, kitchen, activity rooms, library, medication, offices, public restrooms, and elevators. In Arbor Hall, the following rooms were inspected: #5, #7, #20, #21, #25, #26 and #27. In the Assisted Living, the following rooms were inspected: #2, #13, #20, #23, #30, #101, #102, #205, #209, #214, #267 and #284. During the inspection, no signs of pest infestation were observed on walls, floors, furnishings, or equipment. On 11/20/23 between 2:00 pm - 3:47 pm interviews with (7) out of (10) resident #1-#7 (R1-R7) indicated having no issues with pest in the common areas or individual rooms. (R8-R10) reported cockroaches were seen in their rooms; however, the facility sprays to eliminate the problem. Staff #1 (S1) stated the pest control company come to service the facility twice a week for the kitchen. Gam Exterminating Inc. comes to service the facility weekly or as needed. (S1) reported the facility has an annual service contract agreement with Gam Exterminating Inc. The facility provided maintenance service receipts along with the service contract as proof services are maintained. Based on the information gathered, the allegation mentioned above cannot be supported. Based on information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with Ginger Enriquez, and copies of the reports were provided.

INVESTIGATION REVEALED THE FOLLOWING: Allegation #1 : Staff did not seek medical attention for resident. The details of the complaint alleged that resident #1 (R1) had a swollen ankle and that staff did not seek medical attention. The complainant described (R1’s) left ankle was swollen in August 2023 while doing exercises and that administrator did not seek medical treatment. The Department interviewed (R1) at 9:30 am on 09/27/23. (R1) claimed was never injured during an exercise activity and can walk with no issues. (R1) denied ever having the left ankle injured. During the investigation visits on 09/15/23 and 09/27/23, (R1) was observed walking through the hallway with a walker properly and with no difficulties. On 09/27/23 between 11:00 am – 02:59 pm (4) staff out (4) staff #1-#4 all denied that (R1) had ever reported of injuries. (S1) claimed to be unaware making statement about (R1's) injuries to any individuals. (S1-S4) stated if staff had knowledge (R1’s) injuries, it would have been reported and documented. “Daily Body Check Report” is completed by staff, and this would have been addressed with the in-house physician. Interviews conducted between 10:01 am – 3:11 pm with (9) out (9) residents #2-#10 (R2-R10) had no concerns or issues receiving medical assistance timely. (R10) stated that facility staff are proactive and have made improvements by training staff in medical procedures and have been responsive. Interviews conducted between 10:37 am – 12:43 pm with (6) out (6) family representatives witness #1-#5 (W1-W6) reported they did not have any concerns for the health and safety for the residents. (W1-W6) described the care and supervision as sufficient. The Department reviewed the medical assessments reports for (R1) (dated: 08/23/23 and 08/30/23), revealed (R1) had no muscle weakness, was stable, and no falls reported. The Body Check Report” (dated: 08/01/23 – 08/31/23) did not indicate any bodily injury for (R1). Therefore, based on all the information obtained during the investigation, there is no evidence to support the allegation mentioned above. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation #2 : Staff did not provide resident with his P & I. It is alleged that staff withholds resident #1 (R1's) Personal and incidental cash resources. The complainant reported (R1) receives a monthly $322 from the Social Security Administration. The complainant claims the staff is withholding (R1's) cash resources because of overdue balances for (R1) basic services. The complainant also is unclear on what the facility is charging (R1) for basic services. (R1) was admitted on 06/18/21 according to the Admission Agreement (dated: 06/18/22). (R1) has no conservative or power of attorney listed on record. The basic services rate was $ 1,079.32 for a shared room in the assisted living section. A Physician's Report (dated: 04/04/22) required for (R1) needing services in the memory care section in Arbor Hall. (R1) was transferred to a private room in 08/2021 in Arbor Hall after being hospitalized in July 2023 with physician's orders. The basic services is $4500.00 in Arbor Hall. The facility is not charging (R1) $4500 per month for services and a private room, instead the facility is only charging by California Assisted Living (CALA) requirements effective 