Coral Oaks Care Living.

On 04/30/2026 at 1:00 PM, Licensing Program Analyst (LPA) Jose Anguiano conducted a subsequent unannounced annual required visit to complete the inspection. LPA met with Administrator Eleanor Barrientos. LPA toured the physical plant. There were no bodies of water observed on the premises. Resident rooms were inspected. Beds and bedding supplies were observed to be in good condition, adequate lighting was provided, and storage for residents’ personal belongings was observed. Bed linens, comforters, and bath towels were observed to be available during the visit. Bathrooms were operational. Storage areas for personal hygiene items, cleaning supplies, toxins, and sharps objects were observed to be secured and not accessible to residents. Infection control practices and the facility’s Emergency and Disaster Plan were reviewed and discussed with the Administrator during the visit. Records reviewed indicate that fire drills were conducted on 03/12/2026 and were signed by participants. Documentation further indicates that infection control in-service training was conducted on 01/09/2026, with staff signatures confirming participation. Required postings, including the activity calendar and menu, were observed to be posted. A review of the Medication Administration Records (MAR) was conducted and observed to be maintained in order. Additional staff and resident files were reviewed and found to be complete. No deficiencies were cited during the annual inspection. An exit interview was conducted with Administrator Eleanor Barrientos, and a copy of this report was provided.

On 04/23/2026 at 1:50 PM, Licensing Program Analyst (LPA) Jose Anguiano conducted an unannounced annual required visit at the facility. LPA met with Assistant Administrator Michalene Johnson and explained the purpose of today’s visit. Entry was granted. The facility is licensed to serve a total capacity of 84 residents, of which 64 may be non-ambulatory, 20 may be bedridden, and 10 may be on hospice. The facility consists of a one-story building with multiple resident rooms, bathrooms, common areas, a dining room, kitchen, activity areas, and outdoor spaces. LPA conducted a walkthrough of the physical plant, including common areas, resident rooms, bathrooms, and the kitchen. During the visit, the facility was observed to be generally clean, organized, and furnished. The kitchen was observed to be clean, and the food supply was sufficient, including both perishable and non-perishable items. Please see report continuation 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 Fire inspection records were reviewed and indicate the last inspection was conducted on 04/06/2026. Staff reported that pest control services are conducted monthly and that documentation is maintained. Hot water temperature was tested and measured at 105°F. Two staff files and one resident file were reviewed and found to be complete. Due to time constraints and the need for additional information, additional time is required to complete the annual inspection. No deficiencies were cited during today’s visit. An exit interview was conducted with Assistant Administrator Michalene Johnson, and a copy of this report was provided.

