Bellamar Lancaster.

On 11/10/2025, Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced annual required visit. Upon arrival, LPA was greeted by staff and signed in. LPA met with Business Office Director (BOD) Analilia Zarzgoza and explained the purpose of the visit. Executive Director (ED), Kortnie Spitznogle was not available to meet with LPA but would be available by telephone. LPA requested a copy of the current staff schedule and resident roster. At 9:34 a.m., the physical plant tour of the facility was initiated by LPA Rios. With the assistance of Victor Rameriz the Building Services Director (BSD), LPA conducted a tour of the facility, both inside and out. The Inspection Tool was used for todays visit. Common areas , including the lobby, dining area, and activity room within the Assisted Living unit, were observed to assess their ability to safely meet the needs of residents. Observations included cleanliness, the functionality of the signal system, and the presence of appropriate locks. An activity calendar was posted near the dining area, and appropriate postings were visible along the hallway leading to resident rooms. In the activity room, LPA observed four (4) residents along with a nail technician. The floors in the activity room had visible crumbs and debris. LPA inquired about housekeeping and three (3) staff members informed LPA that the housekeeper was scheduled to work today but had not come in. According to the ED, a new housekeeper has been hired; however, the onboarding process may take up to a month. In the meantime, other staff members have been assigned to cover housekeeping duties during the current housekeeper’s days off. The ED also stated that today was not the housekeeper’s regularly scheduled day off, however, an email was sent to staff with instructions to complete housekeeping tasks for the resident rooms assigned for the day. (Continue to 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 LIC 809) At the reception desk, LPA obtained a copy of the weekly meal menu, which included Breakfast, Lunch, and Dinner from Sunday through Saturday. The kitchen was observed for its ability to safely prepare and serve meals. Food service was reviewed for appropriate quantity and proper storage practices. At approximately 9:43 a.m., while touring the walk-in refrigerator and freezer, LPA observed prepared food items and ingredients that were not properly stored or labeled. Inside the refrigerator, LPA observed two containers and a tray containing various repackaged meats in plastic baggies. According to a cook present, the containers held hamburger patties and pickles. LPA did not observe labels indicating the contents or the date they were stored. In the walk-in freezer, LPA observed single servings of pie placed on plates and covered with plastic wrap, as well as uncovered single-serving ice cream. No labels were observed on any of these items. LPA observed a sufficient amount of two-day perishable and seven-day perishable food. The Culinary Service Director utilizes Sysco for meal planing and food ordering. Laundry rooms and other storage rooms were observed for linen, tools, toxic cleansers, and general storage. Laundry rooms accessible to residents were clean and no hazards observed. Storage room and laundry room containing chemicals. detergents and cleaning solutions were observed locked. At approximately 10:33 a.m., the medication room and cart were reviewed for proper storage. The medication room and cart were observed locked. Complete first aid kits are maintained in the medication rooms. LPA observed a box overflowing with medication on the counter. LPA was informed by staff the medication is ready for destruction. Review of medication revealed a liquid medication bottle that according to staff belonged to a resident that passed away December 2024. According to the ED the facility relies on their pharmacy representative to destroy all medications however the representative had not been following through with this arrangement. LPA's review of the Plan of Operation outlines that permanently discontinued medications will not be retained at the facility. Instead, a designated staff member confirms the discontinuation with the physician, discusses it with the resident or responsible party, and ensures proper disposal and documenting the process on the Centrally Stored Medication Record. LPA toured six (6) randomly selected r esident bedrooms , two (2) of which were vacant. Personal accommodations were observed to meet standards for safety, privacy, and comfort. Hot water temperatures in the facility’s bathrooms are logged and maintained by the BSD. During the visit, hot water temperatures were measured and ranged between 105 and 120 degrees Fahrenheit. (LIC809-C continued) 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 The front entrance and back patio area of the facility was inspected to insure that