Ivy Terrace at Garden Grove.

Seven out of seven staff state resident was being assisted but was refusing meals as well as water and tea. Facility charting notes shows staff were documenting amounts of food consumed as well as refusals. Regarding the allegation that staff are socializing and not providing care and supervision, the investigation revealed the following: Six out of seven staff state staff were not socializing in R1's room. S2 and S3 deny any socializing in the room. Regarding the allegation that laundry was not done appropriately, the investigation revealed the following: Laundry is done on AM/ PM shift and laundry is put away on NOC shift. Five out of five staff state doing laundry effectively and are not aware of any items becoming gray from laundering. LPA observed the laundry facilities and each wing does their own laundry and has their own machine to prevent items becoming mixed up. Regarding the allegation that staff are not trained on care plan for a resident, the investigation revealed the following: Five out of five staff state being aware of resident needs and requirements through their job and observing notes and shift change. R1's responsible party provided a list of expectations to staff that were not items on the care plan and were merely requests including certain TV shows and exercise at specific times. Regarding the allegation that there is no staff supervision on weekends or overnight, the investigation revealed the following: Facility schedule shows 6 caregivers and 2 med techs on 1st and 2nd shift and med tech and 2 caregivers on NOC. Facility states filling call outs with overtime. Seven out of seven staff state staffing is fine and resident needs are being met. Regarding the allegation that staff did not address resident's personal hygiene, staff did not meet a resident's incontinence needs and staff did not follow care plan to assign a female for showering, the investigation revealed the following: Seven out of seven staff state R1's needs were being met. Incontinence care is provided at a minimum 3 times a shift. Initially R1 was independent of toileting but as the resident declined, more assistance was needed. All staff interviewed denied resident was not provided incontinence care or showering. Facility does not have shower records as facility changed systems prior to complaint. Staff state that initially a male caregiver would shower R1 but after family requested a female, the male did not provide showering. Seven out of seven staff deny a male caregiver showered the resident after the request. 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 Regarding the allegation that Staff did not assist a resident with making phone calls, the investigation revealed the following: R1's family member requested that staff assist resident with calling the resident's boyfriend. Five out of five staff state that assistance would be offered and the resident would refuse at times. Staff state due to cognitive decline, resident was unsure of who the resident would be calling and would have anxiety to make the call. Regarding the allegation that Staff did not ensure resident was hydrated, the investigation revealed the following: Per family request, staff were to ensure resident consumed 72 oz of water per day along with tea. Five out of five staff state encouraging resident to drink water and tea but resident would refuse at times. Resident had a large jug of water at all times to drink from as the resident wanted. Regarding the allegation that Staff did not provide adequate care and supervision of the residents, the investigation revealed the following: Seven out of seven staff state resident needs are being met. Staff state incontinence care and showering were provided. LPA observed residents in the common area on two different occasions with adequate staffing and residents being assisted. LPA observed residents at meal times being assisted and at activities as well. Seven out of seven staff deny R1 being a victim of an assault from another resident but state that there are behaviors at the facility as it is specifically memory care. Based on observations and interviews conducted, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided to facility. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 During the visit, LPA pulled the emergency cord in room B5 at 10:20 AM. Staff did not respond to the pull. Further investigation by the facility determined that the devices needed to be rebooted after a change of batteries. Two staff and witness states an incident (date unknown) where R1's emergency cord was pulled and the device was not working. Facility is unable to provide emergency pull records due to a change of system but was able to provide fall monitoring response records with an average response time of 4 minutes. Based on interviews conducted and observation, 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. An exit interview was conducted and a copy of this report was provided to facility administrator along with appeal rights.

On 12/12/2023 at 11:00 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at Crescent Landing at Garden Grove Memory Care Facility. LPA Calderon was allowed entry into the facility by Administrator Kyle Coleman. The facility is licensed for 72 residents with memory care issues. Currently there are 54 resident living at the facility. LPA Calderon explained to Administrator Kyle Coleman, the purpose of the 1-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: (5) resident service records, (5) resident medication records, and inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 12/12/2024. The one-story commercial building consisting of (36) resident bedrooms, (36) resident bathrooms, (6) common bathrooms, dining room, commercial kitchen, staff room, office area, commercial washer and dryer/ storage area, backyard with umbrella with table and chairs. No weapons were found or stored on the premises. Commercial Kitchen was inspected and observed to be clean and operational. Checked commercial refrigerators and storage for 2-day supply perishable and 7-day supply of non-perishable foods are present in the facility kitchen. Emergency Water Storage was also located in the kitchen area. LPA Calderon inspected resident room A3, B4, C6, D3. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies . Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. 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 Bathroom #1 hot water temperature properly measured at 109 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 107 degrees Fahrenheit. Bathroom #3 hot water temperature properly measured at 105 degrees Fahrenheit. Facility (10) Carbon Monoxide and (50) Smoke Detectors hard wired and connected were tested and are working properly. The facility (10) Fire Extinguishers were checked and found to be fully charged and accessible . All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked storage cabinet. Facility first aid kit is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. Five (5) resident files were reviewed and found to be complete. LPA Calderon reviewed (5) resident medications and they were all found to be administered according to doctor's orders. Three (3) staff files were checked and have the required documents. The facility does not handle resident's money/cash resources. Commercial General Liability Policy #SB00000007244 policy period from 05/01/2024 to 05/01/2025 underwritten by Everest Indemnity Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. Administrator Coleman to email LPA Calderon a full copy of the commercial insurance policy including all endorsements no later than 12/20/2024. All the required documents are posted in the facility in a clearly visible area. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff and residents were not wearing face coverings. LPA Calderon observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA Calderon advised the Administrator Coleman to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. . According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe deficiencies therefore no citations were issued at this time. Annual Licensing Fee is CURRENT An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Kyle Coleman.

Resident confirms temperature is usually 75 degrees F which the resident states is too hot. Department regulations state rooms shall be between 68 and 85 degrees F. Administrator indicates that the AC is operational and has had no issues with operating. Resident stated that on one occasion there were ants on the resident's pillow. LPA observed no ants in the resident's room. Maintenance Director indicated spraying outside the resident's window for ants when it was brought to his attention. Maintenance Director denies seeing any ants in the resident's room. LPA observed the area outside the window and did not observe any ants there either. Per physician report dated 10/16/2023, resident is diagnosed with Alzheimer's Dementia with psychosis. Based on interviews conducted and record review, the allegations are deemed unfounded, meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to facility representative.

Department regulations require Licensees to assist with arranging for medical or dental care appropriate to the needs of the resident. Per physician report dated 10/16/2023, the resident is diagnosed with Alzheimer's Dementia with Psychosis and Epilepsy. Based on interviews conducted and record review, the allegations are deemed unfounded, meaning the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report was provided to facility representative.