Landmark Villa.

On this day, March 19, 2026, at 11:20 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced in response to the Unusual Incident Report (UIR) submitted by the facility on March 2, 2026. LPA met with Geraldine Tayo, interim administrator (IADM), and informed the reason for visit. UIR indicated that on February 28, 2026, at around 2:35 pm, resident (R1) was found on the floor in his living room by care staff during safety check. R1 presented with confusion and bruises on the back and face. R1 was sent out and came back the same day. R1 was diagnosed with a transverse process fracture on lower back which will heal on his own time. LPA reviewed R1's file and obtained copies of including but not limited to LIC602A Physician's Reports before and after fall incident; Notification of Hospice Initiation; Death Report; Appraisal; LIC625 Appraisal/Needs and Services Plan; hospital After Visit Summary LPA conducted interview. IADM stated R1 was placed on hospice care on March 4, 2026 and passed away after few days. Death Report showed R1 passed away on March 7, 2026. No deficiency cited. Exit interview conducted and copy of this report provided.

On 02/10/2026 at 9:35 AM, Licensing Program Analyst (LPA) J. Clancy-Czuleger conducted an unannounced Case Management Health and Safety check. LPA met with Administrator, Geraldine Tayo and explained the purpose of the visit. During the health and safety check, LPA observed a total of nine (9) Staff throughout the facility. Residents were gathered in the front common areas preparing for the social activity of Bingo. LPA conducted a tour of the facility, including but not limited to residents' bedrooms, bathrooms, common areas, kitchen, and outdoor areas. LPA observed that the kitchen was clean and the food supply was sufficient. Refrigerator temperature was observed at 33 degrees Fahrenheit and the walk-in freezer at negative 10 degrees Fahrenheit. Clients in care appear to be safe and there are no imminent health/safety concerns on today's date. LPA checked four resident files and four staff files, and 4 of 4 were fingerprint cleared and associated to the facility. No deficiencies cited during the health and safety check. Exit interview conducted and a copy of this report provided.

At 2:00 p.m. on this day, January 13, 2026, a virtual meeting was called. The meeting was attended by the following: Licensing Program Manager Jeremy Fong Licensing Program Analyst Alicia Delmundo Licensee/Corporate Officer Prema Thekkek Executive Director Diane Pederson The following were discussed: 1. Subletting of Lease Agreement - shall be withdrawn within 24 hours and submit proof by January 14, 2026. 2. Non-transferability of license (Title 22 section 87109). 3. Letter dated January 1, 2026 sent to the residents and residents' families to be rescinded and proof to be provided to LPA by January 20, 2026. 4. Outstanding annual fee due and late fee charge - Prema Thekkek indicated she is going to pay on this day. Proof to be submitted by tomorrow, January 14, 2026. 5. Process in having the prospective buyer of the property being brought in as management company and abbreviated application and documents to be submitted to Sacramento. Fingerprint clearance and association requirements for the 2 individuals who are/will be in the facility while application is in the process. A copy of this report provided via email to Prema Thekkek and Diane Pederson.

While at the facility for other reason, Licensing Program Analyst (LPA) Delmundo discussed with Executive Director (ED) Diane Pederson the copy of notification to the residents and residents family members dated January 1, 2026 pertaining to change of ownership. The copy was received by LPA on January 2, 2026. LPA discussed the process with the ED and refer the ED to Title 22 Regulations 87109 and Health and Safety Code 1569.191. LPA also discussed the submission of application for new license. LPA requested ED to have LPA updated. Exit interview conducted and copy of this report provided.

On this day, September 11, 2025, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Executive Director (ED) Diane Pederson, and informed the reason for visit. LPA toured the facility inside out with ED. Facility is a 3 story building. LPA inspected the common areas, library, kitchen, dining room, yard, common bathroom and laundry room on the second floor. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Freezers and refrigerators temperatures are checked by kitchen staff and recorded daily, and records showed temperatures were within Regulations range. LPA randomly selected 8 residents apartments for inspection - 2 on the first floor, 3 on the second floor and 3 on the third floor. Hot water temperature in one of the resident's apartments was tested and measured at 110.6 degrees Fahrenheit. The 2 in 1 carbon monoxide and smoke detectors in another resident's apartment was tested and observed in working condition . Facility has evacuation chairs on stairwells . Facility conducts disaster drills at least every quarter, and records showed last conducted August 16, 2025 LPA reviewed 5 staff and 5 resident's files, and interviewed 4 residents. Medications checked, and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Record. Facility does not handle resident's cash resources/P&I. .....continued on 809C 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 LPA received the following updated/current documents on this same day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate No deficiency cited during today inspection. Exit interview conducted, and copy of this report provided.