passageways were clear of any obstruction. No bodies of water observed. In the Memory care unit LPA also conducted an inspection of the common areas, resident bedrooms, medication and storage rooms. The memory care unit is equipped with delayed egress doors. One (1) of four (4) delayed doors was tested by LPA and did not open when held past 30 seconds. The door is an emergency exit that leads to a fenced in back patio. According to the Generations Program Director a resident had been constantly pushing the door to open which may have caused the malfunction. LPA observed the medication cart was unlocked and unattended while LPA waited for staff to become available to open the medication room. According to the staff they were actively providing medications which is why the medication cart was unlocked. In bedroom number 15, LPA observed that the kitchen faucet was bent, a drawer in the bathroom was missing, and the toilet paper holder had been removed, leaving a small hole in the wall. According to the BSD, staff who have daily contact with residents are expected to report maintenance issues so they can be addressed in a timely manner. The BSD stated that now that they have personally observed the needed repairs in room 15, they will document the issues and begin repairs as soon as possible. Facility's fire extinguishers were current and last serviced on 10/02/2025 and located throughout the facility's hallways of the first and second floor. LPA observed flash lights in each fire extinguisher compartment. The facility's smoke alarms are hardwired and interconnected. Carbon monoxide detectors observed in the hallways of both the first and second floors. The last fire inspection was conducted on 03/12/2025 and the facility passed. Due to time constraints, LPA was unable to finish the inspection and will return another day. Pursuant to Title 22 Division 6 of the CA Code of Regulations, citations and appeal rights issued. Exit interview conducted, copy of this report given. Page 3 of 3

(Continued from LIC9099) A review of the facility’s own Program Descriptions, under XII. Transportation arrangement states, "Prestige Assisted Living at Lancaster will have a wheelchair assessable van that will be utilized for transporting residents as needed to medical and dental appointments. It shall also be used for transportation to community activities and on Community business. Only licensed drivers shall be permitted to drive the van. The seating capacity of the van (13) shall not be exceeded". LPA's observation of the vehicle is that it now sits 8 residents. Review of vehicle registration for 01/31/2024 to 01/31/2025 and for the previous year have type vehicle use as "commercial". Review of drivers license for the designated driver at the time has no endorsements listed. An endorsement (P) is required to operate a passenger vehicle. Based on records and observation this allegation is deemed Substantiated at this time. Deficiency cited (refer to LIC9099-D). Appeals provided. Copy of report 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-A) To investigate the allegation LPA Rios conducted a physical plant tour at approximately 2:00 p.m., on 03/28/24. LPA Rios also conducted interviews from 2:30 p.m. to 3:35 p.m., with five (5) residents and three (3) staff. On 01/06/25 at 2:22 p.m. , LPA Rios toured the physical plant of the facility focusing on the four (4) laundry rooms. LPA Rios also interviewed two (2) out of three (3) residents that were approached during physical plant tour. One (1) resident did not respond to LPA's questions. On 02/03/25, LPA reviewed facility's own Service and Rental Agreement regarding Laundry Service and interviewed two (2) more residents. Interviews with nine (9) out nine (9) residents that provided information during interviews corroborate not having any issues concerning laundry being laundered. Based on resident interviews and record review this allegation is deemed Unsubstantiated at this time. Allegation: Staff are mishandling the residents’ personal belongings. It is alleged residents' personal laundry is not being, delivered back to them or completely disappearing. Similar to the allegation above, to investigate the allegation LPA Rios conducted a physical plant tour on 03/28/24, LPA Rios also conducted interviews from with five (5) residents and three (3) staff. On 01/06/25 LPA Rios toured the physical plant of the facility and interviewed two (2) out of three residents that were approached during physical plant tour. One (1) resident did not respond to LPA's questions. On 02/03/2025, LPA reviewed facility's own Service and Rental Agreement regarding Laundry Service and Theft and Loss Prevention Program. LPA also reviewed the Resident's Handbook regarding Theft and Loss. LPA's interviews with eight (8) out of nine (9) residents that provided information for the allegation corroborate not having any issues concerning