Emerald Valley

***CONTINUE FROM 9099C*** Allegation: Staff do not ensure residents’ dietary needs are met — Unsubstantiated During the investigation, LPA reviewed facility menus, including special diet menus posted in the kitchen, and interviewed S4, who demonstrated knowledge of residents’ dietary restrictions, and food preparation procedures. Documentation reviewed reflected that residents’ dietary needs and restrictions were identified in their records and incorporated into meal planning. LPA observed the kitchen area and food storage, which appeared organized, and adequately stocked. Residents interviewed did not report concerns regarding food access, meal quality, or staff withholding food. This agency has investigated the investigations above. We have found that the allegations were 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, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, a copy of this report provided. 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 ***CONTINUE FROM 9099*** LPA interviewed seven staff (S1–S7), three residents, and one responsible party for R2. Interviews conducted did not reveal disclosures or observations consistent with physical abuse, humiliation, or mistreatment by staff. Residents interviewed did not report being sprayed with water, forced into showers, or physically harmed. Staff consistently denied the allegation and reported that residents are treated with dignity and respect. The responsible party for R2 interviewed also did not express concerns regarding staff conduct or treatment of residents. LPA also reviewed Staff files, including notes and reports. No reports of misconduct by the staff were documented. LPA toured the facility including three resident rooms, the memory care unit, and common areas. No evidence of abuse, unsafe practices were observed. LPA also checked the water temperature. Water temperature was measured at 112.9 F. Allegation: Staff do not distribute residents’ medications as prescribed — Unsubstantiated LPA reviewed five resident files (R1–R5), including physician reports, needs and services plans, and Medication Administration Records (MARs). Records reviewed showed medications were documented as administered in accordance with physician orders. No discrepancies were identified during records review. Staff interviewed described medication administration procedures consistent with facility policy and regulatory requirements. Additionally, no residents interviewed reported missed medications or concerns related to medication administration. ***CONTINUE ON 9099C***

***CONTINUE FROM 9099C*** The review of video footage recorded in different days and times, email correspondence and care notes supports that these lapses occurred for extended periods, which is inconsistent with the level of care outlined in R1’s care plan.The combination of recorded footage, staff interviews, and facility records corroborates that care was not provided as required. Allegation: Staff did not provide adequate care and supervision to a resident - Substantiated LPA reviewed R1’s Needs and Services Plan, R1's charting notes, video footage submitted by W1, and conducted interviews with staff S1–S3 and W1. A review of the documentation and recordings showed that staff did not consistently provide care and supervision in accordance with R1’s assessed needs and level of care. Evidence indicated that required assistance and monitoring were not provided at appropriate intervals, demonstrating gaps in supervision. Based on LPAs observations, interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D and civil penalty is being issued. 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 ***CONTINUE FROM 9099*** A review of staff records and logs did not reveal documentation or evidence indicating verbal abuse toward residents.LPA also conducted interviews with three resident (R2,R3,R4). All three residents stated that they are satisfied with the staff. This agency has investigated the investigation above. We have found that the complaint was 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, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted, a copy of this report provided.

***CONTINUE FROM 9099*** S1 also reported that R1 was encouraged to use pendent for assistance in daily activities in addition to regular check-ins. S3 stated that he always went to R1s room to offer assistance and "passed on notes to the next caregiver on shift". LPA reviewed communication log, check-in schedule, and internal caregiver notes. LPA reviewed staff schedule for the month of March and April. On 4/14, S3 stated that he "found R1 on the floor outside of his room with blood coming from R1's head. S1 stated that "911 was called by the med tech, W1 was notified, and R1 was taken to the hospital immediately". W1 stated that she is unable to provide hospital records and pictures. Review of R1's care plan and staff assignment sheet revealed that R1 was on a total assist with activities of daily living. Allegation: Staff did not refund resident according to the resident’s Admission Agreement- Unsubstantiated Review of R1s payer summary revealed that W1 paid the facility $16998.38 on 04/08/2025. On 04/21 W1 was refunded 10081.67 which included 5081.76 for the the part of the month that R1 was not residing at the facility. The summary also showed that R1 was refunded one time move in fee of $5000. W1 stated that she did receive 10081.67 from the facility. S4 stated that "what we have in the admission agreement is what we follow". LPA reviewed the ledger and the admission agreement for R1. Allegation: Staff mismanaged resident medication - Unsubstantiated Review of R1 record revealed that R1 was at the facility for 18 days. W1 stated that she received a call regarding missing medication. No staff member at the facility could verify that called her regarding missing medication. S2 stated that only 1 over the counter medication was missing. S2 further stated that W1 "called and mentioned that she will bring the over the counter medication to the facility". LPA checked the MAR for R1. No missing medication was marked on R1's MAR. LPA also reviewed a sample of resident's (R2,R3) medications. There was no missing medications reported on R2's and R3's MARs. ***CONTINUE ON 9099C*** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ***CONTINUE FROM 9099C*** This agency has investigated the above allegations. We have found that the allegations were 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, therefore the allegations are unsubstantiated. Exit interview conducted, a copy of this report provided.