On this day, May 14, 2025, at 11:35 am, Licensing Program Analyst arrived unannounced to continue the case management visit that was started on January 23, 2025 to obtain additional information. LPA met with Executive Director (ED) Diane Pederson, and informed the purpose of visit. LPA conducted interviews. No deficiency cited. Exit interview conducted and copy of this report provided.

Page 2 LPA conducted inspection with ED on 2/07/22. LPA interviewed the following: staff (ED, S1, S2, S4, S5, S6) on 2/07/22, 9/28/23, 9/05/24, 9/13/24 and 4/30/25; R1’s family member (FM1) on 9/13/24; residents (R2, R3, R4, R6, R7, R8) on 2/07/22, 9/28/23 and 4/30/25. LPA tried to reach staff (S3) and home health nurse (HH1), but they did not return LPA’s calls. Allegation: Resident (R1) sustained pressure injuries while in care. S1 stated she does not remember if R1 had pressure injury but thinks R1 had some redness which is usual when one is staying long on the chair and R1 was attended by home health. S2 stated she was not assigned to R1 but observed caregivers attended to R1. S4 stated she does not remember R1 because residents come and go but if she observes skin issue, she reports to the med-tech and she repositions resident every 2 hours. S5 and S6 stated R1 had pressure injury. S6 also stated that that was also the reason R1 was visited by home health which was also stated by FM1. S5 and S6 stated R1 was a difficult resident. S5 further stated when R1 was repositioned, R1 returned to her original position. R1 was provided wedge; however, R1 asked the staff remove it. Review of home health records showed R1 was certified and re-certified for home health care from 2021 to 2022 and at some point, during these periods, R1 was visited by home health due to pressure injury. On 3/08/22 document indicated R1 was discharged from Home Health. It was noted on the document that R1 has no unhealed or stage 2 or higher pressure injury and had no stasis ulcer. Based on interviews and records review, and LPA unable to obtain information from R1, S3 and HH1, the allegation is unsubstantiated. Allegation: Resident's diapering needs are not being met. It was reported that when HH1 asked R1 to stand up so HH1 can see R1’s buttock wound, R1 said, “Let me first pee in my diaper” and when R1 was done, HH1 helped remove the diaper and amount of urine was weighing 2-3x of urine episode and that was causing the stage 2 pressure injury in the buttock. ..............................continued on 9099C (page 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 Page 3 FM1 stated once or twice R1 called her and told her she was not changed but FM1 said it was something she was not aware of. Although FM1 stated that she run a couple of times when she visited and saw used diaper in a plastic bag in R1's bed, she never observed R1 soaked in urine nor not changed. S1 stated when R1 does not come down to the dining room, S1 goes to R1's room to give R1 medications and S1 observed caregiver changing R1's diaper. There were times when R1 will call for assistance and S1 hears the front desk calling for caregiver to attend to R1. S2 stated she never visually observed R1 soaked in urine or soiled and not being attended. S2 also stated she saw caregivers come and go to R1's room to attend to R1. S4 stated she changes residents’ diapers 3x during her shift and as needed. S5 stated residents who need assistance in changing diaper are changed regularly and as needed. S6 stated she changed residents' diapers every 2 to 3 hours and more often if resident is a frequent wetter. S6 further stated that R1 was a frequent wetter and a lot of time, R1 refused to be changed. Six of the residents interviewed stated the staff assist them when they need help. One of this 6 residents has been living in the facility for 8 years and stated that she needs assistance in changing diaper and staff change her 4 to 5 times and as needed. This resident further stated she never had rashes, UTI and/or pressure injury. Based on information gathered, and LPA unable to obtain information from HH1, S3 and R1, the allegation is unsubstantiated. Allegation: Resident's hygiene needs are not being met. It was reported that HH1 observed feces between R1’s buttock and some part at R1’s back which showed that the feces had been sitting there and that when staff wiped off, R1 was not cleaned entirely . .......continued on 9099C (page 4) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 4 FM1 stated R1 complained about the water being cold and would not want to take a bath, but FM1 tested the water and the temperature was okay. FM1 also stated that when FM1 started coming to the facility, R1 started taking a bath. All 6 residents interviewed stated the staff assist them when they need help. When LPA conducted inspection during the 10-day visit, when LPA and the ED entered one of the residents’ apartment, LPA observed a caregiver present and assisting the resident in that apartment. Based on information gathered, and LPA unable to obtain information from HH1, S3 and R1, the allegation is unsubstantiated. Allegation: Staff does not assist resident when requested. All 6 residents interviewed stated the staff assist them when they need help. When LPA conducted inspection during the 10-day visit, when LPA and the ED entered one of the residents’ apartment, LPA observed a caregiver present and assisting the resident in that apartment. Based on information gathered, and LPA unable to obtain information from HH1 and R1, the allegation is unsubstantiated. Allegation: Staff does not treat resident with dignity and respect. It was reported that HH1 observed the staff being disrespectful to R1. All staff interviewed denied being abusive to any residents. They stated they never observed other staff not treating residents with dignity and respect. ..............continued on 9099C (page 5) 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 Page 5 FM1 stated she never heard any staff being disrespectful to R1 or other residents. All 6 residents interviewed stated staff were never abusive to them and other residents. LPA reviewed Home Health records and documentation and didn’t observe any notes indicating HH1 observed abuse by facility staff. Based on information gathered, and LPA unable to obtain information from HH1, S3 and R1, the allegation is unsubstantiated. Based on interviews, observations and records review, there’s not a preponderance of evidence standard to prove that violations occurred, therefore, the 5 allegations are closed as unsubstantiated. Exit interview conducted and copy of this report provided.

