Bridgepoint at los Altos

On 11/18/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with the administrator Anna Allas and explained the purpose of today's visit. There are currently 134 residents in the facility during this inspection and multiple staff through out the facility. This is a multi-level facility, Age range 60 years and above. Hospice waiver for 10 residents with a total care addendum has been approved. Fire clearance for 150 non-ambulatory residents has been approved. There are 10 residents under hospice care as of today's visit. The physical plant was toured inside and outside of the facility to ensure the safety of the clients. Large dining room is clean and organized for residents. Lunch is being served during today's inspection. The facility also has a bistro adjacent to the main dining room. Dining menu and activities calendar posted. Per facility, menu's for the month and week are communicated via flyers in resident mail cubby and email for residents and family. LPA observed the facility kitchen which is clean and observed that all appliances are in good repair. Per staff, all appliances are in working condition. Knives are stored and locked and secured in the kitchen. Perishable and non-perishable food supplies are observed as in place. Kitchen grade fire extinguisher is observed as in place and with an inspection date of 06/04/2025. Canned food supplies and dried food supplies are stored within the kitchen. Cleaning substances and dish washing chemicals are properly stored and labeled. Per kitchen director, and in service training was conducted around 11/04/2025 with the facility's contracted company that handles the supply and installation of the receptacle's that administer and hold these cleaning supplies. These are observed as in place as functioning and color coded. Eye washing stations are observed as well in the kitchen. Continued on next page... 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 Medications are observed to be locked in the medication room and medication carts. Carts are in place in the medication room. They can be moved around the facility. LPA audited medications of residents at random with staff and all are logged and tracked accurately using an electronic based tracking system. LPA observed that there are multiple fire extinguishers in place on each floor with an inspection date of 06/04/2025. Smoke detectors, carbon monoxide detectors, and full fire sprinkler system is observed in place through out the facility. Central heating and air conditioning is in place. Laundry room is also observed as fully operational and organized. Lint area behind dryers are observed as clean with no lint or extreme dust accumulation. Janitor cart is observed on second floor and are stored in janitor closet when not in use. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Evacuation chairs are in place in emergency exit stairwells as well. Last emergency/disaster drill was conducted in 07/24/2025. Water temperature was measured in resident rooms 165, 134, 271, and 207. Water temperature was measured to fluctuate between 108F and 112F. Of those 4 resident room, LPA observed to be free of odors and contained all the required furniture per regulatory recommendations. Resident rooms have walk in showers with non-skid flooring. Rooms have a pull cord call system in resident bathroom and by the bed in the resident room. Rooms have a kitchenette, but no cooking surfaces. Resident linen supplies are in place. Facility conducted last fire/disaster drill on 10/25/2025. LPA reviewed five staff files and five resident files during today's inspection. All files are observed as current. Staff are actively conducting training and it is observed as current for the staff reviewed. The following updated forms are requested to be submitted to CCLD by 11/25/2025 : • Copy administrator certificate • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule No citations issued. Report is reviewed with Mehrad Moshiri and a copy is provided on this day. Technical violations are given on the attached LIC9102TV pages.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Maria Quintero. The purpose of the visit was to deliver the findings of an investigation conducted by the department. On 03/27/2024, the facility submitted an Unusual Incident/Injury Report stating that resident R1 suffered a self-inflicted injury that resulted in R1's death while under the care and supervision of the facility. R1 was an independent living resident and did not require monitoring or services. R1 was not diagnosed with any mental health conditions nor was R1 on any medications for depression. Based on information from interviews conducted with staff and records reviewed, the investigation is concluded with a finding of unsubstantiated. No deficiencies were cited under California Code of Regulations Title 22 This report was reviewed with Maria Quintero and a copy of this report was provided.

