Sunny Hills Assisted Living (memory Care).

During today’s visit, LPA Gonzalez requested the staff roster, and resident roster. LPA reviewed records for staff #5-#6 (S5-S6) and requested a copies of various documents. Additionally, LPA Gonzalez conducted interviews with staff #1-#5 (S1-S5) and attempted to interview staff #6 (S6). Due to time constraints, and additional information needed, the above allegation needs further investigation. An exit interview was conducted, and a copy of this report was provided.

The investigation revealed the following: For the allegation: Staff does not ensure facility is free of pests. It is being alleged that there are bedbugs and cockroaches in the facility. On 01/22/26, LPA Gonzalez conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff denied the allegation. 5 out 5 staff said pest control services are provided monthly. On 01/22/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate with the allegation. During a records review conducted on 01/22/26, LPA reviewed pest control service invoices from Ok Exterminators dated 11/07/25 and 12/12/25, and National Exterminator Company dated 01/09/26. Documentation reflected that general pest control services were performed on the referenced dates. On 01/22/26, LPA and Jung Hee Kim conducted a tour of the facility and inspected rooms #102 and #113 on the first floor, rooms #206 and #217 on the second floor, rooms #302 and #306 on the third floor, as well as the kitchen and common areas. LPA observed the inspected areas to be clean, sanitary, and free of pests. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of this report was provided to Jung Hee Kim, Administrator.

The investigation revealed the following: Allegation: Staff does not ensure facility is free of pests. It is being alleged that live German cockroaches were observed on facility’s kitchen floor. On 12/30/25, LPA Gonzalez conducted interviews with S1-S5. Of those interviewed, 5 out of 5 staff denied the allegation. 5 out 5 staff said pest control services are provided monthly. On 12/30/25, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate with the allegation. During a records review conducted on 12/30/25, LPA reviewed pest control service invoices from OK Exterminators dated 11/07/25 and 12/12/25. Documentation reflected that general pest control services were performed on the referenced dates. On 12/30/25, LPA and Chansook Koo conducted a tour of the facility and inspected rooms #113 and #114 on the first floor, rooms #228 and #229 on the second floor, rooms #301 and #306 on the third floor, as well as the kitchen and common areas. LPA observed the inspected areas to be clean and free of pests. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited during this investigation. An exit interview was conducted, and a copy of this report was provided to Steve Cho.

