Ranchview Senior Assisted Living.

Licensing Program Analysts (LPAs) Nacole Patterson and Jose De La Cruz conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by and discussed the purpose of the visit to Marketing Manager Maria Flores. The facility's license shows a maximum capacity of 42 non-ambulatory residents, ages 60 and over of which 8 may be bedridden. Delay egress and secured perimeter approved and hospice waiver for 20 residents. During today’s inspection there were 21 residents in care. LPAs and Maria Flores toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Maria, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguishers were serviced within the last 12 months. First aid kits were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs interviewed staff and clients, and reviewed facility records. The files reviewed by LPAs contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Marketing Manager Maria Flores to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided .

Continued from LIC9099 p.1) The prescription was administered at 8:00am and 8:00pm per the prescription order. LPA observed the medication packs in question, which contained R1's name and prescription. The tablets for the prescription were noted to be green in color. The investigation did not give evidence that a medication error occurred or that R1's seizure was related to medication. It was alleged that staff left Resident 1 (R1) in a soiled diaper for an extended period of time. Six (6) staff members were interviewed regarding the allegation. Staff members consistently informed that R1 was checked and assisted with incontinence care every 1-2 hours or more frequently due to R1's diet causing frequent bowel movements. Staff informed that R1's responsible party contacted the facility multiple times per day to make requests regarding R1's care, including for R1 to be changed. No staff had observed R1 not being changed timely or left in soiled briefs for an extended amount of time. An independent investigation was conducted by an outside source protective agency. The outside source informed that their investigation did not produce evidence that staff left R1 in a soiled brief for long periods of time. Review of facility records did not corroborate the allegation. R1's care schedule during the timeframe in question showed that R1 was checked for incontinence care in the morning, noon, evening, and night shift. Records also showed that the facility tracked the frequency and size of R1's bowel movements. A notice of care increase dated 08/27/2024 outlined the care tasks being provided to R1, which included incontinence care. R1's appraisals, Needs and Services Plan, and Physician's report all specified that R1 was incontinent and required assistance with toileting. Text messages between R1's responsible party and staff showed that staff were responsive to the responsible party's requests regarding R1's care. The information gathered evidenced that staff met and provided assistance with R1's incontinence care needs. No evidence was found that R1 was left in a soiled brief for an extended period of time. It was alleged that neglect/lack of supervision by staff resulted in sexual activity between Resident 1 (R1) and Resident 2 (R2). Interviews with staff who were present at the facility during the time of concern confirmed that R2, who had a baseline behavior of walking around the facility, did enter R1's room and lay on R1's bed. However, staff informed that R1 was not in the room during the time nor was R1 in their bed during this incident. (Continued on LIC9099 p. 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 from LIC9099 p.2) Staff informed that the person who made this claim manipulated the incident. Staff informed that R2 was known to walk the facility and sometimes lie in other residents' beds, but never when another resident was in the bed. Staff informed that R1 was in the living room when R2 was found in their bed, and no contact was made between the residents. An independent investigation was conducted by an outside source protective agency. The outside source (OS1) informed that their investigation did not produce evidence that any sexual activity occurred between R1 and R2. OS1 informed that a person known to R1 found R2 in R1's bed, but R1 was not in the bed. OS1 believed that the situation was manipulated for personal gain. No records were found to refute or confirm the allegation. During an unannounced facility visit LPA directly observed R2 walking around the facility. R2 could not be qualified as a valid historian due to impaired cognition. LPA did not observe R2 enter other resident rooms during the visit or have any altercations with another resident. It was alleged that Licensee did not answer communications from resident's representative promptly. Five (5) staff were interviewed regarding the allegation. Staff members unanimously informed that R1's representative called the facility numerous times per day, texted them on their personal phones, visited the facility, and made frequent requests and demands regarding R1's care, which were accommodated. Staff provided examples, such as the kitchen staff being asked to make a fresh fruit smoothie (no frozen fruit) for R1 each morning per request, specific staff being requested to administer coconut oil on R1's hair and braid it daily, ensuring R1 was placed in specific positions at certain time of day with pillows and stuffed animals strategically placed under a specific arm. Staff additionally informed that R1's representative also made unreasonable requests such as requesting a staff member's birthday be celebrated on a different day than R1, even though their birthdays were on the same day and the facility had a longstanding tradition of creating facility-wide events for all resident and staff birthdays. Staff informed that R1's representative called the facility approximately 3-4 times per day for status updates and to make requests for R1's care, and additionally called them on their personal cell phones when they were not on shift. Staff members consistently stated that inquiries from R1's representative were responded to promptly. (Continued on LIC9099 p. 4) 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 from LIC9099 p.3) An independent investigation was conducted by an outside source protective agency. The outside source (OS1) informed that their investigation did not produce evidence that R1's representative was not responded to timely. OS1 informed that the representative was demanding and difficult to please. A second outside source familiar with R1 informed that the representative asked a lot from the facility and was very pushy, calling continuously. The outside source informed that it may have been a matter of misperception regarding the level of response from the facility. Records review revealed communication between R1's representative and the facility via care letter with a timeline of specific care needs and requests made by the representative that had been accommodated by the facility. Text messages between the representative and facility staff also showed the facility's responsiveness to the representative's requests. The investigation did not evidence that staff did not respond promptly to R1's representative's requests. It was alleged that staff did not have proper training to administer medications. Staff interviews revealed that the staff in question had the required training in place before administering medication. The staff in question informed that they were trained by a pharmacy at a different facility, and completed their training at this facility by shadowing and being observed by tenured medication technicians. Management confirmed that the staff in question had the required training prior to passing medications, and provided the staff's medication training credentials. Records review corroborated staff statements regarding the staff member's training, a completion certificate revealing that the staff member completed an 8-hour medication training with a pharmacy on 02/28/2024. Onboarding training documents showed that the staff member completed additional medication training specific to Dementia residents. The investigation did not evidence that the staff in question was not trained for medication administration, per requirement. R1 was unable to be interviewed due to no longer living at the facility. Records review and interviews showed that R1 was non-verbal and suffered from a major neurocognitive disorder, resulting in them being an invalid historian. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