Continued LIC9099-C page 2. On 02/23/2026, between 10:30 a.m. and 4:30 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#4 (S1–S4) and with residents #1–#6 (R1–R6). The investigation revealed the following. Allegation: Staff dropped the resident LPA conducted interviews with Staff #1–#4 (S1–S4). All four staff members (4 out of 4) stated that the facility provides adequate care and supervision to ensure residents are safely assisted at all times. Each staff member (4 out of 4) stated that no resident has been dropped by staff and confirmed that there is no documentation indicating that such an incident has occurred at the facility. S1-S4 denied the allegation. LPA also interviewed Residents #1–#6 (R1–R6). All six residents (6 out of 6) stated that they have never witnessed or experienced any resident being dropped by staff. Residents stated that staff provide appropriate care and supervision, are readily available when assistance is needed, and routinely check on residents throughout the day and night. R1–R6 stated that their daily needs are met, that they feel safe in the facility, and that they are happy living there. None of the residents expressed concerns related to staff handling or safety. R1-R6 denied the allegation. Allegation: Staff are not meeting residents' needs LPA conducted interviews with Staff #1–#4 (S1–S4). All four staff members (4 out of 4) stated that the facility is meeting residents’ needs and that staff provide adequate care and supervision to ensure residents remain healthy and well. S1–S4 reported that they regularly monitor residents, assist with daily living activities, and follow established care protocols. All four staff members (4 out of 4) denied the allegation. LPA also interviewed Residents #1–#6 (R1–R6). All six residents (6 out of 6) stated that staff provide appropriate care and supervision and are available when assistance is needed. 6 out of 6 residents stated that staff routinely check on them throughout the day and night and respond promptly to calls for help. R1–R6 stated that their daily needs are being met, that they feel safe in the facility, and that they are happy with the care they receive. None of the residents expressed concerns regarding staff responsiveness, care practices, or unmet needs. All six residents (6 out of 6) denied the allegation. See continued LIC812-C page 2. 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 LIC9099-C page 3. Allegation: Staff Are Not Following Infection Control Requirements LPA conducted interviews with Staff #1–#4 (S1–S4). All four staff members (4 out of 4) stated that the facility follows all required infection control protocols and provides adequate care and supervision to ensure residents’ health and safety. 4 out of 4 staff stated that they adhere to established policies, including hand hygiene, personal protective equipment (PPE) use, sanitation procedures, and the implementation of resident-specific precautions when necessary. 4 out of 4 staff members stated that they had no cases of COVID-19, UTIs, or pneumonia among residents during March 2025. S1-S4 stated that all incidents are reported to Community Care Licensing and all other appropriate agencies in a timely manner. S1–S4 stated that infection control practices are reviewed regularly during staff meetings and reinforced through ongoing training. All four staff members (4 out of 4) denied the allegation. During the visit, LPA reviewed the facility’s Mitigation Plan Report dated April 16, 2021 , and an approved Infection Control Report dated May 25, 2022 . Both documents reflected current infection control procedures and confirmed that the facility has established systems in place to reduce the risk of illness and comply with regulatory requirements. LPA also interviewed Residents #1–#6 (R1–R6). All residents (6 out of 6) stated that staff provide adequate care and supervision and follow infection control procedures, including compliance with COVID‑19 guidelines and physician‑ordered medical directives. 6 out of 6 residents stated that staff maintain a clean environment, practice proper hygiene, and take precautions to prevent the spread of illness. All six residents (6 out of 6) denied the allegation and expressed no concerns regarding staff practices or infection control measures. Based on interviews, available evidence, observation, information received, and records reviewed, there was not enough 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 deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099 and LIC9099-C was provided to Ellen Barrintos, Administrator. No deficiencies were cited. An exit interview was conducted.

Continued LIC9099-C page 2. In-Service Training (dated 12/10/2025), Sign In and Out Sheet (dated 12/09/2025), La Palma Intercommunity Hospital Medical Records (dated 09/19/2025), and Kaiser Permanente Downey Medical Center Admission and Discharge Records (dated 12/09/2025 and 12/10/2025). On 12/19/2025, between 10:00 a.m. and 3:00 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#4 (S1–S4) and with residents #2–#6 (R2–R6). Resident #1 (R1) was unavailable for an interview as they no longer reside at the facility. R1 transferring to a higher level of care facility. The investigation revealed the following. Allegation: Staff did not provide adequate supervision, resulting in a resident eloping from the facility. LPA interviewed staff #1–4 (S1-S4). All four staff members (4 out of 4) stated that the facility staff ensure they are providing adequate care and supervision to prevent any resident from eloping from the facility. 4 out of 4 staff members reported that R1 signed out on 12/09/2025. They stated that R1 typically remains on the premises and is known to walk around inside the facility, the patio area, or the outside parking lot. On this date, however, R1 left the facility and went for a walk in the community. During routine rounds conducted every two hours, staff noticed that R1 was no longer at the facility and immediately initiated a search. Staff stated they were able to locate R1 later that same day. S1-S4 stated on 12/09/2025, R1 was admitted to Kaiser Permanente Downey Medical Center for observation. R1 was discharged 12/10/2025. 4 out of 4 staff interviewed stated that R1's CT scan showed no evidence of head trauma, and that a full body check revealed no injuries or bruising. On 12/12/2025, R1 was transferred to a higher-level care facility for continued treatment. Staff confirmed that they self-reported the incident to all the appropriate agencies, responsible parties, family members, and R1's physician in a timely manner. According to staff, 4 out of 4 stated that the facility followed Title 22 regulations and implemented the necessary precautions to ensure resident safety at all times. Residents #2–#6 (R2–R6) stated that staff provide adequate care and supervision. 5 out of 6 residents reported that staff are always available to assist and consistently check on residents throughout the day and night. 5 out of 6 residents stated that they did not witness any resident eloping from the facility. R2–R6 also reported that their daily needs are being met and that they are happy living at the facility, expressing no problems or concerns. See continued LIC812-C page 2. 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 LIC809-C page 3. LPA Bunker reviewed Resident #1’s (R1) file, including the Special Incident Report dated December 15, 2025, which confirmed that staff reported the incident to Community Care Licensing, the responsible parties, and all appropriate agencies in a timely manner. LPA Bunker also verified that In-Service Training was conducted on December 10, 2025, covering topics such as making rounds, checking on residents, conducting head counts, reporting changes in condition or behavior, and proper use of the sign-in/sign-out sheet. The sign-out sheet dated December 9, 2025, showed that R1 had signed out. LPA Bunker reviewed R1 medical records from La Palma Intercommunity Hospital dated September 19, 2025, as well as admission and discharge records from Kaiser Permanente Downey Medical Center dated December 9 and December 10, 2025. The CT scan showed no evidence of head trauma. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough 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 deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099 and LIC9099-C was provided to the Ellen Barrintos, Administrator . No deficiencies were cited. An exit interview was conducted.