It is alleged that Resident (R1) sustained multiple rib fractures, including a clavicle fracture, along with a bruise on the lower back and buttocks. The department obtained and reviewed Cedars-Sinai Medical Center Hospital records for R1 dated 09/21/2024 . The department found on 09/21/2024, the facility's Med Tech (MT1) checked R1's vital signs in the a.m. (actual time not found on record) and found R1 was in an altered mental state. The facility then contacted R1's primary physician and called 911. At approximately 8:06 a.m., the Emergency Medical Services (EMS) arrived, and R1 was transported to Cedars-Sinai Medical Center. The department found R1 was in an altered mental state due to R1 not eating and refusing medication for two days. The Cedars-Sinai Medical Records review indicated that the facility informed the hospital that R1 had no history of falls; however, a review of the Home Health records indicated R1 had a secondary diagnosis of repeated falls. Additionally, R1 complained of low back pain and left arm pain prior to the 09/21/2024 hospitalization. On 04/15/2025, at approximately 2:26 pm, the department interviewed Med Tech (MT1), who stated that when R1 experienced an unwitnessed fall, staff did not document unwitnessed falls with Unusual Incident Reports, nor did the staff seek medical attention to rule out invisible injuries after unwitnessed falls. Based on reviews and interviews, the preponderance of evidence standard has been met; therefore, the above allegation is substantiated. Per the California Code of Regulations (Title 22, Division 6, Chapter 8), the deficiency noted above was observed, and a citation was issued (ref. LIC 9099D). At the time of the complaint visit, an immediate civil penalty of $500 was issued, and the licensee was informed that an enhanced civil penalty determination is pending reference to Health & Safety Code § 1569.49. An exit interview was conducted and plans of correction were developed and reviewed. A copy of this report and appeal rights were discussed with Administrator Steve Cho and a hard copy left with Kay Hwang. 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 department attempted to interview the staff members (S2), but they were unable to answer the interview questions. On 07/23/2025, LPA interviewed three staff members (S1-S3), five residents (#2-6, R2-R6). LPA was unable to interview R1 because R1 passed away on 09/21/2024. Allegation: Questionable Death. On 01/27/2025, at approximately 2:58 PM, the department reviewed records from Cedars-Sinai Medical Center regarding the care timeline dated 09/21/2024. According to the Cedars-Sinai Medical Records, R1 was transported from Sunny Hill Assisted Living Facility to Cedars-Sinai Medical Center Emergency Department on 09/21/2024, for altered mental status, with conditions including sepsis, shock, and a urinary tract infection (UTI). The department examined the Cedars-Sinai Medical Records and the death certificate provided by the Special Investigator Assistant (SIA). R1 was diagnosed with severe sepsis and acute UTI. The death certificate listed cardiopulmonary arrest, acute hypoxic respiratory failure, acute kidney failure, and pneumonia as causes of death. On 04/15/25, at approximately 2:26 pm, the department interviewed Med Tech (MT1), who stated that on September 18, 2024, R1 refused food and medications and complained of pain. The department reviewed the Cedars-Sinai Medical Record, which showed that the hospital Social Worker (SW) called Sunny Hills Assisted Living and spoke with a staff member (S2), who stated that R1 had refused all medication and food for the past two days. The SW noted that there were no concerns of suspected abuse or neglect based on R1’s mental state and physical mobility. On 04/15/2025, at 2:26 PM, the department interviewed Med Tech (MT1), who reported that on 09/18 and 19/2024, R1 refused to eat, refused medications, and did not allow MT1 to check R1’s vital signs. The department reviewed the emergency room case for R1, date 09/ 21/2024. R1 passed away on 09/21/2024, at 3:43 PM. A family member was contacted twice to inform them of the critical situation and prognosis. R1 was appropriately assigned a Do Not Attempt Resuscitation (DNAR) status. Subsequently, R1 experienced respiratory and cardiac arrest and died. The department's review of R1’s death certificate indicated that the causes of death were cardiopulmonary arrest, acute hypoxic respiratory failure, acute kidney failure, and pneumonia. Regarding the allegation, “Questionable Death,” based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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 Although the allegation may have occurred or be valid, there is not a preponderance of evidence to prove whether the alleged violation did or did not occur; as a result, the allegation is Unsubstantiated. Allegation: Staff did not notify the resident's representatives about the resident's change in conditions. The complaint alleges that the facility failed to contact the responsible party regarding the resident's change in condition. On 07/23/2025, LPA Richard interviewed Staff #1 (S1), who denied the allegation and reported that when R1 was admitted to the facility on 01/26, 2024, the staff attempted to call the phone number listed in the admission record for R1, but there was no answer. R1 personally signed the admission agreement. The S1 mentioned that they also called the phone number from a previous admission agreement, but again, no one answered. It was noted that R1 has not received any visitors except on one occasion. A couple of times, someone came with another person to speak with R1; that was the last time anyone saw them. For the past eight months, R1 has had that many visitors. On the same date, LPA interviewed three staff members (S1-S3), all of whom denied the allegation. Staff member S3 mentioned that during one attempt to contact the responsible party, the person who answered was very upset and told S3, "Do not call this number anymore; it is up to you now." Additionally, LPA interviewed five residents (R2-R6), with the help of an interpreter, all of whom stated that the facility does contact their families. LPA also reviewed the admission agreement dated 01/26/2024, which indicated that R1 was the only person who signed the agreement. There was no responsible party signature on file. LPA was unable to interview Resident #1 due to R1 passing on 09/21/2024 at Cedar Sinai Hospital. Based on interviews and observations, there is insufficient evidence to support the allegation: Staff did not notify the resident's authorized representatives of the resident's change in condition. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated. Allegation : Staff did not seek medical attention for the residents in a timely manner. The complaint claims that staff failed to seek medical attention for residents in a timely manner. On 07/23/2025, LPA Richard interviewed Staff member #1 (S1), who reported that on 09/21/2024, the caregiver contacted Med Tech (MT) to check the vitals of resident R1. After assessing R1's vitals, Med Tech discovered that R1 was exhibiting an altered mental status. The (MT) immediately notified R1's primary care physician and family. When there was no response, the facility called for Emergency Medical Services (EMS). 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 As a result, R1 was transported to Cedars-Sinai Medical Center. On 07/23/2025, the Licensing Program Analyst (LPA) interviewed three staff members, Staff #1-3 (S1-S3). All three denied the allegations, affirming that staff members never neglected residents and always provided necessary medical attention. They stated that in the event of a Medical Emergency, they would call 911. The (MT) and (S1) reported that on 09/21/2024, staff promptly assisted Resident #1 (R1), who was then transported to Cedars-Sinai Hospital's ICU at approximately 8:06 AM, where R1 was admitted. There were no instances in which the facility failed to seek timely medical attention for a resident. On 07/ 23/2025, the LPA interviewed five residents, Residents #2-6: (R2-R6). All five residents stated that the facility usually calls 911 for them, or the Nurse comes to assist them when needed. Based on interviews and observations, there is insufficient evidence to support the allegation: Staff did not seek attention for the residents in a timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated. Allegation : Staff locked the residents in their rooms. The complaint alleges that every time they visit R1, there is no way to exit the third floor because all the stairway doors are locked, and the elevator requires a key to operate. LPA interviewed S1, who stated that the elevator door is locked. However, if a visitor signs in, we will provide them with a code to open it. Additionally, a staff member is always present on the third floor to open the door for residents who wish to enter. LPA interviewed staff #1-3 (S1-S3), who stated that the residents do not need a key because the rooms are locked from the inside. The residents could open their doors from the inside, but when they are outside, they need assistance when returning to their rooms. S3 also stated that since R1 was admitted to the facility, R1 has only had one visitor following R1's admission to the facility. On 07/23/25, the LPA interviewed five residents (R2-R6), wh