laundry being returned to them when completed. One (1) resident that provided information on 01/06/24 however did state they had personal towels go missing about a year ago and reported it to housekeeping. Resident #6 (R6) states it is no longer an issue. Based on resident interviews this allegation is deemed Unsubstantiated at this time. Allegation: Staff spoke inappropriately towards a resident. It is alleged residents are sternly spoken to by caregivers. (Continued on LIC9099-C) 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 (Continued from LIC9099-C) To investigate the allegation on 03/28/24, LPA Rios conducted interviews from 2:30 p.m. to 3:35 p.m., with five (5) residents and three (3) staff. On 01/06/25, LPA Rios interviewed two (2) out of three (3) residents that were approached during physical plant tour. One (1) resident did not respond to LPA's questions. On 02/03/25, LPA interviewed two (2) residents not previously interviewed. Interviews with eight (8) out nine (9) residents that provided information did not express issues with the way staff spoke to them directly. One (1) out of the nine (9) residents did have concerns of staff using a phrase made near them they believed to be insulting based on their religion. Based on resident interviews this allegation is deemed Unsubstantiated at this time. Allegation: Facility did not abide by the admission agreement. It is alleged the facility only provided services such as meals and medication management, and that residents were on their own for other needs. To investigate the allegation on 03/28/24, LPA Rios conducted interviews from 2:30 p.m. to 3:35 p.m., with five (5) residents and three (3) staff. On 01/06/25, LPA Rios interviewed two (2) out of three (3) residents that were approached during physical plant tour. One (1) resident did not respond to LPA's questions. On 02/03/25, LPA interviewed two (2) residents not previously interviewed. On 02/29/24, LPA Spaeth obtained copies of various residents' admission agreements. On 02/03/25, LPA reviewed facility's admission agreement provided to Community Care Licensing Division (CCLD) and compared it to those obtained by LPA Spaeth. Interviews with eight (8) out nine (9) residents that provided information did not express having issues or concerns related to the basic services agreed upon at admissions. The eight (8) residents corroborated the facility has provided such services. Based on resident interviews and record review this allegation is deemed Unsubstantiated at this time. Exit interview conducted. Copy of report provided. Page 3 of 3

(Continued from LIC9099) LPA conducted a search of an Unusual Incident Report for (R1) in CCLD's files. LPA did not find any Unusual Incident Report involving R1 for 10/18/23 or around that date. LPA's review of R1's medical record provided by the Investigation Branch (IB) revealed R1 was seen at the Antelope Valley Medical Center for a emergency on 10/18/2023. The discharge instructions revealed R1 had a humeral head fracture ( a break in the upper part of the bone in the upper arm near the shoulder joint) . The discharge instructions state the cause may have been from a fall. Facility was unable to provide LPA with a copy of an Unusual Incident Report for the incident in question. Although the documentation did not reveal R1 struck their head the facility did not document the incident to R1 to CCLD timely. Based on the information reviewed this allegation is deemed Substantiated at this time. Deficiencies cited (refer to LIC9099-D). Exit interview conducted. Appeal rights explained and copy of this report signed and delivered. 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 On 03/14/2024, Flores obtained a copy of R1’s Death Certificate from the County of Los Angeles Department of Public Health. On 04/19/2023, Flores received R1’s Hospice medical records. LPA’s review of death certificate documented R1’s cause of death as Alzheimer's disease and dementia with behavioral disturbance. On 04/23/24, Flores reviewed Hospice records for R1. Records indicated that on October 18, 2023, R1 received medical care from the Antelope Valley Medical Center for a fall incident that occurred at this facility. Antelope Valley Medical Center discharge instructions did not indicate R1 struck their head. On 11/07/23, R1 started receiving Hospice services, at the time of admission for Hospice R1 was diagnosed terminally ill; Alzheimer dementia, Hypertension, Chronic Kidney disease, diabetes, and anemia, and had a prognosis of 6 months or less. LPA Rios review of the documents obtained by IB found no clear link between R1’s fall on 10/18/23, and subsequent death on 01/16/2024. Based on the information obtained, there is insufficient evidence to support the allegation, therefore the allegation of Questionable death is deemed Unsubstantiated at this time. Exit interview conducted, copy of report issued.

