Fremont Hills

Continued from LIC9099… Allegation: Staff did not attend to residents' care needs in a timely manner It was alleged that Staff did not attend to residents' care needs in a timely manner. Based on interviews conducted, 6 of 7 residents stated that they have call buttons that they can use if they need staff assistance and have no issues during the daytime with staff responding. Interview with R1 indicated that when R1 uses the call button, staff will take approximately 5-7 minutes to respond. Additionally, interviews with 7 of 8 staff members all revealed that residents may use their pendant for assistance and it will notify the staff through their radio. 7 of 8 staff members stated that the average time to respond to the residents’ call could vary between 5 minutes to 20 minutes. S3, S4, and S6 indicated that when they are busy helping a resident and another resident requests for assistance, other staff members can assist with that request. Interview with W1 revealed that W1 had no issues with the call button when R8 was living in the facility and W2 stated that in the past R4 had issues with the call button response time, however, the issues has been resolved since then. A review of the facility call log report dated 12/04/2025 showed that R1 used the pendant and waited approximately 4 minutes for staff to respond to R1’s call. All the other dates pertaining to R1’s calls had a response time of less than 2 minutes from the dates 12/08/2025 to 12/19/2025. Based on interviews and record reviews conducted, the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated . There is no deficiency noted. Exit interview conducted and a copy of this report was provided.

On 07/22/2025 at 1:20 PM, Licensing Program Analyst (LPA) P.Manalo arrived unannounced to conduct a case management visit. LPA met with Executive Director, Beena Kumar, and explained the purpose for the visit. While LPA P.Manalo was at the facility for a complaint investigation (15-AS-20250325125744) the following deficiency was observed. During the complaint investigation, LPA observed that the call button response time showed there were several incidents where the residents waited for more than 30 minutes for staff assistance. Interview with staff revealed that the facility’s call button system was in disrepair and staff were unable to clear the residents’ call. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report, civil penalty, and appeal rights provided.

On 12/15/2025 at 2:30 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported death report. The facility sent in a death report on 12/12/2025. LPA met with Executive Director (ED), Beena Kumar, and explained the purpose of the visit. Death Report (LIC624A) indicated that Resident 1 (R1) had a change in condition and was taken to the Emergency Room per Kaiser Advice Line on 12/08/2025. On 12/10/2025, R1 passed away at the hospital. During the visit, LPA reviewed incident report, death report, R1's service plan, physician report, observation notes, and physician communication log. Observation Notes and facility incident report dated 12/04/2025 revealed that the paramedics came on 12/04/2025 to assessed R1. It also revealed that the Power of Attorney (POA) refused to send R1 to the hospital. A review of the physician communication log dated 12/04/2025 showed that the facility communicated with R1's physician due to R1's change in condition. LPA will be requesting for a death certificate from the facility. LPA may return at a later time. No deficiencies cited. Exit interview conducted and a copy of this report provided.

On 07/08/2021 at approximately 9:30am Licensing Program Analyst (LPA) Allison O'Hollaren arrived unannounced to conduct a case management visit regarding a self-reported incident that occurred on 05/16/2021. LPA met with Administrator, Michelle Delos Santos and explained the purpose of the visit. During the visit LPA spoke and reviewed incident with Program Director (S1), Managing Director (S2), and Administrator Michelle Delos Santos. S1 confirmed that Resident (R1) left the facility unsupervised. LPA reviewed R1's physicians report that indicated that R1 was unable to leave facility unassisted. After incident, R1 was moved to memory care. The following deficiency was cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.

On 10/22/2025 at 12:00 PM, Licensing Program Analysts (LPAs) P.Manalo and K.Nguyen conducted an unannounced Case Management visit regarding a self-reported incident report. Executive Director, Beena Kumar self-reported the incident on 10/15/2025. LPAs met with Judith Gitonga and explained the purpose of the visit. Executive Director was unavailable during today's visit. LPA P.Manalo received a self-reported incident report from facility that indicated that R1 was given a medication in error of an additional dosage that occured on 10/09/2025. During the visit, LPAs interviewed Staff 1 (S1) and Staff 2 (S2) regarding the medication error. S2 admitted there was a medication error due the change of medication dosage after the medication was refilled by the pharmacy. LPAs will be requesting for the following documents such as hospice's Patient Care Order, Medication Administration Record (MAR), Medication Order Summary, Resident Roster, Staff Contact Information, and Narcotic Log by 10/30/2025. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted with Gotinga. Appeal Rights and a copy of this report provided.