The investigation consisted of the following: On 07/02/25, LPA requested the staff and resident rosters. LPA reviewed service records for resident #1 (R1) and requested copies of the following documents: Physician’s Report, Advance Health Care Directive Form, Admission Agreement, Medication List dated 07/01/25, Resident Care Assessment Form, Appraisal Needs and Services Plan, Preplacement Appraisal Information, Personal Care Program Form, and 2-Hour Rounds Check Policy Form. Additionally, LPA conducted interviews with staff #1-#5 (S1-S5), witness #1 (W1), and residents #2-#5 (R2-R5) and attempted to interview R1. Furthermore, LPA and Steve Cho conducted a tour of the facility. On 09/11/25, LPA Gonzalez received the following documents for R1: Medication Administration Record (MAR) for the months of July and August 2025, and staff notes. The investigation revealed the following: Allegation: Resident is being physically abused while in care. It is being that a resident is being abused on a regular basis and has been observed with multiple bruises and scars on their body. On 07/02/25, between 11:00 AM and 12:15 PM, LPA Gonzalez interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that body checks are conducted daily and any bruising or change in condition is communicated to both the primary care physician and families and are then monitored. 5 out of 5 staff interviewed stated that they treat residents with dignity and respect. On 07/02/25, between 01:35 PM and 2:18 PM, LPA Gonzalez interviewed R2-R5 and attempted to interview R1 but was unable to because the resident was asleep in their room and did not wish to be interviewed. Based on interviews conducted, 4 out of 5 residents denied the allegation. 4 out of 5 residents stated that staff have not physically abused them while in care. 4 out of 5 residents stated that they have not observed staff physically abusing a resident while in care. 4 out of 5 residents stated that staff treat them with dignity and respect. On 09/11/25, LPA conducted a review of records and revealed the following: Physician’s Report (dated: 07/08/25) stated that R1’s ambulatory status is bedridden based upon both physical and mental conditions. Continued 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 Report also stated that R1 has a history of skin condition or breakdown due to thin skin related to age. A review of the MAR for the months of July, and August 2025 noted that certain prescribed medications may contribute to increased bruising. There was no incident reports reporting any physical abuse, scars or bruising. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. Allegation: Facility staff are not properly supervising residents who are a fall risk. It is being alleged that a resident has been observed with multiple bruises and scars on their body, and that staff claim the injuries are due to the resident falling out of their bed. It is also being alleged that a resident is often left alone in their room. On 07/02/25, between 11:00 AM and 12:15 PM, LPA Gonzalez interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that they supervise and monitor residents who are considered a fall risk. 5 out of 5 staff stated that they check on the residents frequently and as needed depending on the residents’ needs. S1 stated that all residents are checked every two hours and as needed. S1 stated that when a resident is considered a fall risk after assessment, they recommend to the family or the party responsible for their special care service called the Personal Care Program, which is offered for an additional fee. If the family denies that extra coverage, then staff will continue to follow their 2-hour Rounds Check Policy which ensures that the residents are checked on every 2 hours when they are in their rooms. On 07/02/25, between 01:35 PM and 2:18 PM, LPA Gonzalez interviewed R2-R5 and attempted to interview R1 but was unable to because the resident was asleep in their room and did not wish to be interviewed. Based on interviews conducted, 4 out of 5 residents denied the allegation. 4 out of 5 residents stated that staff does supervise residents who are a fall risk. 4 out of 5 residents stated that they do not know if a resident has fallen down the stairs. 4 out of 5 residents stated that they are not left alone in their room for a long period of time. 4 out of 5 residents stated that staff treat them with dignity and respect. Continued 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 On 09/11/25, LPA Gonzalez conducted a review of records and observed that there were no incident reports reporting any physical abuse, scars or bruising. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Administrator, Steve Cho.

