Aegis Gardens

On 01/07/2026 at 2:50 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident that was sent on 12/11/2025. LPA met with Director of Operations, Angel Lee, and explained the purpose of the visit. The Executive Director was not available during today's visit. Incident report indicated that on 12/06/2025, R1 was sent to the hospital for a change in condition. On 12/10/2025, the facility was notified by R1's responsible party that R1 was diagnosed with a stage 3 pressure ulcer. During the visit, interview with S1 and a review of the after-visit summary dated 09/26/2025 and 11/21/2025, R1 was diagnosed with stage 2 pressure ulcer. LPA reviewed and obtained Home Health Care Visit Communication Form, Physician Fax Reports, hospital progress notes, and service plan. Documents reviewed indicated that R1's pressure ulcer would reopened once healed. Interview with S1 and Physician Fax Report dated 06/13/2025, revealed that since June 2025, R1's home health was initiated for wound care and home health has been monitoring the wound. Since R1's hospitalization, R1 has not returned from hospitalization. No deficiencies cited. Exit interview conducted with Lee and copy of this report is provided.

On 06/18/2025 at 2:50 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident that occured on 06/06/2025. Administrator self-reported the incident on 06/06/2025. LPA met with Executive Director, Emily Poon and explained the purpose of the visit. LPA received a self-reported incident report from the facility that indicated that Resident 1 (R1) went AWOL by exiting through the front door. The facility notified the police, and R1 was escorted back by the police couple hours later. Interview with Staff 1 (S1) and Staff 2 (S2) revealed that R1 was wandering around the hallways in the facility and exited through the front door. When night staff went to check outside, staff did not see the resident. S1 and S2 stated that after the incident occured, R1 began wearing a Wanderguard Bracelet, have safety checks, and have the AUGi system installed in their room. During record review, LPA observed R1's physician report dated 02/18/2025 indicating R1 needs to have supervision when leaving the facility. LPA also reviewed the facility's training on Use of Wanderguard, Elopement Protocol, and Redirecting dated 06/07/2025 and R1's Care Plan. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiency within a 12-month period may result in civil penalty. Exit interview conducted. Appeal Rights and a copy of this report provided.

On 01/07/2026 at 1:20 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident that was sent on 12/17/2025. LPA met with Director of Operations, Angel Lee, and explained the purpose of the visit. The Executive Director was not available during today's visit. Incident report indicated that Resident 1 (R1) had an unwitnessed fall on 12/16/2025. R1 was experiencing mild pain and was resolved with pain medications. On 12/17/2025, R1 had a change in condition and was sent to the Emergency Room (ER). During the visit, LPA reviewed After Visit Summary, Physician Fax Report Form, Unusual Occurrence Report (Facility Incident Report), Service Plans dated 11/26/2025 and 12/18/2025, and R1's physician report. LPA interviewed 3 staff members. LPA interviewed Staff 1 (S1) and Staff 2 (S2) revealed that R1 is a high risk for falls. A review of R1's service plan indicated that R1 was placed on the additional safety checks throughout the day effective 12/16/2025 and on the Augi sensor system on 11/26/2025. Interview with S2 revealed that communication between family regarding 1:1 care was conducted through the phone after the fall incidents had occured. S3 stated that they heard the motion alarm sound on 12/16/2025, and when they checked on R1, they found R1 on the floor. LPA will be requesting additional communication log between the facility and family regarding 1:1 care services. No deficiencies cited. Exit interview conducted and a copy of this report was provided.

