Escondido Senior Living.

Information obtained from interview with R1 corroborated that they refuse to be showered and allow staff to change their bedding. R1 denied that there are odors coming from their room. It was further advised that R1 does not have any issues or concerns. Information from additional witness corroborated the information that they are aware of R1’s refusals to be showered and change their bedding. During a visit, LPA conducted a room tour of R1’s room and observed and no issues were observed. LPA also observed R1’s refusals on logs dated from the month of November 2023, December 2023 and January 2024 . Based on information obtained through interviews, review of documents, and observation, this agency has investigated the complaint alleging facility staff left residents in soiled clothing and facility staff do not keep the facility free of odors. 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. An exit interview was conducted, and a copy of this report was discussed with and provided to Sales Director, Carline Callaghan.

R3 declined to be interviewed. Three (3) staff were interviewed, and all reported they have never observed residents wear two (2) briefs at a time and had knowledge some residents request to add an incontinent pad to their brief. A witness interview was conducted with R1 and R2’s physician who reported they have never observed any residents at the facility wear two (2) briefs or report they are forced/encouraged to double brief. R1 and R2’s physician added they are not aware double briefing causes any medical issues or increases the risk of skin breakdown. R1 and R2’s physician reported for the past five (5) years they have never observed or suspected any of their patients residing in the facility to be neglected by facility staff. Regarding the allegation, “Staff chemically restrained resident” it was alleged on an unknown date, facility staff chemically restrained Resident 4 (R4) by administering a specific supplement after breakfast. R4 declined to be interviewed. LPA reviewed R4’s Physician's Report (LIC 602A) dated 5/23/22 noting R4 has the capacity to communicate their needs and administer their own Pro-Re-Nata medications. LPA also reviewed R4’s Medication Administration Record (MAR) for December 2023, which listed the supplement in question to be administered as needed at bedtime. One (1) of three (3) staff interviewed reported being authorized to dispense medications, refuted the allegation, and reported the supplement in question is only dispensed at night and at the request of R4. Two (2) of three (3) staff interviewed reported they have never suspected facility staff are over medicating residents or not following medication orders. Regarding the allegation, “Facility has an infestation of bed bugs” it was alleged there is a bed bug infestation in R1’s room and the facility has not obtained professional pest control services. It was further alleged the facility attempted to treat the affected areas themselves but has been unsuccessful. R1 was interviewed and reported in the past, they experienced bed bugs in their room. R1 added they reported sights of bed bugs to the executive director who resolved the issue. R1 reported their room underwent treatment twice and the facility worked diligently to eliminate the bed bugs. The facility reported Western Exterminator Company (WEC) completed an initial inspection of the building on 7/27/2023. An agreement was signed between the facility and WEC on 8/4/2023 and WEC began ongoing treatments on 8/15/2023. LPA reviewed the 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 facility’s Heat Treatments log which noted R1’s room received a heat treatment on 8/22/23, 11/13/23, and 11/27/23. LPA reviewed a proposal dated 12/8/2023, prepared by the Western Exterminator Company (WEC) addressed to the facility. The service specifications noted bed bug heat treatment to various infested resident rooms including R1’s. An interview with Maintenance Director (MD), Roy Hayes revealed the facility owns a heater to treat bed bugs and will immediately treat any areas reported to have bed bug activity in addition to canine bed bug inspections and chemical spray/heat treatments provided by WEC. MD Hayes also added the facility purchased new mattresses and protectors to replace the ones with bed bugs. LPA also reviewed receipts from Amazon (dated 12/5/2023) and Mattress Firm (dated 12/8/2023) noting the purchase of 14 mattresses and mattress protectors. ED McGuirk was interviewed and reported the facility purchased the same exact bed bug heater WEC uses, which allows the facility to immediately treat the affected areas while waiting for Western to become available to conduct an on-site inspection. Although the facility has experienced issues with bed bugs, they are taking appropriate steps to help mitigate the problem. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur; therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was reviewe and provided to ED McGuirk.

to increased behaviors of wandering and confusion, the narrative charting revealed that the recommendation was not followed. LPA conducted interviews, per the interviews conducted with the Resident Services Director, Cherryrose Gajo, the facility implemented a 1:1 Caregiver for R1 and for their safety. Per a records review conducted, revealed that alternative placement was being looked into in or around March 2023 for R1. Per an additional records review (text message), conducted the facility suggested a resource to assist with relocating R1. R1 was unable to be interviewed as they moved out of the facility on 04/17/23. Based on interviews and records review the allegation of illegal eviction is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. An exit interview was conducted and a copy of this report, LIC811-Confidential names list was provided to Cherryrose Gajo, Resident Services Director, and Shaun McGuirk, Executive Director.

On November 06, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the Administrator, Shaun McGuirk. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for (143) Elderly Adults and is currently operating at a capacity of (113) Elderly Adults (740). LPA Mixson toured the facility along with the Administrator and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. Additionally, there were no bodies of water on the premises. The facility is a multi-level building located at 1351 E. Washington Ave Escondido, CA. 92027. Physical Plant: The facility phone number is (760) 741-3055 and it is operable. LPA Mixson observed a sampling of the residents’ living units, and each was equipped with required furniture as per Title 22. LPA Mixson inspected a sample of the facility restrooms, and the hot water temperature tested within regulations. The restrooms sampled were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something,” the "Personal Rights," and the PUB 475. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently at the time of this visit. Medications : Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit. Administrator informed LPA there were safety lights for night throughout the facility. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. 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 Care & Supervision / Administration: Adequate staff are present for the supervision of resident in care. Floor plans, telephone numbers and personal rights were found posted in the facility. The listed administrator possesses a current administrator’s certificate with an expiration date of 12/23/2024. Records Reviewed and Resident/Staff Files: LPA reviewed five staff files and reviewed the facility's staff schedule. The staff files reviewed have criminal clearance and updated First Aid Certification. Five resident files were reviewed and possessed required paperwork. Disaster preparedness: LPA Mixson reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the department standards. Drills are conducted quarterly and one per shift. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures. There were deficiencies observed and/or cited per Title 22, Division 6 of the California Code of Regulations at this time. An exit interview was conducted where a copy of this report was discussed and given to Administrator, Shaun McGuirk.