Licensing Program Analyst (LPA) Karina Canela arrived unannounced to conduct an Annual Required - 1 Year inspection and met with Bernadette Viray, Sales Director. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. LPA conducted a walk-through of the facility with Sales Director and observed COVID-19 precaution postings. A screening station was observed at front entrance of facility for visitors and staff. LPA was screened for COVID-19 symptoms. Visitors are screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. Staff follow indoor visitation requirement of verifying COVID-19 vaccination or a negative COVID test within 72 hours for visitors. The facility has designated visitation areas, provides virtual visits and phone calls for family to stay in contact with residents. Staff and resident's temperatures are taken once a day and LPA observed documentation. Staff clean and disinfect the facility three times daily. Sales Director stated high touched surface areas are disinfected after each use. Staff have documented completion on the following training: infection prevention, symptoms, transmission and PPE use. The facility has a supply of PPE including gloves, face shields/goggles, N-95 respirators, surgical masks and disposable gowns. N-95 respirator Fit testing (Cal/OSHA requirement) has been completed, Sales Director stated the facility would send proof of documentation to CCL. The facility has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 which was reviewed by the California Department of Social Services (CDSS), Community Care Licensing (CCL). Report continued 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 During inspection, LPA did not observe carbon monoxide detector(s) in the common areas or resident bedrooms. An advisory report LIC9102 was given to facility regarding carbon monoxide detectors. LPA requested the following updated documents to be submitted to CCLD Oakland Regional Office by 11/22/2021 : · LIC500 – Personnel Repor t · LIC 9020 – Register of Facility Residents · LIC308 – Designation of Administrative Responsibility · LIC610E – Emergency Disaster Plan · Administrator Certificate · Proof of Liability Insurance · Documents needed to update facility Administrator, to be submitted to CCLD Oakland Regional Office by 12/06/2021: · LIC 200 (fully completed & signed by Licensee) · LIC 308 Designation of Facility Responsibility (signed by Licensee) · Administrator’s Resume or LIC 501 Personnel Record · Administrator’s Qualifications & Duties · LIC 500 Personnel Report (indicating days & working hours for new Administrator) · LIC 503 Health Screening Report – Facility Personnel · TB Test – Showing “Negative” Results · Administrator’s Certificate · First Aid Certification · Fingerprint Association to Facility · LIC 610E Emergency Disaster Plan for Residential Care Facilities For Elderly · Board of Resolution ( designating person as administrator) Facility to notify the CCLD Oakland Regional Office if more time is needed to submit the forms. Exit interview conducted with Sales Director whose signature on this document confirms receipt. No deficiencies cited during this inspection

On 08/28/2025 at 4:05 PM, Licensing Program Analyst (LPA) P. Manalo conducted a Health & Safety inspection as a result of a priority 1 complaint. LPA met with Director of Health and Wellness , Judith Gitonga and explained the purpose of the visit. Executive Director, Beena Kumar, gave authorization for Gitonga to sign the report. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and courtyard area. Hot water temperature was measured at 109.9, 109.5,112.1, 113.4, and 112 degrees Fahrenheit residents’ bathroom. Residents’ bathrooms are equipped with grab bars and non-skid shower pans. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. First-aid kit was complete. Fire extinguisher was observed to be full and last serviced on 06/06/2025. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 4:46 PM, LPA observed Fluticasone Propionate Nasal Spray and medication syrup on top of the medication cart unsupervised by staff. The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with Administrator. Appeal Rights and a copy of this report provided.