Facility Type: RCFE Application Type: CHOW Capacity: 85 Method: Telephone call with CAB Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. Identification of the applicant and administrator was verified by correctly answering identity verification question. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant has been advised to transmit signed LIC 809 with copy of photo ID to CAB. 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 10/29/2025 at 12:00 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. The facility sent in an incident report on 10/27/2025 regarding R1's fracture. LPA met with Health Services Director, Gigi Tamayo, and Director of Operations, Angel Lee, and explained the purpose of the visit. The Executive Director was not available during today's visit. LPA P.Manalo received a self-reported incident report from facility that indicated Resident 1 (R1) had unwitnessed fall on 10/25/2025 and started experiencing pain on 10/26/2025. Responsible party brought R1 to the hospital and was treated with lower leg fracture on 10/27/2025. R1 returned to the facility day of with a leg brace. During the visit, LPA interviewed Health Services Director, Gigi Tamayo, and reviewed R1's Individualized Service Plan dated 10/27/2025 and 09/13/2025, Physician Report, and After Visit Summary. No deficiencies cited during visit. Exit interview was conducted with Tamayo and Lee and a copy of this report was provided.

On 10/08/2025 at 1:05 PM Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. Executive Director self-reported the incident on 10/03/2025. LPA met with Health Services Director, Gigi Tamayo, and Director of Operations, Angel Lee, and explained the purpose of the visit. The Executive Director was not available during today's visit. On 10/04/2025, LPA received an incident report that Resident 1 (R1) was sent to the hospital for a worsening pressure injury on 10/03/2025 and is currently admitted to a skilled nursing facility. During the visit, LPA reviewed and obtained the following documents such as R1's Physician Report dated 10/15/2024, Resident Appraisal, Care Plan dated 08/12/2025, facility's progress notes, and Physician Fax Report. LPA will be requesting for R1's full medical record to be sent to CCLD. LPA may return at a later time. No deficiencies cited during visit. Exit interview was conducted with Tamoyo and Lee and a copy of this report was provided.

During the course of investigation of a complaint ( 15-AS-20230608092900 ), Licensing Program Analyst (LPA) L. Fici learned that resident (R1) sustained a fall on 10/16/2022, 12/20/2022, and 5/9/2023. Review of records revealed the facility did not submit incident reports to CCL on a timely manner. LPA discussed with Gigi Tamayo, RN, Emily Poon, Administrator, and Angel Lee, Director of operations, the above incidents, and Title 22 Reporting Requirement. Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12-month period may result in civil penalty. Exit interview conducted with RN, and a copy of this report given along with appeal rights.

On 04/22/2025 at 2:20 PM, Licensing Program Analysts (LPAs) P.Manalo and K. Nguyen conducted an unannounced Case Management visit regarding a self-reported incident. Executive Director self-reported the incident on 04/05/2025. LPAs met with Executive Director, Emily Poon, and explained the purpose of the visit. LPA P.Manalo received a self-reported incident report from facility that indicated that the Resident 1 (R1) was taken to the hospital for lower back and rib area pain in which R1 was treated for lumbar fracture. LPAs reviewed the After Visit Summary dated 04/07/2025 and status update from doctor dated 04/10/2025. The status update from doctor shows that the fracture of vertebra was due to osteoporosis, sequela. No deficiencies cited during visit. Exit interview was conducted with Executive Director and a copy of this report was provided.

On 10/08/2025 at 12:00 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. The facility sent in an incident report on 08/31/2025 and death report on 10/06/2025 regarding Resident 1 (R1). LPA met with Health Services Director, Gigi Tamayo, and Director of Operations, Angel Lee, and explained the purpose of the visit. The Executive Director was not available during today's visit. LPA P.Manalo received a self-reported incident report from facility that indicated Resident 1 (R1) had unwitnessed fall and was admitted to the hospital for a cervical fracture. On 10/06/2025, LPA received a death report that R1 passed away. LPA reviewed and obtained R1's After Visit Summary dated 04/16/2025, Discharge Summary, Physician Report dated 02/05/2025, Resident Appraisal, Care Plans, and Physician Fax Report. LPA will be requesting full medical record, R1's progress notes dated from April 2025 to October 2025, and death certificate to be sent to CCLD. LPA may return at a later time. No deficiencies cited during visit. Exit interview was conducted with Tamayo and Lee and a copy of this report was provided.