On 04/11/2025 around 8:40 AM, Licensing Program Analyst (LPA) Jose Anguiano and LPA Socorro Leandro, conducted an unannounced annual required visit using the CARE Inspection Tool. LPAs met with the Administrator Eleanor Barrientos explained the purpose of today’s visit and LPAs were allowed entrance to the facility. The facility is licensed to serve a total of 84 residents of which 64 may be non-ambulatory, 20 may be bedridden, and 10 may be on hospice. The facility consists of the following: LPAs toured facility Kitchen, Dining Room, Living Room, the facility is a one-story building located in a main street. The building consists of 42 resident bedrooms, several bathrooms, 1 tv room, 1 activity room, 1 dining room, 1 industrial kitchen, several offices, several storage rooms, and several outside patios with shaded seating. 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 LPAs toured the physical plant. There were no bodies of water on the premises. Rooms were inspected, Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bed linens, comforters, and bath towels were stocked during the visit. Bathrooms were operational. Hot water temperature measured at 130 degrees F to 91 degrees F between 2 bathrooms that were tested. LPAs observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected, and 2 days supplies perishable, and 7 days non-perishable food was maintained. Fire extinguishers were charged, and smoke detectors and carbon monoxide were operable in each resident's room. A review of the Medication Records Administration (MAR) was observed to be maintained in order and accurately. During the visit, LPAs observed the facility's infection control practices. All mandated inspection control posters were posted including Activities Calendar and Food Menu. LPAs conducted an audit of 5 resident records, and 5 personnel records. The administrator certificate is valid. The facility has a Liability Insurance Certificate valid through 03/04/2026. 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 A technical assistance is being provided regarding the posting of Complaint Information (PUB 475*) needs to be resized to 20x26. The Administrator has agreed to resize the poster. Technical Violations are being provided regarding the shower room has a leaky shower head and mold on the walls and hot water temperatures. LPAs observed facility maintenance personnel attempted to adjust the hot water temperature. The Administrator has agreed to deep clean the shower room and conduct maintenance on the shower room’s vent. An exit interview was conducted, and a copy of the report was provided to the Administrator.

The investigation revealed the following: Regarding the allegation: ”Staff does not ensure to provide a safe environment for residents in care.” It has been alleged that the facility does not intervene between resident altercations or issues. Records review have indicated that there have been zero (0) resident-on-resident altercation(s) between the resident(s) in question. CCLD staff interviewed four (4) staff members and six (6) residents, all of which have denied the allegation has taken place. According to CCLD's record reviews and interviews conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstantiated .

(06/12/24) LPA Villegas was able to interview R1 via telephone. The investigation revealed the following: Allegation: Staff hit resident, resulting in resident sustaining a bruise. It is being alleged that facility staff who assisted R1 with being changed pushed R1's hand against R1’s chest which resulted in a bruise. On 06/12/24 LPA interviewed A1 regarding the allegation above, A1 denied the allegation above and reported conducting an investigation when the incident was reported. A1 continued to report that while investigating, R1’s previous roommate who was present during the alleged incident denied the allegation in question, A1 also stated that R1 later reported that the incident was a misunderstanding. On 06/12/24 between 11:30 am-12:30 pm , LPA interviewed staff #1-3 (S1-S3) regarding the allegation above, 3 of 3 staff denied the allegation above and reported treating all residents with respect. On 06/12/24 between 10am-11:30 am LPA interviewed residents #2-6 (R2-R6) regarding the allegation above, 5 of 5 residents interviewed denied the allegation above and reported that staff treat them with respect and feel 5 of 5 residents interviewed reported feeling safe living at the facility. On 06/12/24 LPA Villegas was later able to interview R1 via telephone, R1 reported not having any recollection of the incident as it happened a long time ago however, R1 does recall having a bruise on chest. On 06/18/24 LPA reviewed R1’s physicians reported dated 08/07/23 which indicates in section named "history of skin condition or breaking" that R1 bruises easily. Based on interviews and records reviewed there is not enough 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(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted with Administrator Eleanor Barrientos , and a copy of this report was provided.

The investigation revealed the following: Regarding the allegation “Staff did not seek medical attention for a resident in care,” it is being alleged that on 05/30/2024 staff did not call for help therefore resident had to call ambulance. 6 out 6 resident interviews indicated that staff assist them with medical attention. 5 out 5 staff denied the allegation. 5 out of 5 staff attempted to assist R1 but she refused. 2 staff members indicated that they offered to call for an Uber and take R1 to kaiser but R1 refused; R1 told them that she will call 911 herself. An unusual incident report dated 05/30/2024 states that R1 "has been refusing treatment,” R1 "agreed to go to kaiser for treatment,” moreover both Administrator and Assistant Administrator counselled R1. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. Regarding the allegation “Staff are abusive towards a resident in care” it is being alleged that staff speaks to residents in an aggressive and abusive behavior. 6 out 6 resident interviews denied the allegation. 5 out of 5 staff denied the allegation. R1 is diagnosed with borderline personality disorder and according to her record review and interviews conducted she has a history of verbally fighting with staff and residents. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. Regarding the allegation “Staff discriminates against a resident in care” it is being alleged that due to residents’ medical diagnosis staff discriminates against them. 6 out of 6 resident interviews denied the allegation. 5 out of 5 staff interviews denied the allegation. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. No citations issued at this time. An exit interview was conducted, and a copy of this report was left with the Administrator.