On 10/22/2025 at 2:05 PM, Licensing Program Analysts (LPAs) P.Manalo and K. Nguyen conducted an unannounced Case Management visit regarding a self-reported incident. Director of Health and Wellness, Judith Gitonga, self-reported the incident on 10/21/2025. LPAs met with Judith Gitonga and explained the purpose of the visit. Executive Director was unavailable during today's 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 unwitnessed fall and R1 was treated for a hip fracture. R1 had hip surgery and is in a skilled nursing for recovery. The facility will reassess R1 before returning to the facility. During the visit, LPA interviewed Gitonga and stated that R1 had fell in R1's room. LPAs will be requesting for the following documents such as R1's physician's report, previous and new full care plan, staff schedule, progress notes, and care log for R1 by 10/30/2025. LPAs may return at a later time. No deficiencies cited during visit. Exit interview was conducted with Director of Health and Wellness and a copy of this report was provided.

On 06/05/2025 at 2:25PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit regarding a self-reported incident. Director of Health and Wellness, Judith Gitonga, self-reported the incident on 06/02/2025. LPA met with Judith Gitonga 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 upper leg pain from an unwitnessed fall on 05/29/2025. R1 was treated for a hip fracture. R1 had hip surgery on 05/30/2025 and is in a skilled nursing for recovery. The facility will reassess R1 before returning to the facility. During the visit, LPA reviewed and obtained R1's Physician's Report, Emergency ID Contact Information, Admission Agreement, Service Plan, and the facility's Fall Reduction Program. Admission Agreement showed that the resident was recently admitted to the facility on 05/26/2025. Prior to the resident's fall, the resident was already placed as a fall risk on the service plan for having multiple falls in the last 3 months. However, R1's Physician's Report dated on 05/05/2025 showed that the resident is bedridden. Since R1 is new to the facility, R1 was placed on an hourly check in. LPA may return at a later time. No deficiencies cited during visit. Exit interview was conducted with Director of Health and Wellness and a copy of this report was provided.

On 04/16/2025 at 1:55 PM, Licensing Program Analysts (LPAs) P. Manalo and K. Nguyen conducted an unannounced Case Management Visit. This is a follow up visit that was conducted on 03/14/2025 regarding an incident that was reported to CCLD on 02/27/2025 indicated that Resident 1 (R1) obtained a wound while in the hospital. LPAs met with Interim- Executive Director, Vivian Villegas, and explained the purpose of the visit. The documents that were obtained from the first Case Management visit showed that R1 was discharged from the hospital on 02/25/2025 and was placed on hospice on 03/05/2025. Moving forward, the facility will notify CCLD prior to admitting residents with prohibited or restrictive health conditions. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 03/27/2025 at 1:38 PM Licensing Program Analysts (LPAs) P.Manalo and L. Fontanilla conducted an unannounced Case Management visit. LPAs met with Interim- Executive Director, Vivian Villegas, and explained the purpose of the visit. While LPAs was at the facility to conduct a complaint investigation (15-AS-20250325125744), LPAs observed construction being done on the front patio in front of the facility. Upon verification made with Interim- Executive Director, she stated that they are working on constructing on 19 residents patios. Vivian stated that this project has been in the plan for over a year, and just got approved with a building permit. Interim- Executive Director was unsure if the construction was reported to CCLD. LPAs obtained the following documents such as building permit, plan of the renovations, and letter to family members notifying the construction. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Continue from LIC9099... Allegation- Staff does not treat resident with respect and dignity. It was alleged that Staff 3 (S3) yelled at R1 when asked for assistance and that S3 would leave R1’s diaper in the trash can beside R1’s bed without lining the basket with a trash bag. 4 out of 5 residents interviewed stated that the staff are nice and that they receive good care at the facility. R5 stated that when they call for help at night, R5 can fall asleep after receiving care. Interview with S2 indicated that it’s rare for S2 to observe wet diapers in the beginning of their shift on the resident and in the resident’s room, however, it could be a possibility that staff would forget to pick it up. LPA attempted to interview S3 and S4 and did not receive any call back. 3 out of 5 staff members interviewed expressed that they have not heard any other staff members speak to residents rudely. Allegation: Staff did not provide assistance to a resident in a timely manner. Based on interviews conducted with residents, each resident is provided with a call button or pendant that can be utilized to call staff, if needed. R1 stated that when R1 needed assistance at night, S3 and S4 took a long time to arrive to R1’s room for assistance. S1 also stated that during night shifts, the staff are supposed to attend to resident’s calls together. Interview with R5 indicated that when R5 needs assistance at night, R5 will use the call button and have not experienced any issues with the care at night. Also, 4 out of 5 residents interviewed stated that staff will assist them when needed. Staff interviewed revealed that when residents need assistance, staff will receive a radio call from which resident and room needs to be tended to. If a staff member was unable to attend the call, they will reach out to another staff member that is available to respond to the resident. Continue to 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 Continue from LIC9099-C... A review of the facility’s call log dated 03/25/2025 during the night shift between 1:00 AM to 4:30 AM showed that the response time varied from three seconds to about three and a half hours. S1 stated that during this time the system was having computer issues and could not clear the calls. Staff were able to reset the system at around 5:30 AM on 03/25/2025. After the computer issues were resolved, the response time for when residents would call for assistance varied from seconds to about twelve minutes that night. Although a review of the facility’s Resident Alert Call System policy dated 06/01/2025 does not indicate a response time, interviews with S6 and S7 revealed that staff will attempt to respond within 10 to 15 minutes of a residents’ call. There is no deficiency noted. Based on interviews and record reviews conducted, the above allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated . Exit interview conducted and a copy of this report was provided.

