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On December 26, 2025, Licensing Program Analyst (LPA) Komal Curley conducted a Case Management-Other visit to the facility. LPA met with Administrator, Inderpreet Kaur and explained the purpose of the visit. The purpose of this visit is to follow up on a "Decision and Order" for the exclusion of Staff 1 (S1). According to the administrator, S1 does not work at the facility and a copy of an LIC500 was provided to LPA. No citations are issued during the visit. Report is reviewed with Administrator and a copy is provided.

On 9/15/2025, LPA Grace Donato conducted a Case Management-Other visit to the facility. LPA met with Assisted Living Director Joni Tsukimura and explained the purpose of the visit. The visit is regarding about the stipulation order sent to the facility and to confirm that the staff member (S1) mentioned in the order is no longer working in the facility. No deficiencies cited today. Report is reviewed and a copy is provided.

On June 18, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Assisted Living Director (ALD), Joni Tsukimura, and disclosed the purpose of the inspection. Executive Director (ED), Preet Kaur joined shortly after. The facility consisted of seven (7) buildings from one to three floors each. There was one (1) building with a combination of Assisted Living unit (Lodge) and Memory support unit (Health Center) and six (6) buildings for Independent living units (Redwood, Cedar, Magnolia, Maple, Birch, and Willow). The ALD informed the LPA that the facility had 172 residents in care at the time, including 31 in Assisted Living, 15 in memory support, and 126 in Independent Living. At 9:50 AM, LPA initiated a walk-through of the facility, accompanied by ALD. LPA inspected randomly selected eight (8) resident rooms in Assisted Living and Memory Care units. The rooms were found to be clean, well-lit, and equipped with the required furniture. Emergency pull cords were observed to be functioning in the resident rooms with an average response time of 1 minute. LPA inspected the private bathrooms in random rooms. The bathrooms contained soap, grab bars, towels, a trash can, and non-slip flooring. The hot water temperature at the sink faucets measured between 110.3°F to 113.6°F. “Oxygen in Use” signs were observed posted outside the residents’ room where oxygen was administered. LPA inspected the Assisted Living and Memory Support kitchen and found it clean. The refrigerator, freezer, and pantry cabinets were checked, and there was a sufficient supply of fresh perishable food for two (2) days and nonperishable staples for seven (7) days. 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 No expired food items were found. Open food items were wrapped and dated. The dining rooms in Assisted Living and Memory Care were inspected and were found to be clean, with all furniture in good repair. A weekly food menu and menu with alternate food options are available to the residents. LPA inspected activity areas, library, media room, fitness center, arts and crafts room, and living room areas. LPA observed residents watching TV and engaged in recreational programs and activities. Monthly activity calendar was available for the residents. All common areas were free from obstructions, and hallways were well-lit. Evacuation chairs were observed in the stairwells. LPA inspected locked laundry stations in Memory support and Assisted Living and observed washer and dryer units. Sharp objects, detergents, and chemicals were observed to be locked and inaccessible to persons in care. LPA observed locked centrally stored medication carts in the Assisted Living and Memory Support units. Medications were organized separately for each resident. Narcotics were locked. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. LPA inspected the first aid kit in the medication room and found it fully stocked. LPA toured the outside courtyard and patio areas and found passageways in good condition, free of obstructions, and without any blocking or tripping hazards. These areas had patio tables, chairs, and umbrellas for residents’ use. Delayed egress was observed on emergency exits. LPA inspected the fire extinguishers mounted on the hallway walls in Assisted Living and Memory Care and found them fully charged, with the last service tag dated 12/09/2024. The fire alarm, smoke detector, and fire sprinkler systems are tested annually by a third-party vendor, Battalion One Fire Protection. A staff member tested the carbon monoxide detector in one of the resident’s in LPA’s presence, and it was found to be functional. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster (Fire and Earthquake) Drills were conducted quarterly, with the most recent drill completed on 04/10/2025. LPA reviewed six (6) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, Personal Rights, and Consent forms. LPA observed that 6 of 6 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 6 of 6 staff members were associated with the facility. 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 The following updated forms are requested to be submitted to CCLD by 06/25/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Executive Director. A copy of this report was provided to the Executive Director, Preet Kaur, whose signature on this form confirms receipt of the report.