Interviews revealed that 4 out of 4 staff and 6 out of 8 residents have denied the allegation, while two residents denied the interview. Record reviews revealed that two out of two caregiver records showed required documentation that included adequate documentation required to conduct the direct care of residents at the above-mentioned facility. Based on LPA observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated . Regarding the allegation “Staff member did not treat residents with dignity and respect” It has been alleged that a staff member mistreats the residents and is rude to them. Between 9:00AM and 4:00PM, on 05/22/24, LPA observed numerous caregivers and housekeeping staff constantly browsing the facility grounds to conduct polite treatment of the residents at the above-mentioned facility. Interviews revealed that 4 out of 4 staff and 6 out of 8 residents have denied the allegation, while two residents denied the interview. Record reviews revealed that in-service training on "resident rights" was conducted on 01/15/24 and 01/16/24, which included twenty-three (23) staff who had attended the training at the above-mentioned facility. Based on LPA observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated . Regarding the allegation “Staff member yells at residents” It has been alleged that a staff member yells at the residents and rushes them to eat. Interviews revealed that 4 out of 4 staff and 6 out of 8 residents have denied the allegation, while two residents denied the interview. Record reviews revealed that in-service training on "Recreation, socialization, community resources, social services and activities in the community" was conducted on 04/25/24, which included twenty-one (21) staff who had attended the training at the above-mentioned facility. Based on LPA's record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated . Report Continues, see LIC9099C 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 Regarding the allegation “Staff did not ensure to sanitize facility” It has been alleged that staff did not ensure to sanitize the above-mentioned facility. Between 09:15AM and 09:45AM, on 05/22/24, LPA observed one (1) resident attempting to fill their water bottle, which resulted in a spill. Housekeeping staff immediately responded to clean up as the spill was observed as one (1) housekeeper passed by. Between 10:00AM and 12:00PM, on 05/22/24, LPA observed housekeeping conducting a "deep clean" on room #4. Interviews revealed that 4 out of 4 staff and 6 out of 8 residents have denied the allegation, while two (2) residents denied the interview. Record reviews revealed that during the past 2 months "deep cleaning" has been conducted daily, at various sites, throughout the above-mentioned facility. Based on LPA observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated . Regarding the allegation “Facility is malodorous” It has been alleged that the facility smells like urine. Between 09:00AM and 4:00PM, on 05/22/24, LPA did not detect any malodor upon entering into the facility. LPA did not detect any malodor as LPA and S1 toured the facility. Interviews revealed that 4 out of 4 staff and 5 out of 8 residents have denied the allegation has taken place, while one (1) resident agreed the allegation takes place. Two (2) residents denied the interview. Between 09:15AM and 09:45AM, on 05/22/24, LPA observed one (1) resident attempting to fill their water bottle, which resulted in a spill. Housekeeping immediately responded to clean up, as the spill was observed as one housekeeper passed by. Between 10:00AM and 12:00PM, on 05/22/24, LPA observed housekeeping conducting a "deep clean" on room #4. Record reviews revealed that during the past 2 months "deep cleaning" has been conducted daily, at various sites throughout the above-mentioned facility. Based on LPA observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated . Regarding the allegation “Night shift staff sleep while on duty” It has been alleged that night shift staff members sleep while on duty. Report continues, see LIC9099C 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 Interviews revealed that 4 out of 4 staff and 6 out of 8 residents have denied the allegation, while two (2) residents denied the interview. Record reviews revealed that three out of three NOC caregivers records showed required documentation that shows adequate documentation required to conduct the direct care of residents at the above-mentioned facility during NOC shift. Based on LPA's record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated . Regarding the allegation “Staff do not respond to residents’ call assistance button” It has been alleged that that night shift staff members do not assist the residents and that residents call for staff assistance via the call button, but no one responds to them. Between 3:30PM and 3:45PM, on 05/22/24, LPA tested call lights in three (3) rooms and observed all responses within one (1) minute response time. Interviews revealed that 4 out of 4 staff and 6 out of 8 residents have denied the allegation, which justifies LPA's previous observation. Two (2) residents denied the interview. Based on LPA observations and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated . There have been no deficiencies cited today. An exit interview and a copy of this report has been provided to Ellen Barrientos, Administrator (S1).

On 03/22/2024 at around 2:10 PM, Licensing Program Analyst (LPA) Leandro conducted an unannounced case management visit and met with the Administrator Eleanor Barrientos. LPA explained the purpose of the visit and was accompanied by Administrator and Administrator Assistant inside and outside the facility during this inspection. Facility was in good repair. No deficiencies are being cited based on LPA observations in accordance with the California Code of Regulations, Title 22. An exit interview was conducted and a copy of this report was left with the Administrator.