(Continued from LIC9099 p.1) Staff informed that R1's machine was kept clean and dry when not in use. Staff informed that R1 used their CPAP machine every night. Records review corroborated staff statements regarding R1's consistent use of the machine and its cleaning regimen. R1's Medication Administration Record (MAR) revealed that R1's CPAP machine was consistently administered each evening and cleaned. The record showed that the machine was checked each morning to ensure it was working effectively. Facility Narrative Charting and Outside Agency Reports showed communication between the facility, R1's Primary Care Physician, and R1's pharmacy regarding the CPAP machine. The records showed that the facility was in communication with all relevant agencies regarding R1's former CPAP machine being in disrepair. The records additionally showed that a hold was placed on R1's CPAP machine while R1's outside provider made arrangements for it to be repaired. No records were found to show that the machine was not cleaned after each use or that staff did not assist or attempt to assist R1 with putting the machine on each night. Two outside sources were interviewed regarding the allegation. An outside protective agency also investigated the claims and informed that no evidence was found to corroborate the allegation, and that R1's machine was observed to be clean and regularly administered by staff each night. A second outside source familiar with the issue informed that R1's CPAP machine was new and additional information was not provided regarding details of the claims such as witnesses, dates/times occurred, or specific staff members who had been accused. LPA directly observed R1's former and new CPAP machines during an unannounced facility visit. The formerly used machine showed wear, however, the nasal canal that made contact with R1's face was clean and dry. The new machine was not observed to have any wear and the nasal canal was clean and dry. Both machines were stored in individual, labeled boxes in a secure location. LPA also observed three (3) signs above R1's bed with detailed instructions regarding the CPAP machine's administration. The signs included photos and wording to show what the mask should look like when it is placed on correctly. R1 was not able to be interviewed due to not being at the facility during the visit. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager/Administrator Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