On 03/14/2025, at 2:15 PM Licensing Program Analysts (LPAs), P. Manalo and K. Nguyen arrived unannounced to conduct a case management following up an incident that was reported to CCLD on 02/27/2025 regarding R1 obtaining a wound while in the hospital. LPAs met with Director of Health and Wellness, Judith Gitonga, and explained the reason for the visit. LPAs reviewed R1's Physician's Report dated 2022, 2023, and 2025, Senior Living Standard Level of Care and Service Plan, Service Plan Report, Watermark Assessment, Elopement Risk Screening, Outside Agency Documentation, Progress Notes, and Discharge Summary. LPAs interviewed S1 and indicated that they had done an assessment prior to the resident returning back to the facility. LPAs are requesting to obtain Staff Contact information, Staff Schedule, Previous Service Plan Reports, and other notes pertaining to R1's injury (Caregiver's Notes) by 03/19/2025. LPAs will return at a later time. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

....Continued from LIC 9099 The complaint alleges staff do not ensure resident's personal belongings are safeguarded . The LPA interviewed Witness W1 who stated that Resident R1's belongings had not been stolen or removed from their room. They had been placed in a different location in their room than R1 was used to them being located. The data collected does not confirm the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegation is UNSUBSTANTIATED . Exit interview conducted and a copy of this report was provided. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 ...Continued from LIC 9099 A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099-D. Exit interview conducted and a copy of this report was provided.

On this day 09/27/2024 at 3:35 pm, Licensing Program Analysts (LPAs) Patricia Manalo and Luisa Fontanilla arrived to the facility to conduct a case management visit regarding an elopement and met with Generations Program Director, Molly Young and explained the purpose of the visit. During the visit, LPAs interviewed R1, S1, S2, and Generations Program Director. LPAs obtained R1's Physician's Report and Needs, Services Plan, and updated Care Plan. Based on interviews conducted, R1 was found outside the facility. The Union City Police Department brought R1 back to the facility. The Director states R1 was brought to the doctor the next day. R1 did not sustain any injury during the incident. Generations Program Director stated that the facility will hire additional staffing for AM and PM shifts. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Continue from Lic9099... It was alleged that; Staff do not ensure that resident's hygiene needs are being met while in care and Staff do not ensure that resident's clothing needs are being met while in care. Based on interviews and record review, residents’ activities of Daily living (ADLs) are being cared for and staff are meeting all residents care needs in the morning by care givers. S1 stated that residents’ are on an ADL schedule which indicates that each residents’ ADLs are preformed twice or 3 times a week; some residents’ can request ADLs to be performed if needed. LPA reviewed the facilities point of care logs, which indicates that the residents’ ADLs are being met by care staff. All 3 staff stated ADLs are preformed every day to residents. All 4 residents’ stated that staff care for residents’ ADLs every day and residents’ do not have a problem with their needs being met. Some residents’ are independent and can preform their own ADLs as well. It was alleged that; Staff do not provide assistance to residents in a timely manner and Staff do not ensure that resident is provided with clean bedding while in care. Based on interviews with staff and residents, all 3 staff stated that when a resident calls for assistance, staff will go to the resident’s room to see what assistance the resident needs, and staff will assist resident with their care needs. Staff stated it takes about 5 minutes or less to response to a residents call after a resident pushes their call button or little longer if a staff is assisting other residents. All 4 residents stated that staff come to their room after the call button is pressed, and sometimes it takes little longer but staff do come to their room shortly after. All 4 residents also mentioned that staff clean their rooms and makes sure all bed sheets are clean and new for the resident to use. Page 2 of 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 It was alleged that, the facility is odiferous , and the facility is unsanitary. Based on observation and interviews, LPA observed that the facility is clean and sanitary. LPA did not observe the facility to be dirty and is kept clean and smells good. LPA toured the facility, and entered resident’s rooms and observed that the rooms of the facility are kept clean, sanitary and did not have any smell. Staff stated to LPA that care staff makes sure that the facility and the resident’s rooms are kept clean and do not have an odor to them. Based on Interviews and observation 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 MCD, and a copy of this report provided. Page 3 of 3