Allegation: Facility staff not storing resident medications properly It is being reported that resident returned their medications back to med-tech for storage but observed the box of medication the next day open at the nursing station not locked away. Resident also reported that when they requested staff to assist applying cream to their back, staff was not immediately available until done with another resident. On 1/17/24 at 12:00p pm LPA Shirley reviewed resident file. During file review, LPA reviewed Physician’s Report and saw that R-1 is capable of managing own treatment/medication/equipment. Per Appraisal Needs and Services, R-1 is independent in ADL’s. LPA reviewed the MAR and found that R-1 self-administers all prescribed medications. During the tour of the first station where medications are stored, LPA observed that all medications were locked away in a separate room from nurse’s station. Nurses station is available 24 hours. LPA found it hard to not notice a box of medications easily accessible to residents in care, as technicians are monitoring activity at the counter and counter is free from clutter. On 1/17/24 LPA Shirley interviewed resident 1 – resident 7 (R-1 - R-7). LPA asked, do you believe that staff is storing the medications correctly. Of those interviewed, 5 out of the 7 answered yes. R-1 was not available for interview. On 1/17/24 LPA Shirley interviewed staff 1-staff 7 (S-1 - S-7). LPA asked staff, where are the medications stored. Of those interviewed, 5 out of 7 staff answered locked at the first station. Based on information gathered, the department did not find sufficient evidence to support allegations " Facility staff are not storing resident medications properly.” 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 spoke inappropriately to resident On 1/17/24, LPA Shirley reviewed SIR’s during the time of residents stay. During review, LPA notes that there was only one SIR that involved inappropriate behavior from staff. LPA reviewed the one incident report Con'd 9099-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 which also involves the resident. Resident made a mistake of accusing a caregiver of hitting her. LPA also reviewed memo from an IDT meeting in which the same resident accused a caregiver of demanding and yelling to open the door. Investigation was done and concluded with resident being mistaken. On 1/17/24 LPA Shirley interviewed Staff, staff 1-staff 7 (S-1 - S-7). LPA ask, do you speak inappropriately to residents. Of those interviewed, 7 out of 7 answered, no. LPA Shirley interviewed residents, resident 1 – resident 7 (R-1 – R-7). LPA asked if staff has ever spoke inappropriately to you. Of those interviewed, 5 out of 7 answered, no! Based on information gathered, the department did not find sufficient evidence to support allegations " Facility staff spoke inappropriately to resident.” 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 allegations are Unsubstantiated . An exit interview was conducted and a copy of the LIC 9099 and appeal rights forms were provided to Administrator Eleanor Barrientos.

Allegation: Staff did not prevent resident from physically assaulting another resident The allegation alleges that Resident R1 was hit on the head multiple times by Resident R2. During interviews with Residents (R1-R7), six (6) out of seven (7) stated they have not been hit or felt threatened by any of the other residents. R1 stated that they were hit on the head by R2 and they scratched R1's arm. During interviews with R2, they stated they did not hit R1 on the head and R1 did not hit them, and that neither of them hit each other. R2 further stated that there was an incident with R1 accusing R2 of taking R1's property and when R1 was opening R2's dresser drawer, R2 grabbed R1's arm, and when R1 pulled their arm away from R2's grip R1 got scratched. During interviews with staff (S1-S3) three out of three stated that when the incident between R1 and R2 had calmed down, staff stated they checked R2's drawers for R1's belongings and they did not find anything. During interviews with Staff (S1-S3) and Residents (R1 and R2) five (5) out of five (5) stated the Sheriffs were called and no charges were pressed because R2 was protecting their property from R1 and that if R1 pressed charges then charges would be brought on R1 as well. During interviews with staff (S1-S5) five (5) out of five (5) stated R1 has accused staff and other residents of taking their belongings. Additionally, they stated R1 has moved rooms 4 times due to accusing roommates of stealing R1s belongings and for going through other residents (R5) belongings and throwing their belongings into the trash. Upon document review, LPA observed that R1 has a history of going through other resident’s belongings . Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were observed or cited during today’s visit. An exit interview was conducted with Administrator Elenore Barrientos, and a copy of this report was provided.