On 12/12/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene met with Executive Director, Shaun McGuirk who was informed of the purpose of visit. LPA toured the Assisted Living and Memory Care Unit with Shaun McGuirk. The following was observed, reviewed, and inspected: The physical plant, in general, was in good repair and clean. The facility is operating in the capacity approved by Community Care Licensing (CCL). The buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. LPA inspected a sample of resident bedrooms in the Assisted Living & Memory Care Unit. Resident bedrooms have the required bedding and furniture; such as clean mattresses, night stands, storage space, and sufficient lighting. Room temperatures were comfortable for residents in care. LPA inspected a sample of resident bathrooms; the bathroom appliances were operating in safe and sanitary conditions. LPA measured the hot water temperature in the sampled bathrooms, in which all bathroom sinks measured within regulation. Sampled bathrooms were equipped with non-skid surfaces and grab bars. Each resident is given a pendant to notify staff of any emergencies. LPA toured the kitchen and dining area. The facility was stocked with a 2-day supply of perishable and 7-day supply of non-perishable food items that were labeled appropriately. The facility had a menu posted and available for review. Dishes, glasses, and utensils were in good condition and stored in a healthful manner. LPA inspected the common areas. LPA observed several carbon monoxide alarms throughout the facility. Carbon monoxide & smoke detector were tested and functioning properly. Continue on LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC809. There was a locked and centralized storage area for medications, including refrigerated medications. Medications appeared to be dispensed and documented appropriately. The facility had a designated area for resident files and staff files. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and several activity rooms. LPA observed several activity posters. The facility was also equipped with a complete first aid kit as well as the first aid manual. LPA inspected the outdoor area of the facility. There was shaded area with seating. Overall, the facility was clean, in good repair, and operating in safe conditions for residents in care. All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Three #3 staff and #3 residents' records were reviewed. Three #3 staff and #3 residents were interviewed. No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and a copy was provided to Shaun McGuirk.

(CONTINUED FROM LIC9099) Although the facility has experienced bed bug issues, they are taking appropriate steps to help mitigate the problem. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report was provided.

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct a case management visit in conjunction with complaint control #18-AS-20230703125256. LPA met with Executive Director Amy Banaga and explained the purpose of the visit. On 07/13/2023, a facility visit was conducted with Shawna Emery, Resident Care Coordinator and LIC9099 dated 07/13/2023 was issued. The purpose of today's visit is to amend the findings of UNSUBSTANTIATED to UNFOUNDED on the LIC9099 issued on 07/13/2023. The amended LIC9099 was provided during today's visit. An exit interview was conducted and a copy of this report was also provided.

(CONTINUED FROM LIC9099) the toilet to be full of feces, urine, and toilet paper and the back of the toilet seat was covered in either feces or vomit. Review of R1's Admission Agreement (AA) dated 9/22/2020 revealed R1 was to be provided weekly housekeeping of their assigned room and R1 agreed to keep their room in a clean an sanitary condition. The AA also indicated R1 agreed to be responsible for the care and maintenance of their pet. During an interview with R1, R1 stated they believed their assigned weekly housekeeping day was Friday. R1 reported their room is cleaned every week by Maintenance Director Roy Hayes. R1 also reported that there was nothing wrong with their room and did not smell any odor or see any dog feces on the floor. Review of R1's Resident Assessment dated 9/27/2022 revealed R1 was determined to be at care level 1, meaning they were to only receive assistance with medications however, R1 refused to sign the assessment and therefore does not currently receive medication assistance. The assessment also revealed R1 was independent with bathing, grooming, and toileting. The assessment does not indicate the facility is responsible for cleaning up after R1's dog. Review of R1's Physician's Report (PR) dated 4/18/2019 revealed R1 does not have dementia or MCI, is not confused, does not display inappropriate or aggressive behavior, is able to follow instructions and able to communicate their needs. The PR also revealed R1 maintains the capacity to provide self care and manage medications. Further review of R1's records revealed R1 was served with a 30 Day Termination and Notice to Quit on April 25, 2023 for failing to comply with the facility's pet policy regarding the care and maintenance of their pet. During R1's interview, R1 acknowledged receiving an eviction notice for failing to clean up after their pet but added that they did not think it was necessary because there was no issue with their room. Review of housekeeping checklists for R1's room dated Thursday, June 29, 2023 and Thursday, July 6, 2023 revealed R1 refused housekeeping services on those days. Additionally, after receiving complaints from other residents of odor emanating from R1's room, housekeeping was attempted on Tuesday, April 4, 2023, Wednesday, April 5, 2023, and Tuesday, April 25, 2023 and R1 refused each of these attempts. Four (4) of four (4) staff interviewed revealed R1's weekly housekeeping day is Thursday and R1 regularly declines the service or asks that it be completed at a later time however, when staff return at the requested time, R1 will decline. This agency has investigated the complaint alleging "Resident's room is unsanitary". 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. An exit interview was conducted and copy of this report was provided along with LIC811- Confidential Names list. *This is an amended report.