On 12/16/2025 at 11:27 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver amended report for complaint #15-AS-20250425125708 . LPA met with Executive Director Janelle Douglas and explained the purpose of the visit. Amended report delivered to Executive Director. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Allegation: Staff administered medication to the resident without consent. Based on interviews, record reviews, and documentation obtained during the investigation, there is insufficient evidence to support the allegation that staff administered medication to a resident without consent. Medication Administration Records (MARs), physician orders, and resident records were reviewed and showed no discrepancies or indications of unauthorized medication administration. Interviews with staff and residents revealed consistent procedures for obtaining consent before administering medications, in accordance with physician orders and facility policy. Although the allegation may have been made in good faith, there was no direct evidence or witness statements confirming that staff administered medication to any resident without consent. Therefore, the allegation is determined to be unsubstantiated . Allegation: Staff are not properly trained. Based on interviews, record reviews, and documentation obtained during the investigation, there is insufficient evidence to support the allegation that staff are not properly trained. Staff training records, personnel files, and required certification documentation were reviewed and found to be current and in compliance with Title 22 regulations and facility policy. Interviews with staff confirmed they had received training appropriate to their assigned duties, including ongoing in-service and annual training. Although the allegation may have been made in good faith, there was no evidence to indicate that staff lacked the necessary training to perform their responsibilities. Therefore, the allegation is determined to be unsubstantiated . Report continues on LIC 9099 C2... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff are not following infection control practices. Based on interviews, observations, and record reviews conducted during the investigation, there is insufficient evidence to support the allegation that staff are not following infection control practices. Observations during the inspection showed staff adhering to proper infection control procedures, including the use of personal protective equipment (PPE), proper hand hygiene, and sanitation practices consistent with facility policies and Title 22 regulations. Interviews with staff confirmed that they had received infection control training and understood the required protocols. Review of training records and facility policies indicated that infection control practices are regularly reviewed and reinforced. Although the allegation may have been made in good faith, no evidence or observation confirmed that the staff failed to follow infection control practices. Therefore, the allegation is determined to be unsubstantiated . Allegation: Facility is overcharging the resident in care. Based on interviews, record reviews, and documentation obtained during the investigation, there is insufficient evidence to support the allegation that the facility is overcharging the resident in care. A review of resident financial records, admission agreements, and billing statements showed that charges were consistent with the agreed-upon rates and services outlined in the resident’s contract. Interviews with facility staff and residents (or responsible parties) confirmed that fees and billing practices were explained and documented in accordance with regulatory and facility requirements. No discrepancies or unauthorized charges were identified during the investigation. Although the allegation may have been made in good faith, there was no evidence to substantiate claims of overcharging. Therefore, the allegation is determined to be unsubstantiated. Report continues on LIC 9099C3... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff do not ensure residents are provided with activities. Based on interviews, observations, and record reviews conducted during the investigation, there is insufficient evidence to support the allegation that staff do not ensure residents are provided with activities. Review of the facility’s activity calendar, resident participation logs, and staff schedules confirmed that planned activities are offered on a regular basis in accordance with Title 22 requirements and facility policy. Interviews with residents and staff indicated that a variety of activities are available, including group and individual options, and residents are encouraged—but not required—to participate. Observations during the visit also confirmed that activities were being conducted and residents were engaged. Although the allegation may have been made in good faith, there was no evidence to indicate that staff failed to provide or encourage resident participation in activities. Therefore, the allegation is determined to be unsubstantiated. Allegation: Staff do not provide adequate food service. Based on interviews, observations, and record reviews conducted during the investigation, there is insufficient evidence to support the allegation that staff do not provide adequate food service to residents. Meal service was observed during the visit, and food was found to be properly prepared, well-portioned, and served at appropriate temperatures. The facility’s menu was reviewed and found to meet residents’ nutritional needs in accordance with Title 22 regulations and physician or dietician recommendations. Interviews with residents and staff indicated that meals are provided on schedule, with alternative options available for those with dietary restrictions or preferences. Review of food supply records and storage areas confirmed that the facility maintains an adequate quantity and quality of food. Although the allegation may have been made in good faith, there was no evidence to indicate that staff failed to provide adequate food service. Therefore, the allegation is determined to be unsubstantiated. Report continues on LIC 9099C4... 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: Facility is not in good repair Based on observations, interviews, and record reviews conducted during the investigation, there is insufficient evidence to support the allegation that the facility is not in good repair. During the inspection, the physical plant, resident rooms, common areas, and outdoor spaces were observed to be clean, safe, and well-maintained. No health or safety hazards were identified, and all fixtures, furnishings, and equipment appeared to be in proper working condition. Interviews with residents and staff indicated no ongoing maintenance concerns, and review of maintenance logs showed that repair requests are addressed in a timely manner. Although the allegation may have been made in good faith, there was no evidence to indicate that the facility failed to maintain the premises in good repair. Therefore, the allegation is determined to be unsubstantiated. Allegation: Facility has pests. Based on observations, interviews, and record reviews conducted during the investigation, there is insufficient evidence to support the allegation that the facility has pests. During the inspection, all indoor and outdoor areas—including resident rooms, kitchen, dining area, and storage spaces—were observed to be clean and free of any signs of pest activity. Interviews with staff and residents revealed no recent reports or sightings of pests. Review of pest control service records confirmed that the facility maintains a regular pest control contract and receives routine inspections and treatments as needed. Although the allegation may have been made in good faith, there was no evidence to indicate the presence of pests at the facility. Therefore, the allegation is determined to be unsubstantiated. Report continue on LIC 9099C5... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff do not securely store residents' personal items. Based on interviews, observations, and record reviews conducted during the investigation, there is insufficient evidence to support the allegation that staff do not securely store residents’ personal items. During the inspection, residents’ rooms and storage areas were observed, and personal belongings appeared to be properly stored. Lockable storage options were available to residents who wished to secure their valuables. Interviews with residents and staff indicated that residents are encouraged to keep personal items in their designated areas and that the facility has policies in place to safeguard residents’ belongings. Review of records revealed no reports or complaints of missing or mishandled items. Although the allegation may have been made in good faith, there was no evidence to indicate that staff failed to securely store residents’ personal items. Therefore, the allegation is determined to be unsubstantiated. Based upon interviews conducted and records reviewed, LPA has investigated the above allegations and found that it is Unsubstantiated. A finding that the complaint allegation/s are Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview is conducted, and a copy of this report is provided.