On 03/16/2026 at 2:20 PM, Licensing Program Analyst (LPA) P.Manalo conducted an unannounced Case Management visit to follow up on the incident reports sent on 03/06/2026. LPA met with Business Office Director, Mimi Co, and explained the purpose of the visit. Executive Director, Beena Kumar, was unavailable during today's visit. Incident Report (LIC624) for R1 indicated that the incident occured on 02/20/2026 and R2's incident occured on 02/24/2026. Both R1's and R2's Incident Report was reported to the Department on 03/06/2026. Facility did not follow the reporting requirements. LPA and Co discussed the reporting requirements regulation. During the visit, LPA reviewed and obtained Resident Roster, R1's service plan dated 01/20/2026, R2's service plan dated 01/20/2026, and R2's physician fax reports. Per Co, R2 did not return back from the hospital and passed away on 03/14/2026. LPA is requesting for the facility to send R1's after visit summary from the hospital and R2's death certificate by 03/25/2026. LPA may return at a later time. A Technical Violation has been issued for Reporting Requirements, Section 87211(a)(1). No deficiencies cited. Exit interview conducted and a copy of this report provided.

On 9/29/2023 starting at 2:50 PM, Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct 1-Year Annual Required Inspection. LPA met with Viray, Bernadette, administrator (ADM) and explained the purpose of the visit. The facility’s fire clearance was approved for One Hundred Forty (140) non-ambulatory residents, of which Ten (10) may be bedridden. Upon entry, LPA observed three (3) staff and two (2) residents present during inspection. Starting at 2:56 PM, LPA toured facility with ADM including but not limited to one hundred nine (109) bedrooms, 109 bathrooms, kitchen, common area and backyard. The facility consists of 109 total bedrooms, which eighty five (85) bedrooms are private, and twelve (12) 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 73 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 on the second floor was measured at 119.8 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 detectors were in operating condition during visit. Fire extinguisher was observed last serviced on 6/6/2023. 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 4:03 PM, LPA reviewed 10 of 10 staff records. At 5:14 PM, LPA reviewed 10 of 10 residents' records. At 6:25 PM, LPA reviewed 10 of 10 residents' medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/6/2023: · LIC 308 Designation of Administrative Responsibility · LIC 500 Personnel Report · LIC 610E 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 11/10//2022, at 11:30 AM, Licensing Program Analyst (LPA) Liridon Fici arrived unannounced to conduct an Annual Infection Control Visit. LPA was greeted by Bernadette Viray- Executive Director . During the inspection, LPA toured facility including but not limited to front entrance, kitchen, common areas, hand washing stations, bedrooms, bathrooms, and backyard. LPA observed COVID-19 signage throughout the facility. Hand washing signs were posted at hand washing stations. LPA observed paper supplies and PPEs are sufficient. Facility has a sufficient 2-day perishable and 7-days non-perishable food supply. All sharps and toxins were locked up and inaccessible to residents in care. Common areas are disinfected frequently throughout the day. Water temperature is measured at 117.0 degrees F. Fire extinguisher was last serviced on 1/29/2022. Facilities room temperature is maintained at 70 Degrees F. First aid kit is complete. Carbon monoxide and smoke detectors are operable. Facility passages inside and out are free of obstruction and does not pose a health and safety risk for persons in care. During record review, LPA observed facility has a copy of their Infection Control Plan and Disaster Plan on file No deficiencies cited during today's visit. Exit interview conducted with Executive director, and a copy of this report provided.