During interview on 03/19/2025, staff S3, Assisted Living Director, stated that the boxes in the MARs may have been due to the resident being out of the facility without the resident’s absence being recorded. During visit on 01/09/2025, LPA Marrufo interviewed 10 residents. 7 out of 10 interviewed residents stated that staff provide them their medications as prescribed. 3 out of 10 interviewed residents stated that they do not require assistance from staff with being provided medications as prescribed. LPA Marrufo obtained a copy of the Dinning Services Food Servers Schedule, which indicates that there 10 food servers scheduled per day. LPA Marrufo obtained a copy of the Kitchen Schedule, which indicates that there are four cooks scheduled each day as well as an AM and a PM dish runner. LPA Marrufo obtained a copy of the Dinning Menu, which indicates breakfast, lunch, and dinner are served each day. Lunch and dinner include soup, salad, three entrees, and dessert. During interview on 01/12/2023, ADM Moshiri stated that residents are allowed to have second servings and residents are delivered meals to their living units when residents are under quarantine or isolation. During visit on 03/19/2025, the communal dinning services were suspended due to cases of gastrointestinal symptoms at the facility. During interviews on 01/09/2025, 9 out of 10 interviewed residents stated that the thought the food service at the facility was good. 1 out of 10 residents stated the food service at the facility is sometimes good and sometimes not good. 9 out of 10 interviewed residents stated that the food is delivered on time. 1 out of 10 interviewed residents stated that the food is not always delivered on time and is sometimes delivered cold. 9 out of 10 interviewed residents stated the food quality is good. 1 out of 10 interviewed residents stated the food quality needs improvement. On 03/19/2025, LPA Marrufo interviewed staff S1, who is a cook at the facility, and staff S2, who is the Culinary Service Director. S1 stated that S1 ensures that residents are provided with adequate food service by washing and preparing foods and preparing them at temperature as well as ensuring food is not overcooked or undercooked. Page 2 of 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 S2 stated that S2 ensures that residents are provided with adequate food service by hiring qualified staff and acquiring the best ingredients. LPA Marrufo obtained copies of R1-R4s Care Plans. R1, R3, and R4’s Care Plans do not require monthly checking and recording of vitals and weight. R2’s Care Plan requires monthly checking and recording of vitals and weight. LPA Marrufo obtained a copy of R1 and R2’s Care Tracking Logs from 11/01/2022 to 01/31/2023. R1’s Care Tracking Log has 78 entries recording staff assisting R1 with toileting and 19 entries recording staff assisting R1 with dressing. R2’s Care Tracking Log has 33 entries recording staff assisting with toileting, 8 entries recording staff assisting with dressing, and six entries recording staff assisting with bathing. R2’s Care Tracking Log has entries on 11/10/2022, 12/15/2022, and 1/12/2023 in which staff checked R2’s vitals. The entries do not include the results of R2’s vitals. The entries on 11/10/2022 and 1/12/2023 indicate that R2 refused to be weighed. LPA obtained a copy of R2’s Vitals Record, which does not have any vitals data entered from 06/09/2022 to 02/09/2023. During interview on 03/19/2025, staff S3, the Assisted Living Director, stated that it is possible R2’s vitals data were recorded on apreviously used electronic MARs system, which the facility discontinued to use since July 2024 and can no longer access. On 01/09/2025, LPA Marrufo interviewed 10 residents. 9 out of 10 residents stated the staff provide them with all services. 1 out of 10 interviewed residents stated that he/she is independent and does not need staff to provide him/her with services. 7 out of 10 interviewed residents stated staff check their vitals once a month. 1 out of 10 interviewed residents stated staff check his/her vitals once a month, but sometimes the staff go longer than a month before checking his/her vitals. 2 out of 10 interviewed residents stated that they do not need the staff to check their vitals. Page 3 of 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 6 out of 10 interviewed residents stated that the staff check their weight once a month. 1 out of 10 interviewed residents stated that staff check his/her weight, but staff have not weighed him/her during the holiday months of November and December. 1 out of 10 residents stated he/she refuses to be weighed. 2 out of 10 residents stated they do not need the staff to weigh them. On 03/19/2025, LPA Marrufo interviewed 4 staff care givers. 4 out of 4 interviewed care givers stated that they change resident diapers, shower the residents, assist them with changing clothing, and escort the residents to activities. 3 out of the 4 interviewed care givers stated that they do not remember R1 or R2. 1 out of the 4 care givers stated to have remembered both R1 and R2. The care giver stated to have assisted R1 and R2 with changing their diapers. The care giver stated to have observed R2 to be in soaked diapers from the night before. The care giver stated to believe that the night shift staff may not have checked R2’s diaper to check if it was soaked. LPA Marrufo asked the care giver how he/she knew whether R2 had a soaked diaper throughout the night or instead had urinated shortly before the care giver’s shift. The care giver stated to have not known for sure which was the case. LPA Marrufo obtained the Activities Calendar from December 25, 2022 to January 31st, 2023. The Activities Calendar indicates there were multiple activities offered each day. On 01/12/2023, LPA Marrufo interviewed staff S4, Wellness Director. S4 stated that activities are offered every day, including daily exercise activities and weekly activities such as bingo, art, and karaoke. During interview on 01/09/2025, 10 out of 10 interviewed residents stated that activities are offered at the facility. During interview on 03/19/2025, 4 out of 4 interviewed staff stated that they escort resident to activities and encourage residents to participate in activities. During visits on 01/09/2025 and 03/19/2025, LPA Marrufo toured the Activity Room and observed sign-ups for activities as well as activity materials. Page 4 of 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 Based on information from interviews conducted with staff and residents, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22 This report was reviewed with Administrator Rod Moshiri and a copy of this report was provided. Page 5 of 5. END REPORT