Facility Type: RCFE Application Type: CHOW Capacity: 80 Census (if any clients in care): COMP II by CAB successfully completed Method: Telephone call COMP II Participant: JENNIFER COONS Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. Identification of the applicant and administrator was verified by photo ID . During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of property

On 1/16/2023 at 4:30PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a health and safety check as a result of a priority 1 complaint. LPA met with Connections For Living Director, Brandie Barrios. Executive Director (ED) Marissa Espinoza was not available at the time. LPA toured facility including but not limited to the resident bedrooms, bathrooms, common area, kitchen, and outdoor area. Facility temperature was maintained at 73 degrees F. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Refrigerator was 31 degrees F and freezer was -2 degrees F. Resident's medications were kept locked in the medication room. Smoke detectors are interconnected with sprinkler system. Carbon monoxide detector observe. Fire extinguisher was observed to be full. There are no accessible bodies of water observed. At 1/16/24 at 5:15PM during the health and safety checked LPA did a random checked of hot water temperature in five resident room in memory care until. 5 residents’ temperature were measured above 121 degree F. Type A deficiency is cited per Title 22 California Code of Regulations. Exit interview was conducted with Brandie. A copy of this report and Appeal Rights were provided via email.

It was alleged that staff mismanaged resident's medication; however, based on the investigation, including interviews, record reviews, and observation, there was insufficient evidence to support the allegation that staff mismanaged a resident’s medication. Medication administration records and staff documentation were consistent with prescribed orders, and no discrepancies were observed during the review. Staff demonstrated appropriate medication handling and administration procedures in accordance with facility policy and regulatory requirements. Allegation: Staff speak inappropriately to residents in care During the course of the investigation, LPA conducted 6 staff and 6 residents' interviews. It was alleged that staff spoke inappropriately to residents in care. Based on the investigation, including interviews with 5 staff, 6 residents, and a review of relevant records, there was insufficient evidence to support the allegation that staff spoke inappropriately to residents in care. Residents interviewed did not report instances of verbal mistreatment, and no witnesses or documentation corroborated the allegation. Staff demonstrated appropriate and respectful communication with residents during observations. Based upon interviews conducted and records reviewed, LPA has investigated the above allegations and found that it is Unsubstantiated. A finding that the complaint allegation/s are Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview is conducted, and a copy of this report is provided.

***CONTINUE FROM 9099*** W1 stated R1 appeared un-showered and disheveled on several occasions.LPA’s review of the shower schedule and progress notes showed that showers were offered regularly, consistent with the care plan. Shower refusals were documented in instances, including one entry where staff noted the resident declined assistance due to discomfort. The progress notes reflect hygiene tasks were being logged routinely. S1 and S3 confirmed that R1 was offered showers two to three times per week and sometimes refused. S1 recounted staff helping R1 with a full shower two days before the ER visit in March. LPA interviewed R2 who shared that "caregivers provided help with personal hygiene as needed according to the care plan". Allegation: Staff do not ensure that the resident has clean clothes — Unsubstantiated W1 shared concerns in emails that R1 was observed wearing soiled or dirty clothes, including one incident on 03/26/2025. The laundry logs and daily care notes indicate that clothing changes were performed regularly and clean clothing was available in R1’s room at the time of visit. S1 stated " incident noted by the home health nurse was attributed to a disconnected catheter, not due to lack of clean clothing". During the investigation visits, LPA toured R1, R2 and R3's rooms and found the rooms to be clean and sanitary. S2 and S4 stated that R1’s laundry was done at least twice weekly and clean clothing was rotated regularly. S2 stated " when the resident cooperated, he was dressed each morning in clean attire". Video evidence provided by W1 showed instances of unkempt appearance but did not clearly establish ongoing pattern of issues related to clothing hygiene. Allegation: Staff are not meeting resident’s hygiene needs — Unsubstantiated W1 expressed concern about R1's hygiene in emails and interviews. LPA's review of ADL documentation, grooming logs, and progress notes confirmed that hygiene tasks, including oral care, changing of briefs, and grooming, were being addressed regularly per care plan. ***CONTINUE ON 9099C*** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ***CONTINUE FROM 9099C*** Entries documented refusals at times, particularly during early morning hours. LPA also toured R1 and R2 and R3’s rooms during visit. LPA observed the rooms were clean and sanitary. S3 and S4 explained that hygiene assistance was offered at least twice daily, and any refusals were documented. S4 noted that grooming tasks were “more difficult when the resident was fatigued or irritable”. LPA interviewed R2 and R3 who did not report hygiene issues among staff. While W1’s observations and concerns are noted, the documentation and interviews do not support a consistent failure in meeting general hygiene needs. Allegation: Resident left in soiled clothing for extended period of time — Unsubstantiated On 03/26/2025, W1’s home health nurse reported that upon arrival at approximately 11:00 AM, R1 was found in wet clothing due to a disconnected catheter. The nurse noted that the resident’s brief and pants were wet, and that R1 declined to be changed at that time. W1 expressed concern that this condition may have been ongoing since 7:00 AM, based on her video monitoring. However, the time of catheter disconnection and when soiling first occurred could not be independently verified. Interviews with S2 and S5 indicated that routine overnight checks were completed and that no visible soiling was observed during their shifts. Progress notes and daily logs for 03/25–03/26 do not reflect any unaddressed episodes of incontinence. While W1's documentation suggests that R1 may have remained in soiled clothing, documentation and staff interviews do not support a finding that R1 was knowingly left in soiled clothing for an extended period of time by staff. This agency has investigated the allegations above. We have found that the allegations were 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, therefore the allegation are Unsubstantiated. Exit interview conducted, a copy of this report provided.

***CONTINUE FROM 9099*** Interviews with S1–S3 also confirmed that S4, S5, and S6 restrained the resident while in the second-floor memory care unit. Review of the documents indicated that the resident remained restrained overnight, which led to disciplinary action and termination of the involved staff members. Based on LPA's interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D Exit interview conducted and a copy of this report and appeals rights provided.