Continue on Lic9099 It was alleged that; Resident was left on the floor for an extended period of time and staff do not ensure adequate supervision is provided to residents in care. Based on interviews conducted, all staff stated that staff check on residents every hour to 2 hours to make sure residents are doing well. Staff stated that, depending on residents’ care plan, staff will check on residents more often than others to ensure that residents are doing fine. During the AM, and PM shifts, staff stated that there are 3 to 4 care staff plus one med tech, and during the NOC shift, there are 2 staff in the memory unit and 2 staff in the assisted living unit plus ones med tech. All residents stated that staff check on residents daily and often to ensure residents are doing well. It was alleged that; Staff do not ensure resident receives bathing assistance and staff do not respond to resident’s signal system in a timely manner. Based on interviews and record review conducted, staff stated that ADLs are performed on a daily basis and showers are given to all residents, usually in the mornings or as needed per resident’s needs. LPA reviewed point of care (POC) logs which indicated that staff are preforming R1’s ADLs which are documented. Staff stated when a resident calls for assistance, it alerts staff on their radio, so staff knows which room to go to. LPA reviewed facility call log, which indicated that staff are responding to R1’s calls in a timely manner when R1 calls for assistance. Residents stated that ADLs are preformed on a daily basis by staff or residents are able to care for their own ADLs without staff assisting them. Residents have also stated that when a resident calls for staff, staff are there to assist residents within 5 minutes to 10 minutes. It was alleged that; Staff do not follow resident’s dietary restrictions. Based on interviews conducted, all staff stated that if a resident has a dietary restriction, a log is created that informs staff what each resident can or cannot have. If a resident need purred food, mechanical soft foods, no certain meats, or low salt foods, etc, facility will accommodate for those dietary needs. Dietary logs are located in the memory care unit, in the kitchen and dinning area for staff to see. 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 ADM, and a copy of this report provided.

On 8/16/2022 at 4:15PM Licensing Program Analysts (LPA) L. Hall and L. Fici arrived unannounced to conduct a Case Management visit. LPAs met with Stefanie Thune-Barnes, Managing Director. LPAs went to the facility to deliver an Immediate Exclusion letter. LPAs verified that Staff 2 (S2) was not present at the facility. LPAs advised Staff 1 (S1) that S2 shall be removed from guardian. No deficiencies cited during visit. Exit interview conducted. A copy of exclusion letter and report provided.

Continued from LIC9099. Based on LPA interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. A copy of this report and appeal rights provided. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Continued from LIC9099. On the allegation resident left in soiled diaper for an extended period of time LPA A. O'Hollaren interviewed Staff 2 (S2) which stated staff goal is to change residents every two (2) hours or when soiled. Review of hospice notes did not indicate resident was left in soiled diaper. On the allegation staff not providing adequate laundry services. LPA A. O'Hollaren interviews and record review indicates laundry services are provided once a week, and additional laundry services, as needed or requested, are available for an additional fee. LPA A O'Hollaren conducted a tele-visit with S1 on 10/23/2020. During tele-visit LPA observed R1's bedroom. The laundry basket was not full , but did have a few clothes inside, the sink area was clean, the smoke detector green light was on, but there were 2 blinds missing. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED . Exit interview conducted and a copy of this report provided.

On 1/13/2023, at 12:10PM, Licensing program analysts (LPAs) L. Fici And C. Lin arrived unannounced to conducted a case management about an incident that the LPA was informed about. LPAs met and was greeted by Administrator, BERNADETTE MILO and explained the purpose of the visit. On 1/11/2023, LPA was informed of an incident at the facility occurred on 12/31/2022 and the administrator failed to submit an Lic624 to CCL. Administrator emailed LPA an Lic624 regarding the incident that occurred on 1/11/2023. LPAs discussed with administrator the regulation on reporting requirements to be submitted to CCL on a timely manner. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. Deficiency is being cited due to reporting requirements Exit interview conducted with administrator, appeal rights given with a copy of this report.