On 3/28/2024, at approximately 9:30 a.m. Licensing Program Analysts (LPAs) Maria (Mita) Partoza a case management visit in regards to an incident report involving a resident and met with Executive Rod Moshiri. LPA stated the purpose of the visit. LPA conducted a file review and requested copies of the resident's file including but not limited to admission agreement, medication list and physician's report. No deficiency cited at today's visit.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Administrator Rod Moshiri. The purpose of the visit was to address incident reports filed by the facility concerning medication errors, including an LIC624 Unusual Incident/Injury Report for an incident that occurred on 12/09/2022 and reported to the Department on 12/15/2022. The incident from 12/09/2022 involved a medication technician who gave another resident's morning medications to resident R1. LPA Marrufo requests that the facility submit a Plan of Action to the Department by 02/20/2024 explaining how the facility will train staff and prevent medication errors. An Advisory Note was issued. See LIC9102 for more information. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Rod Moshiri and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Administrator Rod Moshiri. The purpose of the visit was to obtain documents in regards to an incident that occurred on 01/07/2023 and was self-reported by the facility. During visit, LPA Marrufo obtained copies of R1's Physician's Report, Assessment, and Progress Notes. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Rod Moshiri and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Interim Executive Director Donna Daniel-Herr. During visit, LPA Marrufo observed a visitor screening area at the entrance. LPA Marrufo observed a 30-Day supply of PPEs and cleaning supplies. LPA Marrufo observed a perishable food supply of at least 2 days. The facility has contracted a service for daily meal preparations while construction is ongoing in the kitchen area of the facility. LPA Marrufo observed the resident common areas and staff lounge areas. No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Interim Executive Director Donna Daniel-Herr and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Interim Executive Director Donna Daniel-Herr. The purpose of the visit was to investigate a medication error reported by the facility via LIC624 Unusual Incident Report that was reported to the Department on 11/16/2022. The incident occurred on 11/10/2022 and involved staff S1 and S2 discovering during a medication audit occurring during a shift transition that resident R1's medication had gone missing. During visit, LPA Marrufo interviewed staff S3 and Interim Executive Director Donna Daniel-Herr. LPA reviewed facility records, including R1's Centrally Stored Medication Log (CSML) and Medication Administration Record (MAR), Invoice with company contracted to pick up destroyed medications from the facility for further disposal, Memorandum dated 11/14/2022 and addressed to all Assisted Living Medical Technicians, Attendance Roster for Staff Training on Missing Narcotics dated 11/14-18/2022, and Weekly Controlled Narcotic Shift Count Log, and Disposal of Medications Policy. R1's CSML states that the missing narcotic was logged into the record on 10/14/2022 and is to be administered as needed. R1's MAR indicates the medication was never administered to R1. S3 stated during interview that the procedure for destroying narcotic medications is to pour them into a destruction bottle and have two Medication Technicians sign and document the destruction process in the residents CSML. Then, the medications are picked up by the medication destruction company. S3 stated the facility procedure is to have two staff audit the medications per each change in shift and attest to the medication audit in a log. LPA Marrufo obtained a copy of the Weekly Controlled Narcotic Shift Count Log. S3 stated that facility staff did not know what happened to R1's missing medication. See LIC809-C for more information. 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 facility Memo states that for each shift, the oncoming Medication Technician assumed responsibility for all narcotics and attests that the count is correct. It states both the incoming and outgoing Medication Technician must visually confirm and sign off on the count of medications at the change of each shift. No deficiencies were cited at this time as per California Code of Regulations Title 22. An Advisory Note was issued. See LIC9102 for more information. This report was reviewed with Interim Executive Director Donna Daniel-Herr and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Michelle Benigno and Christina Thomas. During visit, LPA Marrufo observed a visitor screening area with symptom screening questions and temperature check. LPA Marrufo observed hallway bathrooms to have hand washing signs and available soap and paper towels. LPA Marrufo observed a 30-day supply of PPEs in the facility medicine room and supply room. LPA Marrufo observed a two week supply of perishable and non-perishable food in the facility kitchen. LPA Marrufo observed the facility dinning room and bistro areas. LPA Marrufo observed the staff break room to have plastic partitions and COVID-19 related signs. LPA Marrufo toured the facility hallways. No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Christina Thomas and Michelle Benigno and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Jayden Bettencourt, Wellness Director. On 05/28/2021, the Department received a death report from the facility regarding resident R1’s death from self-inflicted gunshot wound. The Department conducted an investigation of neglect and lack of supervision resulting in R1’s death from a self-inflicted gunshot wound. The Department interviewed 6 facility staff and 1 resident and reviewed records. Interviewed staff stated resident R1 always appeared cordial with care staff, did not complain, and did not show any indication that R1 was depressed or wanted to commit suicide. R1 did not require multiple checks in a day. R1 preferred to stay in R1’s room, and staff encouraged R1 to come out of R1’s room and join activities. Needs and Services Plan and physician’s report were reviewed. Needs and Services Plan dated 03/20/2021 indicated R1 does not need safety checks. Physician’s report dated 08/11/2017 indicated R1 does not have any suicidal behavior. No deficiencies were cited as per California Code of Regulations Title 22. Based on the Department’s investigation through interviews and record reviews, the Department has found that the investigation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This report was reviewed with Jayden Bettencourt and a copy of the report was provided.

Licensing Program Analysts (LPA) David Marrufo and Ryker Heberle conducted an unannounced Case Management visit and met with Administrator Maria Quintero. The purpose of the visit was to inquire about a death that occurred at the facility. The facility submitted a death report for the incident on 05/28/2021. During visit, LPAs Marrufo and Heberle interviewed Administrator Quintero. LPAs obtained the following documents for resident R1, the resident who was reported to have died in the death report: Physician's Report and Service Plan. LPAs requested copies of the police report and coroner report once they are available. No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Maria Quintero and a copy of the report was provided.