Emerald Valley staff first noticed redness on R1 bottom on 11/26/2023. Home health was requested on 11/28/2023 and a follow up was requested again on 12/7/2023, but services did not begin until 12/15/2023 after F1/Power of Attorney (POA) called R1’s doctor for a referral. Home health nurses visited R1 on 12/15/2023 and instructed staff to reposition R1 every two hours, and to change the dressing when it became soiled. Home health physical therapist found R1 sitting in R1 wheelchair, on R1 pressure injury, and reminded staff not to let R1 sit on R1 injury. R1 was admitted into the hospital on 12/20/2023 for low blood pressure, sacral pressure injury and blood in R1 urine. A hospital nurse (name unknown) staged R1 pressure injury as a stage 3, which was estimated to have been present for the past three weeks. R1 required debridement surgery and was discharged from the hospital back to Emerald Valley with hospice services. R1 was interviewed and said staff put R1 in R1 chair and R1 sat there all day. Staff always told R1, “We’ll get back to you,” when R1 requested help from them. R1, F1 and F2, frequently pressed R1 call button to request staff assistance but were rarely helped. Staff always said they were busy or made excuses. Emerald Valley caregivers were interviewed and admitted they found R1 lying in soiled diapers and soiled bedding on multiple occasions. NOC shift caregivers endorsed to AM and PM shifts to not put R1s water bottle on R1 bed as it often leaked and got R1 clothes and sheets wet. Because they could not transfer R1, they left R1 in wet clothes and bedding until the AM shift could change R1. Med techs were also interviewed and stated caregivers put off repositioning R1 because “R1 was too heavy.” Caregiver told me one of the other caregivers they need to constantly ask staff to reposition R1. Since staff rarely responded to their requests for help, F1 and F2 repositioned R1 themselves when they visited R1. Based on the information obtained, the findings are substantiated. Continues on LIC9099-C2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff did not meet resident's diapering needs- Substantiated It was alleged staff did not meet resident’s diapering needs. On 1/16/2024, LPA reviewed caregivers’ care notes dated 11/28/2023 which noted while S7 was conducting a round check, S7 noticed R1’s water bottle behind R1’s bed fell over and water leaked on R1’s bed. S7 cannot transfer R1 and S7 left R1 in the wet bed. R1 was not changed until the following morning. R1 was in bed with wet sheets and clothes the entire night. On 1/23/2024, LPA interviewed W3 who stated that on 12/30/2023, W3 arrived at the facility to provide wound care to R1. W3 observed R1 lying in a soiled bed and diaper from 9 a.m. until 1:20 pm when facility staff arrived. Allegation: Staff did not ensure proper medication assistance was provided to resident in care- Substantiated Allegation: Staff did not attend to resident's call button- Substantiated It was alleged staff did not ensure proper medication assistance and staff did not attend to resident’s call button. On 12/30/2023 at 9:00 a.m., W5 was at R1’s bedside and R1 complained of pain. W5 pushed the call button to contact staff, but staff did not respond to R1’s call button until 1:20 p.m. According to W5, S8 who has the keys to the medical cart was on break. LPA attempted to interview S8 multiple times, but LPA was unable to obtain additional information. On 1/23/2024, LPA interviewed W3. W3 stated when W3 arrived at the facility to provide wound care to R1, W3 observed R1 lying in a soiled bed and diaper. W3 informed a facility staff that W5 has been trying to call a staff since 9:00 a.m. to assist R1 with medication. However, W3 stated no staff has responded and confirmed that staff did not respond until 1:20 p.m. On 1/16/2024, LPA reviewed R1’s medication administration record (MAR) and LPA did not observe pain medication was administered to R1 on 12/30/2024. Report Continues on LIC 9099 C3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff did not ensure resident's wound care needs were met- Substantiated It was alleged that staff did not ensure the resident’s wound care needs were met. On 1/16/2024, LPA reviewed caregivers' notes dated 11/28/2023, which noted that while S7 was conducting a round check, S7 noticed R1’s water bottle behind R1’s bed had fallen over, and water leaked on R1’s bed. S7 cannot transfer R1 and S7 left R1 in the wet bed. R1 was not changed until the following morning. On 1/25/2024, LPA interviewed S7 via phone. S7 admitted that S7 left R1 knowing that R1's wound cannot be wet for a long period of time. On 11/28/2023, S2 noted R1 had redness on the peri-area and an open area on the top of R1 buttocks. On 12/20/2023, S8 noted that R1 bottom got infected, and S8 sent R1 to the hospital due to low blood pressure and an infected bed sore on R1 bottom. LPA attempted to contact S8 multiple times but was not able to get any new information. On 12/20/2023, R1 was sent out to the hospital for low blood pressure and an infected bed sore. R1 was admitted into hospice care on 12/22/2023. S3 instructed S1 and S13 that R1 will need to be transferred back to bed after breakfast and remain in R1's bed throughout the day and needed to be repositioned every two hours on each shift. S3 instructed S1 and S13 based on R1’s after-visit summary dated 12/22/2023 and hospice care plan. However, when asked, S3 was unsure if R1 was being rotated every two hours as instructed, due to a stage 3 pressure ulcer on R1's upper buttocks. Based on record reviews and interviews, the allegation above is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. - An immediate civil penalty of $500 is being assessed on today’s date. Civil penalty determination related to serious bodily injury is pending. LIC 421 IM is being issue today. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099-D. Exit interview conducted with Administrator, Marissa Espinoza a copy of this report and appeal right was provided. 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 It was alleged that staff did not provide activities to residents in care; however, on 1/16/2024 at around 2:00 pm, while conducting a health and safety LPA observed the activities calendar on the countertop in the memory care unit and the AL unit. LPA observed residents who were in groups doing artwork and some were watching an animal show on television. LPA observed that residents are being encouraged by staff to join the activity. LPA observed R2 and R3 was sleeping in their room. LPA interview S2 on 1/16/2024. S2 stated that S2 would encourage residents to join the activity, but some refused, and we cannot force anyone. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.