At 12:30 pm on this day, 1/23/25, Licensing Program Analyst (LPA) Delmundo arrived unannounced in response to the Unusual Incident Report (UIR) submitted by the facility on 1/20/25. LPA met with Executive Director (ED) Diane Pederson, and informed the reason for visit. LPA also met with Resident Care Director Geraldine Tayo. UIR indicated that on 1/19/25 at approximately 5:00 am, staff (S2) stated she witnessed the caregiver (S1) physically and verbally handling resident (R1) roughly. S1 was removed from schedule and the ED notified R1's daughter, Ombudsman and Community Care Licensing. Investigation was conducted and S1 was terminated. LPA reviewed R1's file and conducted interviews. LPA obtained copies of resident roster, staff schedule, facility staff's statements, and including but not limited to the following R1's documents: LIC601 Identification and Emergency Contact Information; LIC602A Physician's Report; Appraisal and Re-appraisal No deficiency cited on this day. Exit interview conducted and copy of this report provided.

On this day, September 5, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Executive Director (ED) Diane Pederson, and informed the reason for visit. LPA also met with Resident Services Director Geraldine Tayo. ED submitted an updated Infection Control Plan on September 28, 2023. LPA toured the facility inside out with ED. Facility is a 3 story building. LPA inspected the common areas, activity room, library, kitchen, dining room. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Freezers and refrigerators temperatures are checked by kitchen staff and recorded daily. Medication room was observed attended by staff. LPA randomly selected 12 residents apartments for inspection - 4 on the first floor, 4 on the second floor and 4 on the third floor. Hot water temperature in one of the common bathrooms was tested and measured at 113.6 degrees Fahrenheit. Facility has carbon monoxide and smoke detectors that were observed in working condition. Fire extinguisher in the kitchen checked, observed fully charge with tag showed serviced January 11, 2024. Facility has evacuation chairs on stairwells . Facility conducts disaster drills at least every quarter, and records showed last conducted June 11, 2024. LPA reviewed 5 staff and 5 resident's files. Medications checked, and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Record. Facility does not handle resident's cash resources/P&I. .....continued on n809C 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 Page 2 LPA received the following updated/current documents on this same day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. $3M Liability Insurance certificate No deficiency cited during today inspection. Exit interview conducted, and copy of this report provided.