On 04/22/2025 at 1:50 PM Licensing Program Analysts (LPAs) P.Manalo and K. Nguyen conducted an unannounced Case Management visit regarding a self-reported incident. Executive Director self-reported the incident on 03/31/2025. LPAs met with Executive Director, Emily Poon, and explained the purpose of the visit. LPA P.Manalo received a self-reported incident report from facility that indicated Resident 1 (R1) was admitted for hospitalization for a UTI and internal brain bleed. LPAs record review of the After Visit Summary dated 04/01/2025 shows that R1's internal brain bleed was due to a hemorrhagic stroke. No deficiencies cited during visit. Exit interview was conducted with Executive Director, and a copy of this report was provided.

On 04/22/2025 at 10:15 AM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Executive Director, Emily Poon, and explained the purpose of the visit. LPAs toured the facility inside and out including but not limited to residents' apartments, bathrooms, activity rooms, beauty salon, kitchen, common area and courtyard. There are no bodies of water observed. LPAs observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 71 degrees F. The hot water temperature in residents’ shared bathroom were measured at 117.1, 112, and 119 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid shower pan. 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 detector were in operating condition during visit. Fire extinguisher was last serviced on 06/20/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 03/05/2025. At 10:20am, LPAs reviewed 7 residents records. At 11:25 am, LPAs reviewed 7 staff records and all are associated to the facility. At 1:20 PM, LPAs reviewed two sample of resident’s medications. All records were observed to be complete and up to date. No deficiencies were cited during visit. Exit interview conducted and a copy of this report provided.

On this day 09/13/2024 at 2:10 pm, Licensing Program Analysts (LPAs) Patricia Manalo and Luisa Fontanilla arrived to the facility to conduct a case management visit regarding a incident report and met with Executive Director, Emily Poon and explained the purpose of the visit. During the visit, LPAs interviewed R1 and S1 by obtaining an interpreter service. LPAs attempted to interview R1. However, due to R1's dementia, LPAs were unable to obtain relevant information. LPAs interviewed S1 and S1 demonstrated to LPAs how the incident occurred. No deficiencies were cited during visit. Exit interview conducted and a copy of this report provided.

On 6/25/2024 at 12:20PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Director of Operations, Angel Lee and explained the purpose of the visit. The facility’s fire clearance was approved for 85 non-ambulatory of which 48 may be bedridden. LPA toured the facility with Director of Operations including but not limited to 6 residents apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 70 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 109.3, 117.8, 111.0 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. Freezer temperature measured at 0 degrees F and refrigerator measured at 40 degrees F. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguishers was last serviced on 6/20/2024. Emergency Disaster Plan was last posted on 6/13/2024. First aid kit was observed to be complete. Fire drill was last conducted on 5/25/2024. At 1:00pm, LPA reviewed 6 residents records. At 2:00pm, LPA reviewed 7 staff records and 6 of 6 have current first aid training and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Continue from LIC9099... It was alleged that staff obstructed the facility passageway. During the visit, LPA observed the memory care hallway by the exit door free of obstruction. However, on 10/24/2025, LPA received an incident report from ED verifying that on 10/15/2025 and 10/22/2025, there were chairs blocking the side exit door in memory care to prevent the ball from getting into the hallway. During the visit, interviews with 4 of 4 staff confirmed that the chairs were utilized to block the exit door during games and activities with residents. 4 of 4 staff members also showed LPA where the three chairs would be placed during activities in which LPA observed to be in the hallway in front of the side exit door. Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided.

Continue from Lic9099 It was alleged that, Staff did not treat residents with dignity and respect and staff did not include resident's responsible party in the reappraisal process. Based on interviews and record review conducted. All 5 staff stated that the care given to residents is good and that the staff tends to residents’ care needs at all times. Residents are treated with respect and cared for when residents needs assistance with anything. 4 of the 5 residents interviewed stated that they do not have any concerns with care and that they are treated well in the community. During record review, LPA communicated with S1 and confirmed that there was a re-appraisal conducted for R1 and R1's representative was notified. It was alleged that, Facility is charging resident for services not agreed upon. Based on interviews and record reviews conducted, family staff communicated with LPA and confirmed that RP was notified regarding R1's level of care is increasing, and that the facility wants to hold a meeting to further speak about R1’s care. Staff stated that R1 is in need for a one on one due to resident’s higher level of care. Based on Interviews record review conducted, Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted with Director of Operations , and a copy of this report provided