On 8/19/2025 at 10:30am Licensing Program Analysts (LPAs) Ardalan Gharachorloo and Kelly Nguyen arrived unannounced to conduct a Required - 1 Year inspection at approximately, and met with Interim Executive Director, Vercina Curley and explained the purpose of the visit. LPAs toured the facility with the Interim Executive Director and observed some COVID-19 precaution signs posted in common areas to promote hand washing and physical distancing. Infection Control Policies last updated on 12/4/2024. This facility is licensed to serve up to 80 residents. There are 4 floors being used and the facility consists of living room/front area, activity rooms, gym, theater room, indoor outdoor dining and 80 private residence rooms. No accessible bodies of water or fire safety hazards observed. Fire Extinguisher were found to be charged and serviced 9/3/2025. Floors have stair evacuation chairs. The facility has hard wire Smoke alarms, fire sprinklers that are serviced yearly and Carbon monoxide detectors. Hot water measured at an average of 102.6 Degree Freiheit of sample residents’ apartments. Fire Drill last conducted on 7/18/25. Liability Insurance issue on 6/1/2025 to 6/1/2026 under Amador Valley I, LLC 7601 in addition to DBA Emerald Valley. Car registration issue from 9/30/24 to 9/30/2025. LPAs reviewed 6 clients’ records and 10 staff records, and all were complete. A sample of 6 residents’ medications were reviewed. Exit interview conducted with Interim Executive Director a copy of this report is provided No deficiencies cited during this inspection

***CONTINUE FROM 9099*** LPA also conducted interviews with two residents (R1 and R2). Both residents stated that they are satisfied with the cleanliness of their apartments and reported that they frequently observe housekeeping staff maintaining the apartment, dining area, and common areas in a sanitary condition. This agency has investigated the allegation above. We have found that the allegation was 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, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted, a copy of this report provided. 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 ***CONTINUE FROM 9099*** The LPA also observed soiled cooking equipment, including grills and stove tops with accumulated grease and food debris, which posed a risk of cross-contamination. Based on LPA's observation and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D Exit interview conducted and a copy of this report and appeals rights provided.

On 08/02/2024 at 11:00 AM Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 06/19/2024. LPA met with Executive Director, Marissa Espinoza and explained the purpose of the visit LPA received a SOC 341 from Reporting Party (RP) indicating that there was a altercation between R1 and R2. Staff immediately intervened and separated both R1 and R2. No further issues with the residents. LPA L. Alexander collected documents pertinent to the incident report. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.