01/01/23 $1344.82. The facility is only authorized by (CALA) the following: Room and board $64.82; Care and Supervision $678; SSI/SSP $20 for total basic services payable $1344.82. (R1) is paid each month by (SSI/SSP): Supplemental Security (SSI) $914; State Supplementary Payment (SSP) $578.82 total for Non-Medical Out of Home (NMOHC) payment standard is $1492.82. Once the basic services of $1344.82 are deducted, (R1's) Personal and Incidental (P&I) allowance is $168 each month. According to staff #1 (S1) the facility was granted as the payee for (R1's) SS1/SSP benefits from 06/2023 - 08/2023. The payee was changed to (R1's) family representative effective 09/1/23. With the current changes in payee, the facility has not been paid for September 2023. A review of (R1's) Record of Resident's Safeguarded Cash Resources LIC 405 for 2023 indicates that (R1) has a (P&I) credit balance of $504.00. The Department interviewed (R1) at 9:30 am on 09/27/23. (R1) claimed not to handle finances and that it is being handled by a family member. (R1) confirmed receiving (P&I) money from the business office when requested. (R1) only request for $20 only has needed as (R1's) preference. (R1) explained there is no need for additional money as everything is here at the facility. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Interviews conducted between 10:01 am – 3:11 pm with (9) out (9) residents #2-#10 (R2-R10) had no issues related to finances. (R7-R10) stated they handled their finances. Interviews were conducted between 10:37 am and 12:43 pm with (6) out (6) family representatives witness #1-#5 (W1-W6) reported that family members handled cash resources for residents. Therefore, based on all the information obtained during the investigation, there is no evidence to corroborate the allegation mentioned above. Allegation #3: Staff are not meeting resident’s hygiene needs. Allegation #4: Staff are not meeting resident’s laundry needs. According to the complaint report, resident #1 (R1) was not bathed and was wearing dirty clothes. The complainant described (R1’s) hygiene as not being met and was seen in dirty clothes and socks. The complainant did not elaborate on details nor provided the date or time when (R1) was seen in this state. In the Department's observations on 09/15/23 and 09/27/23, (R1) appearance on both occasions were pleasant. On 09/15/23 at 11:30 am while (R1) was in line for a lunch meal, (R1) was dressed in a plain dark navy blue sweatshirt and denim jeans. On 09/27/23 at 9:30 am was seen in a T-shirt and a plaid pants while watching television. (R1) appeared to be in clean clothing and well-groomed. (R1) was interviewed on 09/27/23 at 9:30 a.m. and reported no issues with hygiene assistance from staff. (R1) indicated being bathed three times a week, and laundry is done by staff weekly. On 09/27/23 between 11:00 am – 02:59 pm (4) staff out (4) staff #1-#4 confirmed that (R1) is being assisted with hygiene weekly. (S1-S2) denied (R1’s) ever appeared in disheveled or unclean clothes. (S1) claimed the clothes on (R1) are donated and not purchased by (R1) or (R1's) family members. Donated clothing may often present the appearance that it is not of the best quality or condition according to (S1). Interviews conducted between 10:01 am – 3:11 pm with (9) out (9) residents #2-#10 (R2-R10) verified to not having issues with lack of assistance with hygiene or laundry services. (R7-R10) claimed to be independent and can self-care for themselves. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (R10) expressed having preference to wash one's laundry, since (R10) prefers not having clothing handled by others. Interviews were conducted between 10:37 am and 12:43 pm with (6) out (6) witnesses #1-#6 (W1-W6) reported no issues with resident's hygiene requirements being met. (W1-W6) had no issues with the resident's clothes being laundered by the facility. A review of the facility’s Shower List Log (dated: 08/01/23 – 08/31/23) indicated that (R1) is given pm showers on Monday, Wednesday, and Friday (3) times a week initiated by staff. (R1) is being monitored for “Incontinence (2) Hour Check” from 8 am – 9 pm and for “(1) Hour Activity Monitoring” from 7 am – 10 pm marked by staff on record along with “Daily Body Check Report”. Therefore, based on all the information obtained during the investigation, there is no evidence to support the allegations mentioned above. Based on information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegations mentioned above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Ginger Enriquez, and copies of the reports were provided.