Allegation: The facility only admits residents based on race The allegation alleges that the facility turned away clientele who inquired about moving in and were denied based on race. During record review, LPA received and reviewed an Admission Packet which is given to perspective residents. In the packet is the facility’s Anti-Discrimination Policy that states "It is the policy and practice of Sunny Hills Assisted Living and Memory Care and its agents and employees not to engage in housing discrimination based on a current or prospective resident’s race, color, national, origin, religion, sex, familial status, disability or any other classification protected by applicable federal, state or local law." Additionally in the packet is Personal Rights in Privately Operated Residential Care Facilities for the Elderly that states in number (4) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. LPA additionally received and reviewed the facility’s multilingual brochures. LPA observed the brochure has multiracial photos. During the facility inspection, LPA observed multilingual signs posted throughout the facility, including the menu, activity schedule, and other required postings. LPA received and reviewed staff In-Service training logs dated 10/20/2023 and 10/14/2022, on the topic of the facility’s Non-Discrimination Policy. During interviews with Staff S1-S7, were asked if they have heard of or know of a person inquiring about the facility that was turned away based on race, gender, color, marital status, or national origin, seven (7) out of seven (7) stated no, not that they have knowledge of. Additionally, Staff S1-S7 were asked if they have turned a person away who was inquiring about the facility based on race, gender, color, marital status, or national origin, seven (7) out of seven (7) stated no, they have not turned any inquiring persons away. During an interview with Staff S1, stated when they became the administrator they had multilingual brochures made so they could expand their advertising to all communities. During interviews with Residents R1-R8’s Responsible Party’s Witnesses W1-W7, were asked if they were told the facility is a Korean facility only, seven (7) out of seven (7) stated no, they were not told the facility was a Korean facility. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated . LPA did not observe or cite any deficiencies. An exit interview was conducted with Reception, Chan Sook Koo, and a copy of this report was provided.

The investigation revealed the following: Allegation: Resident is being physically abused while in care. It is being alleged that a resident is being abused on a regular basis and has been observed with multiple bruises and scars on their body. On 07/02/25, between 11:00 AM and 12:15 PM, LPA Gonzalez interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that any bruises and cuts observed on a resident are reported to the med-tech and management, and are then monitored. 5 out of 5 staff interviewed stated that they treat residents with dignity and respect. On 07/02/25, between 01:35 PM and 2:18 PM, LPA Gonzalez interviewed R2-R5. Based on interviews conducted, 4 out of 5 residents denied the allegation. 4 out of 5 residents stated that staff have not physically abused them while in care. 4 out of 5 residents stated that they have not observed staff physically abusing a resident while in care. 4 out of 5 residents stated that staff treat them with dignity and respect. On 07/02/25, between 01:15 PM and 1:35 PM, LPA Gonzalez interviewed W1 and revealed that they appreciate the staff at this facility and all they do for the residents in care. W1 stated that the staff at this facility are very caring and go above and beyond for their family member, and the other residents in care. W1 stated that they understand that with age, the residents can become weak and fragile, and they are more prone to falls. W1 stated that they have no safety concerns for their family member at this facility, and that they have 100% confidence that the staff at this facility will provide the best care possible. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. Continued 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 Allegation: Facility staff are not properly supervising residents who are a fall risk. It is being alleged that a resident has been observed with multiple bruises and scars on their body, and that staff claim the injuries are due to the resident falling out of their bed. It is also being alleged that a resident is often left alone in their room. On 07/02/25, between 11:00 AM and 12:15 PM, LPA Gonzalez interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed denied the allegation. 5 out of 5 staff interviewed stated that they supervise and monitor residents who are considered a fall risk. 5 out of 5 staff stated that they check on the residents frequently and as needed depending on the residents’ needs. S1 stated that all residents are checked every two hours and as needed. S1 stated that when a resident is considered a fall risk after assessment, they recommend to the family or the party responsible for their special care service, which is called the Personal Care Program, for an additional fee. If the family denies that extra coverage, then we will continue to follow their 2-hour Rounds Check Policy which ensures that the residents are checked on every 2 hours when they are in their rooms. On 07/02/25, between 01:35 PM and 2:18 PM, LPA Gonzalez interviewed R2-R5. Based on interviews conducted, 4 out of 5 residents denied the allegation. 4 out of 5 residents stated that staff does supervise residents who are a fall risk. 4 out of 5 residents stated that they do not know if a resident has fallen down the stairs. 4 out of 5 residents stated that they are not left alone in their room for a long period of time. 4 out of 5 residents stated that staff treat them with dignity and respect. Based on observation, records reviewed, and interviews conducted, the department did not find sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Administrator, Steve Cho.