(Continued from LIC9099 p.1) One of the staff interviewed directly changed R1 themselves prior to the appointment. Additionally, LPA was contacted by facility management prior to the incident, on 2/20/2025 regarding the situation. Management informed that Law Enforcement came to the facility to investigate the allegation and did not express any concerns regarding R1's care. Management informed that R1 was clean and dry prior to the appointment in question. Management also informed that R1 frequently refused to take their prescribed medication at the correct time, which would have prevented the frequent major incontinence episodes. Management informed that they had been trying to navigate this situation with R1 for some time, as they could not violate R1's personal rights by forcing R1 to take their medications; facility staff have been diligent with assisting R1 clean up after each incontinence episode. Review of facility records did not corroborate the allegation. The records reviewed corroborated staff statements regarding the timeline of events the day of incident. Review of R1's Medication Administration Record (MAR) corroborated staff statements that R1 refused to take the prescribed medication at the recommended time, 11:00am, in order to prevent incontinence episodes. The MAR showed that during the month of February 2025 to present day, R1 refused to take their medication at the recommended time 23 (twenty-three) out of 27 (twenty-seven) times. The MAR showed that R1 consistently accepted the medication at 12:00pm, after they had eaten instead of before, which resulted in the major incontinence episodes. R1 accepted the medication at the recommended time 4 (four) out of 27 (twenty-seven) times. Additional facility records show documentation of R1's medication refusals at the recommended time and refusals to shower after having subsequent incontinence episodes. The records showed that R1 was assessed for skin issues, incontinence needs, and showered/groomed the day of concern and the day prior to the incident. Outside source interviews did not corroborate the allegation. An outside agency involved with R1's care informed that R1 has presented to the agency for appointments soiled on different occasions, leading them to believe that the facility was not ensuring R1's incontinence needs were met prior to the appointments. However, the agency admitted that they did not reach out to the Licensee regarding their concerns and were not aware of R1's pattern of refusing the medications necessary to prevent the incontinence episodes. The agency admitted that they did not confirm if the facility had assisted R1 with incontinence care prior to transport, and an assumption was made regarding the facility not meeting R1's incontinence care needs. Requests to additional outside sources for interview were not returned. (Continued on LIC9099-C p.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 from LIC9099-C p.2) LPA interviewed R1 privately during the visit. R1 informed that things were going well at the facility. R1 stated that staff assisted them with incontinence care when needed and helped them with hygiene care. R1 confirmed during interview that the Licensee was meeting all of their care needs. LPA directly observed R1 during this unannounced facility visit. R1 was observed to be clean, groomed, and appropriately dressed for the temperature. LPA did not observe any health or safety issues for R1. Additionally, LPA has directly observed and spoken with R1 during previous facility visits for unrelated circumstances. During past visits LPA observed R1 to be clean, groomed, and appropriately dressed for the temperature. LPA has not observed any health or safety issues for R1 during previous facility visits. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Genoveva Guerrero, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Case Management Visit.  LPA was greeted by and met with Licensee Jeffrey Settineri and Marketing Director Maria Flores to discuss the purpose of the visit. Today's visit is in response to the self reported death of Resident 1.  Resident 1 passed away on 1/16/25. LPA conducted a wellness check at the facility; no health or safety issues were identified. No deficiencies were cited or observed on this date. An exit interview was conducted with Licensee Jeffrey Settineri and Marketing Manager Maria Flores who was provided with a copy of this report and Appeal Rights (LIC9056 03/22).  Their signature confirms receipt of these documents.

(Continued from LIC9099 p.1) Staff informed that they did not engage during R1's behavior episodes and backed away until they allowed care to be given. Management conducted an internal investigation and followed the required reporting timeframe. The facility's internal investigation did not produce evidence that the claims occurred, as the source was unable to provide details, descriptions, date/time, or any other information that would give evidence that the complaint was true. Management staff informed that R1 was assessed after the claims were made and did not have any marks, bruising, or injuries. Resident interviews did not corroborate the allegation. Residents interviewed informed that they enjoyed living at the facility and were treated well. Residents were observed to be clean, groomed and properly dressed for the temperature. Interview with R1 did not provide evidence that the allegations were true or that the events occurred. Outside sources did not corroborate the allegations. Outside sources had not observed any staff treat any client without dignity or handle them roughly. An outside source familiar with the allegations informed that the person who made the claims did not provide any additional details such as the person(s) involved, date/time of the occurrence, or other information that would give evidence that the claim was valid. Outside sources expressed concern that the claims were made with motive of manipulation. Outside sources did not have concerns regarding resident care at the facility. Records review revealed that management submitted the required reports for the alleged abuse, showing that they conducted an internal investigation. The records showed no corroboration that the events occurred. During an unannounced facility visit LPA directly observed the resident in question. The resident was noted to have no bruising, scratches, or marks indicating injury. LPA observed the resident using full range of motion within the area of concern. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violations occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Marketing Manager Maria Flores. The facility's license shows a maximum capacity of forty-two (42) non-ambulatory residents, of which 8 may be bedridden, ages 60 and over. During today’s inspection there were twenty-five (25) residents in care. LPA, Marketing Manager Maria Flores, and Manager Wendy Diaz toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Marketing Manager Maria Flores, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and clients, and reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Marketing Manager Maria Flores to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