On 12/13/2023, LPA G. Luk interviewed staff which revealed that escort services were provided to residents. S4 stated that facility was providing small group activities during the 3 COVID outbreaks. S4 stated that residents were escorted to small group activities and walks in the courtyard area. LPA G. Luk reviewed a sample of resident's service delivery records and observed that residents were provided escort services during the 3 COVID outbreaks. Facility emailed residents and family during each COVID outbreak which indicates that dining room will be closed; However, there will be small group activities and exercise in the courtyard was provided. LPA observed activity schedule where small groups activities were conducted at different times. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore these allegation is UNSUBSTANTIATED . No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.

Continue from Lic9099 It was alleged that, Staff improperly administered resident's medication. Based on record review conducted, LPA communicated with RP and it was confirmed that R1’s medication was crushed and given to R1 without a physician’s order on July 8, 2023. On July 11, 2023, a request was sent to the primary physician to crush medication for R1 and on July 12, 2023, R1’s physician approved request to crush medication for R1. Based on LPAs observations and interviews which were conducted 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 Exit interview conducted with Director of Operations , and a copy of this report provided along with appeal rights.

Continue from Lic9099 It was alleged that, an illegal eviction was given to the resident and the resident’s representative. Based on interviews and record reviews conducted, all 3 staff stated if a resident’s level of care increases and the facility can not meet the care needs for the resident any longer, an eviction notice is given to the resident and the resident's representative explaining the reason for eviction. The facility determined R1’s change of condition by ongoing evaluation for R1 and conducting reappraisals which informs the facility of R1’s higher level of care on June 7, 2023. On July 8, 2022, R1 was admitted into Aegis gardens and an appraisal was conducted. The facility was able to meet R1’s care needs, however, over the course of time, R1’s care needs increased, and the facility was not able to meet R1’s care needs. The facility conducted re-appraisals for R1 when R1’s care increased. Based on Interviews record review conducted, Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted with Director of Operations , and a copy of this report provided.

Continue from Lic9099 It was alleged that, licensee initiated eviction process in retaliation against resident. Based on interviews conducted, all three (3) staff members stated the reason for eviction is due to a higher level of care. All 3 staff stated when a resident’s care increases, and the facility can not meet a resident’s needs any longer, an eviction process is applied. This eviction process was not due to retaliation of R1. Reporting Party (RP) did not disclose any information to LPA regarding the reason the eviction process was based on retaliation. Based on Interviews record review conducted, Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted with Director of Operations , and a copy of this report provided.

On 2/15/2024, at 10:10am, Licensing Program Analysts (LPAs), L. Hall and T. Syess, arrived unannounced to conduct a case management visit. LPAs met with Gigi Tamayo, Health Services Director, and explained the purpose of the visit. LPAs arrived to deliver complaint findings from amended complaint dated 6/13/2023. 15-AS-20230613151024. LPAs obtained signatures on amended complaint document LIC9099 and LIC9099C. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 9/29/2023, starting at 10:10 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct a case management visit to deliver amended report originally dated 8/23/2023. LPA met with Gigi Tamayo, Registered Nurse (RN) and informed her the reason for visit. During visit, LPA obtained original report dated 8/23/2023 from RN. No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.

On 9/22/2023, starting at 10:07 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct a case management visit to deliver amended report originally dated 8/24/2023. LPA met with Emily Poon, General Manager (GM) and Gigi Tamayo Registered Nurse (RN), and informed them the reason of visit. During visit, LPA obtained original report dated 8/24/2023 from RN. No deficiencies are being cited on this date. Exit interview conducted with GM, and a copy of this report provided.