On 1/15/2025, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Steve Cho/Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (120) elderly adults ages 60 and above, of which (120) can be non-ambulatory and (35) bedridden on rooms:100-116,228,302-329. The facility has an approved hospice waiver for (10). The facility is a four-story building located on a main street. The basement/first floor consists of a parking garage. The second floor consists of the medicine room, industrial kitchen, front desk, dining room, several community rooms, patio area with shaded seating, and resident rooms for assisted living. The third floor consists of resident rooms for assisted living, and community rooms. The fourth floor consists of the memory care unit, the bedridden unit, and resident bedrooms. LPA Iniguez and the Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. LPA inspected a total of (5) bedrooms and (5) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were found to be within Title 22 regulations and were operational. Smoke and carbon monoxide detectors were in operable condition. The water temperature ranged from 105.0°F to 116.2°F, and the room temperature ranged from 76°F to 78°F. The evaluation Report continues on the next page, LIC 809-C , providing further details of the inspection findings. 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 Iniguez observed that the facility was clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 12/5/24. A review of (5) residents' service files and (5) staff personnel files was maintained in order. LPA reviewed (5) Medication Administration Records (MARs) and found no discrepancies. LPA observed the facility's infection control practices. All mandated inspection control posters were displayed throughout the facility. A copy of liability insurance was provided to LPA . Facility Annual Fess current. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies during this visit; therefore, no citations were issued. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Steve Cho / Administrator.

Six out of six staff interviews, including S1, indicated there has not been any recent evictions and residents have not complained about being with an eviction. Six out of six resident interviews, including R1, indicated they have not been served an eviction notice. Five out of six residents indicated they are treated with dignity and respect. R1 did not understand the question. Regarding the allegation “Staff unlawfully evicted a resident," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Administrator Steve Cho.

The details of the complaint alleged that R1’s call button was faulty and R1 yelled for assistance for hours, but no one came. On 06/26/24, from 10:00am-2:00pm, LPA interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. R1 could not be interviewed because R1 is no longer at the facility and no new contact information was given. 4 of 4 staff denied the allegation that the Staff did not ensure that the resident's call assistance button was operable. All staff (S1-S4) stated that each room and bathroom have a working call button that alerts the front desk when pushed. Additionally, when the button is pushed, a caregiver is paged to go and check on the resident. The staff stated they have no knowledge of anyone complaining that they were not assisted when the call button was pushed. S1 further stated that S1 had no knowledge of R1 calling for assistance and not receiving it. LPA toured the facility and checked two downstairs rooms (Room 102 and 103) and three upstairs rooms (Room 201, 202, and 206) and found the call buttons all worked and that they registered at the front desk computer. LPA noticed that it took the staff less than five minutes to respond to the call alert. LPA interviewed R1-R8 about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff did not ensure that the resident's call assistance button was operable. All residents interviewed stated that their call button works and when they need assistance and push the button for help, they are given the assistance they need. Based on interviews, there is insufficient evidence to support the allegation that the Staff did not ensure that the resident's call assistance button was operable. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . Allegation #2- Staff did not assist resident in a timely manner. The details of the complaint alleged that R1 fell on the floor in the middle of the night, called for help, and no one assisted R1 until hours later. 06/26/24, from 10:00am-2:00pm, LPA interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. R1 could not be interviewed because R1 is no longer at the facility and no new contact information was given. 4 of 4 staff denied the allegation that the Staff did not assist resident in a timely manner. All staff (S1-S4) stated that all residents are assisted in a timely manner and had no knowledge of R1 falling. S1 stated that there is no record of R1 falling, and R1 did not fall to S1s knowledge. Report continued 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 LPA interviewed R1-R8 about the allegation and 7 of 8 residents that were interviewed denied the allegation that Staff did not assist resident in a timely manner. All residents interviewed stated that they have not had any problems with getting assistance in a timely manner from the staff when they need help. Based on interviews, there is insufficient evidence to support the allegation that the Staff did not assist resident in a timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . No deficiencies were cited. An exit interview was conducted with Steve Cho, Administrator, and a hard copy of this report was provided.