At 9:05 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced annual inspection at the facility mentioned above. LPA met with Executive Director, Kortnie Spitznogle . LPA explained the reason for the visit. This facility is licensed as a Residential Care Facility for the Elderly. The facility has an approved fire clearance for a capacity of sixty-eight (68) non ambulatory residents of which seven (7) may be bedridden on the ground floor only. LPA Rios along with Maintenance Director, Victor Ramirez conducted a physical plant tour of the facility at approximately 9:25 a.m., LPA observed the following: The main entrance is being utilized for the visitors and employees. Screening area is located immediately upon entrance. There is a reception desk by the entrance to greet visitors. A sign in sheet, hand sanitizer, are available for guest and residents. The facility has a designated waiting area upon entrance. Common areas: LPA toured an activity room by the dining area. Activity calendars were posted in different areas available to residents. The dining area was clean and spacious to sit the capacity of the facility. Located by the dining area is an outdoor space with a grill and outdoor furniture for residents. There are no bodies of water in the facility. A breakfast menu was posted by the dining area available to residents. Kitchen/Food Inspection: In the kitchen L PA observed staff in the process of cleaning after serving breakfast. LPA observed a white board with information about dietary restrictions and needs of certain residents. The facility works with two companies to come up with nutritious meals and the weekly menu. According to the Head Cook food purchasing is done every Tuesday or as needed. Bedrooms: LPA toured three (3) vacant and seven (7) occupied resident bedrooms. Bedrooms were appropriately furnished and had sufficient lighting. Bedrooms that were being repaired or updated were locked, inaccessible to residents in care. (Continue to 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) Bathrooms - LPA observed resident bathrooms were clean and sanitary. The restrooms have grab bars and non skid shower mats. Hot water temperature was measured in four (4) randomly selected bathrooms on the first floor and second floor. Hot water measured at a range of 116.1°F to 118.7°F within regulation. Two (2) delayed egress doors were tested on the first floor and were observed functioning properly. Smoke/carbon monoxide detectors were located throughout the facility. Smoke detector log is kept by the Maintenance Director. Smoke detectors in resident rooms are checked monthly by Maintenance Director. Records indicate no issues. Fire extinguishers appeared to be fully charged and service tag displayed last serviced date 09/09/2024. LPA observed two (2) evacuation chairs at the top of two (2) stairways. Records Review - LPA reviewed five (5) residents records to insure compliance of licensing forms. LPA reviewed certificate of liability insurance, Emergency Disaster Plan LIC610, staff schedule and emergency drill training. The last fire alarm test was conducted with the Fire Drill on 11/01/2024. LPA Rios was informed by the Administrator and Executive Director, Prestige Assisted Living At Lancaster had been sold and the sale occurred sometime in September 2024. According to the Administrator and Executive Director, staff including themselves, were made aware of the sale sometime last week. LPA was informed the Licensee is currently working on a written notice to provide to residents and their responsible party. A follow up interview with the Executive Director informed LPA the sale had not been finalized. According to staff interviews, staff and residents were not aware of the licensee's intent to sell or that an offer to purchase the facility was made. Due to time restraints, LPA was unable to complete the annual visit at this time. LPA did not finish reviewing staff records or medication documentation at the time of this visit. A follow-up visit will be conducted at a later date to complete the annual inspection. Deficiency observed (refer to LIC809-D). Exit Interview Conducted. Appeal Rights and a copy of this report issued.