Continued from Lic9099... It was alleged that; Staff did not dispense medication according to doctor's orders. Based on Interviews, and record review conducted, S1, S2, S3, and S4 stated that S4 accidentally grabbed the incorrect eye drop bottle and was about to administer medication to resident on 8/19/2023. Reporting Party (RP) noticed S4 was going to use the incorrect eye drops, and RP stopped S4 before administering the eye drops into R1's eyes. S5 was a witness when RP realized S4 grabbed the incorrect eye drop bottle. The correct eye drops for R1 was grabbed and administered to R1 accordingly. S4 was suspended from the community until the investigation was finished. On 6/23/2023, a different staff had provided multiple drops into R1's right eye and should have only gotten one drop. LPA conducted record review, which confirmed that S4 made a medication error dated 6/23/2023, which was self reported to CCL. Based on LPAs interviews which were conducted and record review, 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. Exit interview conducted with RN, and a copy of this report provided along with appeal rights.

Continue from Lic9099 It was alleged that; Due to lack of supervision, resident had multiple falls, and staff stole resident’s belongings. Based on interviews conducted, Rp stated that she believes that it is not the facilities fault for resident having a fall. All 5 staff members stated residents are able to use their pendant to call for staff at any time when a resident is requesting assistance from staff members. Staff members have confirmed with LPA that a safety checks are done by staff to ensure all residents are okay and safe. R1, R2, R4, and R5 stated that their belongings were not missing while in care by staff. It was alleged that; Staff did not keep resident’s personal information confidential, and Staff discouraged resident in using pendant frequently. Based on interviews conducted, All 5 staff and all 5 residents stated that staff allows residents to push their pendants any time they want without any restriction when a resident needs assistance. It was alleged that; Due to insufficient staffing, resident was transported to the dining room an hour early. Based on interviews conducted, All 5 staff and all 5 residents stated that staff takes residents to the dining area 20 to 30 minutes prior to mealtime. Staff have also stated some residents enjoy going to the dining area early so resident can watch staff prepare for meals and speak to staff while waiting for their meals. S5 stated staff will knock on the resident’s door as a reminder to go to the dining room. Based on Interviews record review conducted, Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation are UNSUBSTANTIATED . Exit interview conducted with RN, and a copy of this report provided.

The department received additional information from RP and all documents, and the interviews conducted by former LPA, L. Fici, was re-reviewed by LPA, L. Hall. LPA met with and delivered the amended report. Allegation: Staff did not seek medical attention for a resident in a timely manner. The RP stated it took the staff approximately 45 minutes to contact 9-1-1 for resident (R1). Based on interviews and record review, including 2 incident reports, R1 was given the wrong medication (belonging to another resident) around 8:00am on May 28, 2023. The staff (S1) notified S4 (registered nurse) around 9:24am of the error, this was the time S1 had realized the mistake had occurred. S4 immediately conducted an assessment with R1, including taking vitals in the presence of R1’s family. The vitals were stable and R4 informed R1’s doctor via fax of the error. Around 10:15 am R1 was observed to be ‘sleepy’ and vitals were rechecked and observed to have changed. At this time, 9-1-1 call was immediately made and R1 was transported to Kaiser Hospital. R1 was discharged back to the facility on May 29, 2023. Based on record review of communication between the facility and the physician. It indicates that the facility had sent notification to the physician at 10:07am on May 28, 2023, that contained the medication that was taken and R1’s vitals that were taken when S4 was first notified. The physician replied on May 30, 2023, that R1 had been seen in the emergency department. Review of previous complaint dated June 1, 2023, control #15-AS-20230601140155, the Health Service Director (HSD) submitted a plan that will provide training in medication errors, assess the medication assistance process, and make the necessary changes to prevent errors. The Health Service Director also will enforce documentation standards for medication policy per the plan submitted to Community Care Licensing Department. Based on Interviews conducted, 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 with RN, and a copy of this report provided.