INVESTIGATION REVEALED THE FOLLOWING: Allegation: Resident sustained multiple pressure injuries while in care. The details of the complaint alleged resident # 1 (R1) sustained multiple pressure injuries while in care at this facility. As reported on the Report of Suspected Dependent Adult/Elder Abuse (SOC 341) form. Specifically, the complaint focused on an incident that occurred on 12/14/21 when (R1) was hospitalized at Harbor UCLA Medical Center Hospital. Indicated on the (SOC-341) (R1) presented multiple wounds described in various stages from unstageable to wound healing in Stage 3. In medical records, a total of (15) wounds were identified. The Department reached out to the complainant for further comments but was not available. The Admissions Agreement indicated (R1) was admitted at Carson Senior Assisted Living (CSAL) on 04/19/21. (R1) was medically assessed according to (R1’s) Physician’s Report dated 04/19/21 as ambulatory in fair physical health status. (R1’s) capacity for self-care required assistance with activities of daily (ADL) however did not require continuous bed care and a history of skin breakdown. According to service records (R1) was admitted on 04/20/21 by St. Paul Home Health Services (SPHHS). Home health services included services 2 or 3 visits weekly by a licensed registered nurse who attended to (R1’s) medical health condition that included a wound care order. The medical records for (R1) presented between 04/19/21 to 12/14/21, (R1) transitioned between hospitals, skilled nursing homes, and Carson Senior Assisted Living (CSAL). As a result of these transitions, (R1’s) wound care orders remained consistent with St. Paul Home Health Services. Each time (R1) was readmitted back at (CSAL), (SPHHS) was reinstated. In accordance to a Medical Body Assessment and Body Documentation for (R1), wound assessment and care was conducted on 09/24/21, 10/14/21, 11/23/21, 11/24/21, 12/04/21 by (CSAL) (SPHHS) and Omni Wound Physicians (OWP). The West Coast Wound Company conducted an additional wound assessment and wound treatment plan on 12/02/21. No wounds were classified as stage 3 or stage 4 in any of the assessments. (Evaluation Report continues LIC 9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Staff #1-#2 (S1 and S2) provided a written Declaration dated 04/14/22 indicating confirmation (R1) had continuous wound care under (SPHHS) and throughout transitions between hospitals, skilled nursing homes, and (CSAL). Interviews with (3) out (5) staff #3-#5 (S3-S5) on 04/18/22 all verified body assessments were conducted regularly and noted on charts for (SPHHS) and home health notified. (S3-S5) reported (R1) was able to reposition was not bedridden and was not neglected in care or supervision. On 04/04/22, the Department interviewed (9) out (166) residents #2-#10 (R2-R10) who had no pressure injuries and were complimentary of care staff. (R2-R10) reported care staff are caring, accountable, and responsive to residents in care. On 08/23/23, the Department interviewed resident #1 (R1) who is being cared for at Country Villa Belmont Heights Healthcare Center confirmed (R1) was on home health. When (R1) was a resident at (CSAL) that home health was assisting with (R1’s) wounds. (R1) reported the staff at (CSAL) were fair and they assisted when home health was not available. (R1) did not feel neglected and received assistance until (R1) required a higher level of care. (R1) stated that (R1) always had wounds and it was being addressed at (CSAL) to prevent further infections. (R1) stated (R1) was able to reposition (R1) in bed and was not considered as bedridden. (R1) does not hold the (CSAL) responsible for the wounds as (R1) was being assisted by home health services along with care staff at (CSAL). Based on information gathered, an inspection of the facility, observation, analysis of (R-1)'s service records medical records, and home health records, Declarations, and interviews conducted, the Department found no evidence to support NEGLECT OR LACK OF SUPERVISION: Resident sustained multiple pressure injuries while in care is Unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur as a result, the allegation is Unsubstantiated. An exit interview was conducted with Ginger Enriquez and a copy of the report was provided.