Pavilion at el Dorado Hills, the.

Staff did not provide adequate supervision to residents in care Based on six staff interviews (6) it was determined that residents are provided with adequate care and supervision. During the interview process it was reported that staff check on residents every two hours and as needed. It was reported that staff are conscience of keeping the residents clean and dry. Staff are aware of resident needs for adequate care and supervision per their needs and service plan. Interviews did not indicate any concern in proper care and supervision for residents by staff. Therefore, the allegation is UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Staff did not ensure that residents’ hygiene care needs are met at the facility Staff did not provide sufficient activities for residents in care Staff did not provide adequate laundry services to residents in care Department conducted record review, staff, and resident interviews to investigate this allegation. Six (6) staff interviews indicated that staff were providing all ADL assistance, including activities, adequate laundry services and toileting residents per their needs and service plan. Staff interviews indicated that staff assisted residents with their toileting needs every 2 hours or as needed. Interviews reflected that resident care needs were met by staff and there were no issues to address, therefore the above allegation is UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Staff did not clean resident rooms Facility is unsanitary Department investigated above allegations. The facility was toured on 9/23/25 and several other occasions and observed to be clean, sanitary, and free from odor. Resident rooms, common areas, kitchen area, and dining room were toured. Six (6) staff members were interviewed in which they stated housekeeping and other staff keep the facility clean and free from odor. Staff stated due to resident incontinent care needs, at times there may be a temporary smell, but staff take care of the problem in a timely manner. Due to interviews and observation, the department finds allegation to be UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted. report left with Administrator.

Staff caused injuries to resident in care Staff restrained resident in care The Department conducted interviews with staff members and reviewed records regarding allegations above. Staff interviews revealed that they were not aware of any injuries or restraining’s of any residents in care; therefore, the above allegations are found to be UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Staff are not properly trained The Department conducted interviews with staff members and reviewed records regarding the allegation above. Staff interviews revealed that staff have adequate training (on boarding and ongoing) regarding infection control guidelines and other required topics and there were no issues. Staff interviews also reflected that the facility has adequate supplies of PPE and other care items to take care of residents. Record reviews indicated that the facility has all the required documentation regarding staff training per Title 22 Regulations, therefore these allegations were found to be UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Staff did not change residents in care for an extended period of time Staff did not provide feeding assistance to residents in care The department conducted interviews, facility observation and record review to investigate the above allegation. During interviews with facility staff and residents, it has been discovered that facility provided appropriate care to the residents based on resident’s documented needs and service plans. During department visits on 10/20/25 and 10/28/25, the Department observed that staff were attentive to residents’ care needs and helping them with their care needs, including feeding and toileting. Staff interviews reflected the fact that the facility provides adequate staffing and there were no issues with staff who do not help residents with feeding and toileting. Staff stated that they were assisting residents with toileting needs every 2 hours or as needed without any issues. Resident interviews did not express any concerns in this area; therefore, these allegations are found to be UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Continued on page 2 ... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 2 ... Staff spoke inappropriately to residents in care The department interviewed six (6) staff and attempted three (3) resident interviews during a complaint investigation. The department conducted a tour of the facility on 10/20/25 and 10/28/25 and conducted interviews with residents and staff. Interviews indicated that all staff treat all residents with dignity and respect and do not speak inappropriately to residents. During a facility tour on 10/20/25 and 10/28/25, facility staff were observed to be attentive to residents’ needs and treating residents with dignity and respect. During residents’ interviews, residents did not express any concern in this area. Based on facility tours, interviews and observation, the department found that there is no evidence that facility staff do not treat residents with respect or speak inappropriately to residents; therefore, these allegations are found to be UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted. Report left with Administrator.

Facility is malodorous Department investigated allegation, “Facility is malodorous”. The facility was toured on 9/4/25 and several other occasions and observed to be clean, sanitary, and free from odor. Resident rooms, common areas, kitchen area, and dining room were toured. Four (4) staff members were interviewed in which they stated housekeeping and other staff keep the facility clean and free from odor. Staff stated due to resident incontinent care needs, at times there may be a temporary smell, but staff take care of the problem in a timely manner. Due to interviews and observation, the department finds allegation to be UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Staff did not provide first aid to resident after a fall Staff are not following reporting requirements The department conducted interviews, facility observation and record review to investigate the above allegations. During interviews with facility staff, it has been discovered that facility provides first aid to residents after a fall as well as call 911. Additionally, the department confirmed that incident reports were sent to CCLD; therefore, the department finds allegations to be UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted and report left with facility.