On 9/7/2023 starting at 9:05 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct a case management visit to deliver amended report originally dated 6/9/2023. LPA met with Gigi Tamayo, RN and informed her the reason for visit. During visit, LPA obtained original report dated 6/9/2023 from RN. No deficiencies are being cited on this date. Exit interview conducted and a copy of this report provided.

On 7/5/2023 starting at 1:20 PM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required Inspection. LPA met with Emily Poon, Administrator (ADM) and explained the purpose of the visit. Administrators certificate (6003257740) is valid and expires on 3/25/2024. The facility’s fire clearance was approved for eighty-five (85) non- ambulatory residents, which forty-three (43) may be bedridden and 4 residents may be on hospice. Upon entry, LPA observed five (5) staff and seven (7) residents present during inspection. Starting at 1:50 PM, LPA toured facility with ADM including but not limited to sixty-four (64) bedrooms and 69 bathrooms, kitchen, common area and backyard. The facility consists of 64 total private bedrooms which 10 bedrooms are shared. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 Degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents'. The hot water temperature in residents’ bathroom was measured at 117.7 Degrees Fahrenheit. Residents’ bathrooms are equipped non-skid mats. There is a minimum of one-week supply of nonperishable and 2-day supply of perishable foods. Sharps and toxins were locked and inaccessible to residents'. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was observed last serviced on 7/20/2022. First aid kit was observed to be complete. 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 Starting At 2:23 PM, LPA reviewed 10 of 10 staff records. At 3:16 PM, LPA reviewed 10 of 10 residents' record. At 4:26 PM, LPA reviewed a sample of 10 of 10 residents' medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 7/12/2023: · LIC 308 Designation of Administrative Responsibility · LIC 500 Personnel Report · LIC 610D Emergency Disaster Plan (9 Pages) · Liability Insurance No deficiencies cited during visit. Exit interview conducted with ADM, and a copy of this report provided.

On 7/19/2023 at 1:08 PM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct a Case Management. LPA met with Gigi Tamayo, Registered nurse (RN). When LPA L. Fici opened a 10-day initial complaint visit (15-AS-20230711115733) on 7/19/2023. R1 was hospitalized on 1/30/2023, and returned to the community on 2/4/2023. LPA observed R1 with a restricted health condition and reviewed R1's file and observed facility did not request an exemption before re-admitting R1 with a restricted health condition. S1 stated that the facility did not request an exemption. The following deficiency was observed: - On 7/19/2023, LPA reviewed R1's file and did not observed an exemption for a restricted health condition. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.

Continue from Lic9099 It was alleged that, Staff charged residents for services not received. Based on interviews and record review conducted, S1, S2, and S3 stated that tray service was complimentary during the time when the facility had a Covid-19 outbreak, and no residents were charged. All three staff stated tray service is the only service that is complimentary during a Covid-19 outbreak. LPA confirmed with S1, S2, and S3 that if tray service was charged, a refund is granted back to the residents’ representative. LPA interviewed and spoke to R1- R6’s representatives, and they have all stated that were was no extra charge made by Aegis Gardens for tray services during COVID-19 outbreak. In addition, R1-R6 were not charged for escorting and eating supervision during the time of Covid-19 outbreak dated for October 16 - November 17, 2022, January 01-23, 2023, and February 06-16, 2023 . LPA reviewed residents’ statement invoices which indicated there were no extra service charges made to the residents’ representatives by Aegis Gardens. Based on Interviews and record review conducted, 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 with RN, and a copy of this report provided.

On 6/23/2023 starting at 11:25 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct a case management visit to deliver amended report originally dated 6/9/2023. LPA met with Gigi Tamayo, Registered Nurse (RN) and informed her the reason for visit. During visit, LPA obtained original report dated 6/9/2023 from RN. No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.