(Continued from LIC9099) Allegation: Facility did not provide adequate incontinent care. It is alleged residents are left to sit in their soil undergarments. To investigate this allegation, LPA Rios reviewed Complaint Control #31-AS-20200131112457 with the allegation; facility failed to provide proper incontinence care. On 02/27/2024 LPAs Angela Panushkina and Huma Rahimi conducted interviews with six (6) residents and based on four (4) resident interviews the allegation was deemed substantiated at the time. Due to the both allegations involving incontinent care this allegation is deemed Substantiated. The facility has submitted a plan of correction that was received and cleared by LPA Panushkina on 03/04/2024 no citation will be issued on today’s visit. Allegation: Staff are mishandling the residents medications. To investigate the allegation LPA reviewed an incident report submitted to Community Care Licensing (CCL) for an incident that occurred on 03/04/2024. Mentioned on the incident report was that resident #2 (R2) was given another resident's medication. According to the report staff #1 (S1) was preparing medication for R2 when they were called away to provide assistance. When S1 retuned they continued to pass medication to R2. S1 shortly after realized they had provided the wrong medication to R2. LPA's interview with staff Jesse Wong revealed S1 received a re training from him that included reviewing previous medication training. LPA's review of S1 records revealed they received their initial medication training on 12/29/2021 and an annual training on 02/21/2022. Based on the information reviewed this allegation is deemed Substantiated at this time. Allegation: Staff did not address the flooding issues on the facility grounds. It is alleged a room in the memory care unit had a flood and the facility has not dealt with it. To investigate the allegation LPA Rios conducted a tour of room #2 at approximately 2:50 p.m. in the designated memory care unit and observed the carpet still had extensive water damage. LPA observed some carpet pulled up from the entrance of the room and fans in the room used to dry flooring. LPA smelled a musty odor in the room. Interview with staff #2 (S2) revealed the room had a flood that originated from it's bathroom and the facility is working on remodeling the room. Room is currently vacant and is kept locked. Based on observations this allegation is deemed Substantiated at this time. (Continue to LIC9099) (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 Allegation: Staff do not respond to the residents timely. It was alleged residents are left to wait for staff to respond to them for assistance. To investigate the allegation LPA Rios observed S2 push the call buttons in room 101 two out of the three button affixed on the wall did not light indicated the batteries needed to be replaced. In room 105 with permission, LPA pressed the pendent on the resident's neck, after a few minutes staff #3 was called to disregard the call, S3 informed the indicator did not go on. Furthermore interviews with staff revealed this had been an issue discussed and the facility had already taken action to remedy the situation by testing all call buttons and replacing batteries when needed. LPA interviews with two (2) out of (5) residents revealed they had had experienced long wait times but they have not experienced it recently. Based on interviews and observation this allegation is deemed Substantiated at this time. Deficiencies cited on LIC9099-D Exit interview conducted. Appeal rights explained and copy of this report signed and delivered.