Regarding Allegation #1 : this investigation revealed based on interviews conducted with Staff #1 - #4 (S1-S4), Residents #1 - #4 (R1-R4), and a review of the requested documents that the facility is following COVID-19 protocols. Administrator Park informed LPA Brown that the facility follows COVID-19 protocols during a COVID outbreak - including the facility’s mitigation plan. Administrator informed LPA that there is a weekly COVID testing for staff and residents and whenever there is a positive case, it’s reported to CCLD (via fax) and to the local public health department (via RedCap). Administrator also stated to LPA that facility staff encourages their residents to wear a face mask when inside or outside the facility. LPA conducted an inspection and observed the facility is following their mitigation plan measures. LPA interviewed four (4) facility staff members and 4 of the 4 staff members interviewed corroborated that they have been trained in COVID protocol procedures and that staff encourages the residents to wear their face mask while inside or outside the facility. LPA interviewed four (4) residents and 4 of the 4 the residents corroborated facility staff are following COVID-19 procedures when there are positive cases. Residents also confirmed that the facility provides them with face masks to use while inside or outside the facility. A review of the facility’s COVID-19 incident reports that were submitted to CCLD (via fax) documented notifications made to DPH (via RedCap) that was confirmed by Administrator Park. A review of the facility’s staff training records documented staff were provided with “COVID-19” training on various topics (i.e., Cleaning for COVID-19 (05/30/22); Guidance on 2019 Novel Corona Virus or COVID-19 (06/01/22); Donning & Duffing (06/14/22), Handwashing & 6-feet Distancing (06/16/22); Mask FIT Testing (06/17/22); Cough Ettiquette & Cleaning for COVID-19 (06/18/22). Based on the evidence gathered, interviews conducted, and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation of OTHER: Staff did not follow proper Covid-19 safety protocols is found to be UNSUBSTANTIATED. Regarding Allegation #2 : this investigation revealed based on interviews conducted with Staff #1 - #4 (S1-S4), 4 of the 4 corroborated that staff do allow residents to have visitors. Administrator Park informed LPA Brown that during a COVID outbreak facility staff will contact the resident’s responsible person and encourage the family member(s) not to visit their loved one(s) while the resident(s) is in quarantine, and/or until their test result returns negative. In the memory care unit, visitors would visit their loved one(s) in the patio area. Facility encouraged an appointment to let facility staff know when a resident’s family was coming to visit their loved one at the facility to make sure there was enough space and to get the resident to the patio area for visitation. Administrator Park confirmed that when the facility had an outbreak, facility staff asked 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 resident’s family to call ahead because the facility did not want to have a lot of visitors in one space to avoid spreading the virus. Although some resident’s family member(s) would show up unannounced to the facility, they would agree to visit their loved ones outside the resident(s) room and were never denied visitation. Interviews conducted with Residents #1 - #4, (R1-R4) 4 of the 4 the residents corroborated that facility staff allowed them to have visitors during COVID and were never denied of their visitation rights. RA Ceniceros observed COVID postings at the main entrance of the facility (photo). A review of the facility’s staff training records documented staff were provided with “PERSONAL RIGHTS” training on various topics (i.e., HIPPA Compliance (10/26/22) and Resident's Rights (12/22/22). Based on the evidence gathered, interviews conducted, and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation of PERSONAL RIGHTS: Staff are not allowing resident to have visitors while in care is found to be UNSUBSTANTIATED. An exit interview has been conducted and a copy of the Complaint Report was provided to the new Administrator (Steve Cho).