On February 19, 2025, at 12:40 PM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Case Management – Other inspection visit for an suspected elder abuse incident, reported by the facility through SOC 341. Upon arrival, the LPA was greeted by the Assisted Living Director (ALD), Joni Tsukimura. The LPA disclosed the purpose of the visit. The ALD informed the LPA that there were (30) residents in Assisted Living care and total facility census was 169. On 01/27/2025, the resident (R1) reported an incident to staff member (S2). R1 stated that on 01/25/2025, around 9:00 PM, staff member (S1) assisted them with the shower. After that, S1 helped them to stand at the side of the shower so that R1 could hold onto the rails facing the wall, and S1 then proceeded to dry R1 with a towel. R1 stated that S1 brushed their hand with the towel against R1’s breast. R1 mentioned that it happened a second time and felt more deliberate, so they asked S1 to leave. On 02/19/2025, at 1:13 PM, LPA interviewed ALD. ALD stated that R1 was not able to describe the person. When ALD initially talked to R1, ALD didn’t have the schedule with them as they were not sure who was working on the Saturday night. ALD stated that they asked R1 to describe the person who could have given them the shower, but R1 was still not able to identify the staff. ALD added that they didn’t go back with a picture to help R1 identify the staff. ALD confirmed that the facility notified the Los Altos Police Department. An officer called back and talked to R1 in the presence of R1’s family member (FMD). The police officer didn’t come to the facility, and no police report or complaint was made. R1 didn’t want to file a police complaint. R1’s family (FM1) was aware of this incident. On 02/19/2025, at 1:36 PM, LPA interviewed R1’s family member (FMD). FMD stated that R1 was anxious to talk about this incident with the LPA and that R1 had anxiety, with many things for R1 being anxiety-based. FMD mentioned that the staff was amazing and that R1 had built a good rapport with them. 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 FMD stated that R1 never felt that S1’s actions while assisting them with the shower were inappropriate and that, in R1’s mind, they weren’t thinking they were reporting something inappropriate. FMD added that R1 was taken aback when this incident was reported to the police, as it was never an issue that R1 was concerned about. FMD explained that at times, R1’s Parkinson’s-related anxiety took over and that they helped R1 process and dissect the incident, considering it one of those moments. FMD stated that it was just a case of R1 getting used to a new person helping them. There was never anything inappropriate with what S1 did, and according to FMD, S1 had their own style within appropriate boundaries. No deficiencies were cited during today's visit. An exit interview was conducted with the Assisted Living Director. A copy of this report was left with the Assisted Living Director, Joni Tsukimura, whose signature on this form confirms receipt of the report.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Administrator Deborah Gonzalez. The purpose of the Case Management visit was to conduct a health and wellness check on resident R1, who transferred to the facility from another facility. During visit, LPA Marrufo visited R1 in R1's apartment. LPA Marrufo asked R1 if the facility staff have been providing R1 with meals, assistance with medications, assistance with hygiene and personal care, and assistance with contacting family and loved ones. R1 responded affirmatively to all of the previous questions. LPA Marrufo toured R1's room and observed there to be bedding, hygiene items, clothing, and available soap and paper towels in the bathroom. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Deborah Gonzalez and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Administrator Debbie Gonzalez. The purpose of the Case Management visit was to obtain further information regarding the death of resident R1. The Department received the Death Report on 11/04/2022. R1 had a fall in R1's living unit. Facility staff did not witness the fall. However, the resident had a video camera installed in the bedroom that recorded the fall. The Death Report states that the fall contributed to R1's death. During visit, LPA Marrufo reviewed video recording of the fall and obtained timestamp information regarding the time of the fall and facility staff response time. R1 had triggered R1's emergency pendant after the fall. The timestamp information states that staff entered R1's room to respond to the fall approximately 2 minutes after the fall. LPA Marrufo obtained copies of R1's Physician's Report. The staff who responded to the fall were not present during visit. LPA Marrufo obtained the contact telephone numbers for 6 staff who responded to the fall. No deficiencies were cited at this time as per California Code of Regulations TItle 22. This report was reviewed with Administrator Debbie Gonzalez and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Deborah Gonzales. The facility entrance had a visitor screening area. The facility bathrooms had available soap and paper towels. A perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days was observed. A 30-Day supply of PPEs were observed. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Deborah Gonzales and a copy of the report was provided.