Allegation: Facility failed to provide proper incontinence care To investigate this allegation, LPAs conducted an interview with the Administrator, Memory Care Director, Nurse and one (1) staff member and were informed that the facility provides at least two (2) showers per week and staff checks on residents every two (2) hours. However, interviews with four (4) out of six (6) residents revealed that the facility staff does not provide proper incontinent care and residents stay soiled for extended period of time. Based on interviews, this allegation is deemed Substantiated. Allegation: Facility is unsanitary To investigate this allegation, LPAs conducted visits to random resident rooms in a Memory Care unit and conducted an interview with a Memory Care Director and one (1) staff. Interviews with staff reveal that rooms are cleaned, and linen gets changed every day. However, upon entry to three (3) out of four (4) rooms LPAs noticed an odor. LPAs advised Memory Care Director, that although the rooms are cleaned in the morning, and the linen gets changed, staff should also be instructed to open some windows for ventilation and allow for air to circulate and relieve the rooms of foul odors, caused by resident incontinence. Based on LPAs observation of the physical plant, the allegation is Substantiated . Deficiencies cited on LIC9099-D Exit interview conducted. Appeal rights explained and copy of this report signed and delivered. 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 compliance with Title 22 Regulations. Between 11:00am – 1:30pm, LPAs conducted an interview with the Administrator, Office Manager, Nurse, Memory Care Director, former Activity Director, one staff (1), one (1) MedTech, and six (6) residents. Allegation: Resident sustained unexplained injury resulting in hospitalization It was alleged that, around December 2018, the facility had a motorcycle club entertainment scheduled for the residents and during that time R1 sat on a motorcycle and fell off causing an injury on his/her foot. Interview with the former Activity Director, confirmed that during that event R1 sat on a motorcycle, however, no major injuries occurred. LPA was informed that R1 had a minor scratch on a leg. Interviews with the Administrator, Memory Care Director and a former Activity Director, revealed that due to R1’s diabetes and smoking R1 developed a diabetic wound on his/her right foot. Based on interviews and record reviews, this allegation is deemed Unsubstantiated, at this time. Allegation: Facility staff failed to notice a change in resident's condition. To investigate this allegation, LPAs conducted an interview with the Administrator, Memory Care Director and a former Activity Director and were informed that due to R1’s diabetes and smoking R1 developed a diabetic wound on his/her right foot Review of records revealed that as of 05/2/2019, R1 was admitted on Home Health. Review of records also revealed that R1 was seen by a Would Specialist every day from 05/02/19 – 05/14/19, and every other day from 05/14/19-05/9/20. Lastly, review of hospice records revealed that R1 was placed on hospice as of 05/10/20. Based on interviews and record reviews, this allegation is deemed Unsubstantiated, at this time. Allegation: Facility failed to follow proper rate increase procedures for resident To investigate the allegation LPAs reviewed R1's facility file and spoke with the Administrator. The documents reviewed include: R1’s assessments, admission agreement and notices issued for rent increase to the R1’s responsible party. R1 was admitted to this facility on 04/22/2015 and record review indicated that on 11/1/2018 the first letter of rent increase was emailed and mailed to R1’s responsible party. Moreover, the 2 nd rate increase letter was sent to the R1’s responsible party on November 26 th , 2019. Notice indicated the new rate will be effective on February 20 th , 2020. R1 did have a change in the level of care based on the initial Continue on 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 assessment and new assessments. LPA obtained and reviewed a copy of service rate increase notice that explained the additional charges and services to be provided. Based on interviews and record reviews, this allegation is deemed Unsubstantiated, at this time. Allegation: Facility staff failed to meet the needs of the resident. It was alleged that R1 requested three pictures to be hanged on the wall and the facility staff failed to meet R1’s needs. Interview with the Maintenance Director revealed that upon resident’s request, the order is being placed through a mobile application called “TELS”. Once the order is registered on TELS, the request is being completed based on a priority or as received in Queue. LPAs were also informed that R1’s request had been completed within the first week. Moreover, interviews with six (6) residents expressed no concerns regarding this allegation. Therefore, based on interviews, this allegation is deemed Unsubstantiated. Allegation: Facility staff failed to transport resident to doctor appointment To investigate this allegation, LPAs conducted an interview with the Administrator, Memory Care Director and were informed that based on a facility Admission Agreement, all residents are provided with a scheduled transportation to medical and dental appointments within a ten (10) mile radius. In addition, interviews with six (6) out of six (6) residents confirmed that facility does provide a transportation and all residents expressed no concerns regarding this allegation. Moreover, interview with a former Activity Director revealed that during R1’s stay at this facility, R1 had a doctor’s appointment once a month. LPA was also informed that R1 never missed an appointment nor was refused a transportation by the facility. Based on interviews and record reviews, this allegation is deemed Unsubstantiated, at this time. Exit interview conducted and copy of this report signed and delivered.