On 09/04/25, Licensing Program Analyst (LPA) Lavinia Muscan and Licensing Program Manager (LPM) Laura Munoz arrived at the facility unannounced. LPA and LPM met with Administrator Kim Delgado and explained the purpose of the visit. Department and Administrator toured the facility and accompanied El Dorado Hills Fire Department to check egress doors for compliance. No deficiencies cited. Exit interview conducted. Report left with facility.

Staff do not ensure that resident needs are met in a timely manner – UNFOUNDED During the investigation the department interviewed residents and staff and completed file reviews. Four (4) resident interviews stated that staff meet resident care needs and respond in a timely manner. The department interviewed six (6) caregivers on duty in which they stated residents do not have to wait for long periods of time for care, and staff respond to residents’ needs in a quick manner. Due to the information gathered, the Department finds the allegation to be UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Staff does not treat residents with dignity or respect - Unfounded Staff speak inappropriately in the presence of residents The department interviewed eight (8) staff and four (4) residents during a complaint investigation. The department conducted a tour of the facility on 06/05/25, 07/15/25 and 07/24/25 and conducted interviews with residents and staff. Interviews indicated that all staff treat all residents with dignity and respect and do not speak inappropriately to residents. During a facility tour on 06/05/25, 07/15/25 and 07/24/24, facility staff were observed to be attentive to residents’ needs and treating residents with dignity and respect. During residents’ interviews, residents did not express any concern in this area. Based on facility tours, interviews and observation, the department found that there is no evidence that facility staff do not treat residents with respect, or speak inappropriately to residents; therefore, these allegations are found to be UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted. Report left with facility.

Resident poses a risk to other residents in care. Staff do not ensure residents are provided a safe and healthy environment. Based on observation, record review, and statements reviewed, the department determined that there was insufficient evidence that the facility has a resident that poses a risk to other residents and that staff do not ensure residents are provided a safe and healthy environment. Based on three (3) staff interviews, three (3) resident interviews, and department observation, residents and staff stated their needs are being met and that they feel safe; therefore, the allegations are UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Staff do not ensure facility doors are in good repair. Staff do not ensure facility has adequate supplies. Based on observation and statements reviewed, the department determined that there was insufficient evidence that the facility’s doors are not in good repair as they all were observed to be working at the time of visit on 4/14/25 and 4/29/25. Based on interviews with three (3) staff and three (3) residents, the Department determined that there are adequate supplies for residents in care. Staff have adequate supplies per resident needs and residents did not verbalize any shortage of any supply items; therefore, the allegations are UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Staff does not ensure facility is kept clean. Based on three (3) staff interviews, three (3) resident interviews, and department observation, the department observed the facility to be clean and sanitary. During department visits on 4/14/25 and 4/29/25 the facility did not observe to be malodorous including resident rooms, common areas and restrooms. Residents stated their needs are being met and that they feel safe. Staff interviews indicated that the facility is kept clean and sanitary without and concerns; therefore, the allegation is UNFOUNDED . A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted. Report left with facility.

Licensing Program Analyst (LPA) Lavinia Muscan arrived on April 29, 2025 to conduct the annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (5) and staff (5) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training. LPA and AED Bridget Botez toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, kitchen, hallways, memory care dining room, and memory care common areas. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use. Water temperature is within compliance. In the areas toured, there were no health or safety violations observed. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by end of the month. Exit interview conducted. A copy of this report was printed and given to AED.

Licensing Program Analyst (LPA) Lavinia Muscan arrived on 5/14/24 to conduct the annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (5) and staff (5) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training. LPA and Business Office Manager Bridget Botez toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, kitchen, hallways, memory care dining room, and memory care common areas. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use. Water temperature is within compliance. In the areas toured, there were no health or safety violations observed. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by end of the month. Exit interview conducted. A copy of this report was printed and given to Business Office Manager.

Staff did not distribute residents’ medications as prescribed. Department conducted interviews with staff and residents, records were reviewed, and facility observation was done to investigate this complaint allegation. Five resident files were reviewed, and all files contained updated physician reports and ongoing Centrally Stored Medication Logs. The Medication Administrator Record (MAR) was reviewed for 5 residents, which showed residents medications are accounted for and being administered as ordered. This agency has investigated the complaint alleging staff did not distribute residents’ medications as prescribed. We have found that the complaint was unfounded , meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview with Executive Director. Copy of the report provided to facility. 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 handled resident in a rough manner. Department conducted interviews with staff (4) and residents (4), records were reviewed, and facility observation was done to investigate this complaint allegation. During the investigative process, there was no information provided that indicated staff handled clients in a rough manner. Furthermore, there is no evidence showing the residents suffered any injuries by any staff. Based on the interviews conducted, the complaint is unsubstantiated . Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated. Exit interview with Executive Director. Copy of the report provided to facility.