On 08/02/2024 at 10:15 AM Licensing Program Analyst (LPA) L. Alexander conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 06/17/2024. LPA met with Executive Director, Marissa Espinoza and explained the purpose of the visit. The Incident report stated that at approximately 9:20 PM, R1 was found outside the community lying face down in a bush. LPA interviewed S1 and S2 for further details. S1 stated that the Wander Guard alert went off and the alarm was heard. S1 stated that S3 went to R1's apartment to check if they were in their room and they observed that they were gone. S1 stated that S3 and S4 went outside looking and they observed R1 laying in a bush face down located in the front entrance of the facility. S1 stated that this occurred between 9-10 PM during shift change. S1 stated that R1 had no injuries. S1 stated that the facility increased their safety checks for R1 throughout the night. S1 stated that there was a care conference with S1, S2 and R1's responsible party. S1 stated that they started "16 Checks" for R1. S1 stated that R1 moved to the memory care unit on 07/31/2024 which would provide oversight and simulation for R1. LIC809-C Continued... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LIC809-C Continued... LPA obtained a copy of R1's Physician's Report, Needs and Services Plan, Resident Assessment and Care Staff Schedule for 06/09/2024. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.

On 07/26/2024 at 11:27 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Marissa Espinoza and explained the purpose of the visit. LPA toured the facility including but not limited to 4 residents’ apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 75 degrees F. The hot water temperature in a residents’ shared bathroom was measured at 115 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 09/10/2023. Emergency Disaster Plan was last posted on 02/16/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 06/13/2024. LPA reviewed 6 residents records and 6 staff records, and all were complete. LPA also reviewed a sample of resident’s medications and medication logs. The following documents were reviewed during the visit: LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, Liability Insurance and Current Administrator’s Certificate renewal documents. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 12/5/2023 at 2:30 PM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator (ADM) Marissa Espinoza and explained the purpose of the visit. The required annual inspection is incomplete and LPA will return to complete inspection at a later date. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 7/22/2022 starting at 4:00 PM, Licensing Program Analysts (LPAs) K. Nguyen and L. Francisco conducted a face to face Component III presentation. LPAs conducted Component III with Jennifer Coons, Executive Director. LPAs presented Component III power point and discussed the regulations embodied in the power point. LPAs observed participant gained knowledge about running and maintaining the facility in accordance with regulations. Exit interview conducted and a copy of report provided.

On 4/19/2023 at 9:20AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a health and safety check as a result of a priority 2 complaint. LPA met with Director of Sales , Elisa Graber. Executive Director (ED) Marissa Espinoza was not available at the time. LPA asked Elisa to called ED to informed her the reason for visit, also obtained verbal permission for Elisa to sign the report. LPA toured facility including but not limited to the resident bedrooms, bathrooms, common area, kitchen, and outdoor area. Facility temperature was maintained at 73 degrees F. Hot water temperature was measured at 119 degrees F in a resident's bathroom sink. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Facility order food supplies twice a week. Refrigerator was 31 degrees F and freezer was -2 degrees F. Resident's medications were kept locked in the medication room. Smoke detectors are interconnected with sprinkler system. Carbon monoxide detector observe. First-aid kit was complete. Fire extinguisher was observed to be full. There are no accessible bodies of water observed. No deficiencies are being cited on this date. Exit interview conducted. A email of this report was provided

On 7/22/2022 at 1:55PM, Licensing Program Analysts (LPAs) K. Nguyen, and L. Francisco arrived unannounced to conduct Pre-licensing Inspection. Facility is currently licensed and pre-licensing is requested due to change of ownership. Upon arrival, LPAs met with Nabila Shah Business Office Manager and explained the purpose of the visit. Jennifer Coons, Executive Director later arrived at 3:30PM. LPAs toured facility with Business Office Manager including but not limited to random 5 residents’ apartment, common areas, multiple activity rooms, kitchen, laundry room, and front patio. Passageways and hallways are free of obstruction. Required posters are posted on the wall with Emergency Disaster Plan. A comfortable room temperature is maintained at 73 degrees Fahrenheit (F) in the lobby room. Each residents’ apartment is equipped with a heating and cooling unit. Refrigerator temperature is maintained at 30 degrees F and freezer temperature is maintained at 0 degrees F. Fire extinguisher was last serviced on 9/10/21. First Aid kit was complete. Carbon monoxide/smoke detectors were observed and interconnected with the sprinkler system Resident's room have nonskid mats and grab bars by the toilet and in the showers. All resident rooms have pull button that is centrally connected to the front desk. No issues noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed, and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.