On 6/6/2023 at 10:20 AM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct a case management visit regarding an incident report received on 5/20/2023. LPA met with Gigi Tamayo (RN) and explained the purpose of the visit. Incident report dated for 5/18/2023 revealed that Resident 1 (R1) reported ingesting calligraphy ink during facilities activity. RN stated that resident was doing calligraphy as part of resident’s activity in the facility. S1 informed RN that the resident had black ink all over her hands and mouth. S1 observed resident's hands and mouth with black ink, S1 asked S2 to help clean resident’s hands and mouth, and S3 informed RN about the incident. Facility staff took R1's vital signs and assessed her if R1 had any pain from ink. Facility called 911 for further evaluation. R1's representative was notified, poison control was notified and RN stated that poison control could not find much information if the ink was harmful to ingest. R1 returned to the facility on 5/18/2023 with no concerning health issues. LPA collected the following documents: After visit summary, and Physician's visit report form. No deficiencies cited during visit. Exit interview conducted with RN and a copy of this report provided.

On 7/20/22 at 10:40AM, Licensing Program Analysts (LPAs) J. Sampair and L. Fici arrived unannounced to conduct a case management visit concerning a 7/3/22 incident report. The LPAs met with Health and Services Director, Cathy Zhou. In the 7/3/22 report, Staff 5 (S5) was accused by Resident 2 (R2) of hitting their spouse, Resident 1 (R1) on 7/2/22. Facility notified Ombudsman, but not the police. During this case management visit, the LPAs reviewed records and conducted interviews of residents and staff. The record review of S5 found no previous complaints and up-to-date training. During the interviews of three (3) staff members and one (1) resident, though neither were R1 or R2 due to their current condition, the LPAs found concurrence with the findings of the internal investigation that there was "no evidence" that S5 had hit R2. S5 returned to work on 7/5/22. LPAs collected the following documents: staff roster, resident roster, and a copy of internal investigation. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On today’s date around 1:10 PM. Licensing Program Analyst (LPA) L. Fici and Licensing Program Manager (LPM) Y. Flores-Larios arrived unannounced to conduct a case management visit. LPA and LPM met Health and Services Director, Cathy Zhou and explained the purpose of the visit. During inspection conducted on 7/20/2022, census was reported as 97; however, facility is licensed for 85. LPA and LPM requested residents roster which reflected census of 73. LPA and LPM conducted an interview with Emily Poon- General Manager (GM). GM stated that the census is 97% as they only have two vacant apartments at the moment, Facility capacity is under 85. Current census is 73. LPA and LPM confirmed facility is not over capacity. No deficiencies cited on todays visit. Exit interview conducted with General Manager. Copy of report was handed to provider.

On today’s date 7/20/22 around 1:00pm, Licensing Program Analysts (LPAs) L. Fici and J. Sampair arrived unannounced to conduct an annual Infection Control Inspection. LPAs met with Health service director, Cathy Zhou and explained the purpose of visit. LPAs toured facility with service director including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen, and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, Covid questionnaires, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Common touched surfaces are disinfected at least once daily. Bathrooms are equipped with liquid soap, paper towel and trash bins with touchless lids. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for residents and staff. 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 on Lic809-C The following forms are to be updated and submitted to CCLD By 7/27/22. - LIC500- Personnel Report - An updated copy of Administrator certificate No deficiencies cited on todays inspection. Exit interview conducted and a copy of this report provided.

On 12/30/2021 at 1:40PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a case management visit regarding an incident report received on 12/28/2021. LPA met with Health and Services Director, Cathy Zhou and Emily Poon, General Manager. Incident report dated 12/28/2021 revealed that Resident 1 (R1) reported abuse from Staff 5 (S5). Facility notified law enforcement and R1's responsible party. LPA interviewed three (3) of four (4) staff. LPA was not able to interview Resident 1 (R1) due to diagnosis. Interview with Staff 1 (S1) revealed that S5 was the caregiver for R1 on the day of the incident. R1 was being assisted by S5 in the bathroom when the incident occurred. R1 reported the incident to Staff (S4). S4 reported the incident to S1. S5 was suspended immediately and after the investigation was terminated on 12/28/2021. Facility will be conducting an abuse training for all staff on 1/5/2022. LPA collected the following documents: Staff roster, Resident roster, and training documents for S5. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.