(Continued from LIC9099 p.1) Outside sources further revealed direct observations of R1 making statements about fictional and/or public figures that could not have occurred. R1's Responsible Party (POA) was interviewed for the investigation and informed that R1 recanted their accusation, informing that the incident did not occur and they recalled a dream in confusion that did not happen in real life. During the course of staff/outside source/agency interviews, LPA observed that staff and outside sources were given different versions of the same story by R1, which conflicted in details, people involved, and the substance of the events. Records review revealed documentation of R1 having increased agitation and behavior issues, including incidents of unprovoked physical aggression toward staff and other residents. Records review further revealed that the Licensee has been in communication with R1's family and requested a care conference and updated assessment to address the new behaviors. A previous investigation was conducted by the Department in July 2023 regarding claims made by R1 that found to be without evidence that the event occurred. Interview with R1 did not corroborate the allegation. R1 stated that staff were very nice and no staff had ever done anything to physically harm or mistreat them. Interview with R1 also revealed conflicting recollection of the accounts they made to outside sources and staff. R1 did not recall making any accusations against staff members. Based on records and interviews, the allegation that staff inappropriately touched resident 1 (R1) is unfounded, meaning it was false, could not have happened, and/or is without a reasonable basis. The allegation has therefore been dismissed. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

(Continued from LIC9099) Regarding the allegation, "Neglect resulting in resident being severely malnourished", staff interview revealed consistent accounts of Resident 1 (R1) refusing to eat, often becoming agitated and spitting food out. Staff interview further revealed that the Licensee had ongoing contact with R1's doctor and responsible party regarding the lack of food intake, which resulted in adjustments that increased R1's nutrition intake. Outside source interview was consistent with staff interviews regarding R1's resistance and agitation with food and beverages. Outside source interviews did not express concern regarding the care being provided to R1 at the facility. Records review was consistent with staff interviews regarding R1's eating issues, revealing alternate prescribed interventions by R1's physicians to assist with nutrition and fluids. Interview attempts with R1 were unsuccessful. Regarding the allegation, "Neglect resulting in resident suffering dehydration", staff interview revealed that in addition to meals, R1 also frequently refused offers to drink water and became agitated. The Licensee advised R1's doctor, and a plan was made to increase R1's liquid intake. Outside source interviews did not corroborate the allegation. Records review was consistent with staff interviews regarding R1's drinking challenges and gave evidence to the interventions prescribed by R1's physician to help with liquids intake. Interview attempts with R1 were unsuccessful. Regarding the allegation, "Neglect resulting in resident sustaining multiple pressure injuries", staff interview revealed that R1 was not ambulatory and the Licensee was active in attempting to prevent pressure injuries by obtaining a special cushion for sitting, as well as a low air mattress bed. Staff interview further revealed that the Licensee took the appropriate steps to notify R1's medical professionals regarding pressure wounds that began to develop. Outside source interviews revealed that the pressure injuries sustained by R1 were not a result of the care being provided by the facility. Outside source interviews did not express concern regarding the care provided to R1 by the Licensee. Interview attempts with R1 were unsuccessful. Regarding the allegation, "Neglect resulting in resident sustaining serious injury", staff interview revealed that the noted injuries sustained by R1 were due to multiple falls that occurred prior to their admittance to Ranchview Senior Assisted Living. Staff statements were corroborated with resident records. (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 (Continued from LIC9099-C) Outside sources interviewed did not express concern regarding R1's care and treatment at the facility; outside sources informed that R1 sometimes forgot that they were non-ambulatory and attempted to walk. Interview attempts with R1 were unsuccessful. Regarding the allegation, "Staff did not observe change in condition", staff interview revealed that staff checked on R1 every 1-2 hours due to being a fall risk. Staff interview further revealed that staff immediately contacted 911 and provided direct care to R1 after a fall at the facility. Records review corroborated staff statements and revealed that staff did observe R1's changes in condition and contacted R1's responsible party and physician timely. Interview attempts with R1 were unsuccessful. Based on interviews, direct observations and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Marketing Manager Maria Flores, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

[Continued from LIC9099] Resident 2 (R2) was observed to have a side positioning foams while sitting in the wheelchair. R2 medical record was reviewed and there was a Doctor's order for the side positioning cushions. Resident 3 (R3) was observed to have a safety belt around the body.  LPA Domingo observed closer and the safety belt was a positioning cushion that was holding the cushion on the wheelchair. R3's records were reviewed and there was a Doctor's order for the positioning cushion that was being held in place with a safety belt which was not around R3's body. LPA Domingo observations of R1 through R3 concur with the Medical Record and Doctor's orders for the positioning cushions.  Interview with outside source 1 (OS1) observed resident's with the safety cushions being held onto the wheelchair was positioning.  OS1 confirmed that there was no observation of staff using a belt to restrain residents. Interview with outside source 2 (OS2) stated that that there was never any observations of staff using a belt to restrain a resident. Based on LPA's observations and interviews with outside sources and records reviewed there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated . An exit interview was conducted with the Manager Wendy Diaz, to whom a copy of this report, and the Licensee Appeal Rights (LIC 9058 03/22) were provided.