Licensing Program Analyst/ Ruby Velasco and Licensing Program Manager/ Eva Alvarez conducted an unannounced visit to this facility. The purpose of today’s visit was to conduct an Annual inspection. LPA met with Administrator/ Eleanor Barrientos and Assistant Administrator/ Michalene Johnson. Facility is licensed for 64 non-ambulatory residents and 10 bedridden residents. The facility no residents on Hospice and has no hospice waiver. The facility currently has 42 ambulatory residents and 30 non-ambulatory residents, who are residing in the facility. There are 5 residents diagnosed with mild Dementia residing in the facility. There are 6 residents receiving Home Health. The facility is handling residents’ money and have provided a copy of an active surety bond. LPA toured the physical plant, inspected food service, reviewed staff records, and reviewed resident files. The facility conducted a fire drill on 7/22/23. The facilities consist of 42 resident bedrooms, 44 bathrooms, activity room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Bathrooms are clean, sanitary, and fixtures are working properly, The bathrooms are equipped with devices that provide assistance. The facility water temperature properly measured at 105-110 Degrees Fahrenheit. Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean and hazard free. All doorways were free of obstructions. 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 Kitchen was inspected and observed to be in compliance with Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were inspected. Smoke detectors and Carbon monoxide detectors were tested and found to operating properly. The First Aid kit is fully stocked. Outside grounds were toured and no bodies of water were observed. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises. A deficiency was cited 87465 (h)(2) under California Code of Regulations, Title 22, Chapter 1, Division 6, Chapter 8 and corrected at the time of visit.

Licensing Program Analyst (LPA) Ruby Velasco and Licensing Program Manager I LPM Eva Alvarez, conducted an unannounced visit to the facility for the purpose of the facility's required 1 year evaluation on 8/24/2023. LPA and LPM, introduced and informed Assistant Administrator, Michalene Johnson purpose of visit. Assistant Administrator Michalene Johnson assisted LPA and LPM with this visit. Administrator, Eleanor Barrientos arrived later on during the visit. The facility is a single story with (42) resident bedrooms that have their own restrooms in addition there are (2) shared shower rooms equipped with assistive devices. During the facility tour the LPA Velasco observed the main entrance where required postings were present. LPA Velasco toured the dining room and observed posted menu, a wheelchair accessible dining bar area, seating to accommodate all residents. LPA Velasco observed the kitchen was clean, sanitary and with sufficient perishable and nonperishable food items. LPA Velasco observed food is properly stored and marked with storage dates. LPA Velasco observed the facility's activity room, an activity's assistant facilitating an activity where an activity was in progress. LPA Velasco observed a monthly calendar of activities posted outside of the activity room. LPA Velasco toured the facility's laundry room and observed a staff member washing residents clothing. The residents clothing is gathered one time per week or more by a staff member, the clothing is laundered and then returned to the resident. LPA Velasco inspected several storage rooms throughout the facility where linens, PPE, client storage, maintenance, supplies and an emergency food supply is stored. LPA Velasco, observed an outside common area located in the rear of the facility. LPA Velasco observed patio, table and canopy that provides shade. LPA Velasco observed two designated smoking areas and a garden tended to by the residents. During the tour of the facility LPA Velasco observed four fully charged fire extinguishers, a back up generator for power outages, and an ample supply of PPE's that are accessible to staff and LPA Velasco observed surveillance cameras located in the facilities common areas. LPA Velasco, observed passages in and outside of the facility were clear of obstructions. LPA Velasco, conducted a record review of residents with special health needs. The facility has three residents with mild dementia, two residents currently receiving services from home health. LPA Velasco, reviewed staff training's required to support individuals with dementia. LPA Velasco was unable to finish this visit due to time constraints and will return at a later date to complete this inspection. During todays visit LPA Velasco there were no citations issued. This report was reviewed with Assistant Administrator Michalene Johnson and a copy of the report was provided.

On 08/16/2023 Licensing Program Manager (LPM) Ulysses Coronel & Licensing Program Analyst (LPA) Socorro Leandro conducted a Case Management - Other visit and met with Administrator Eleanor Barrientos and the purpose of todays visit was explained. During todays visit LPM and LPA conducted a tour of the facility which included bedrooms number 34, 35 and 36. LPM, LPA and Administrator inspected residents beddings and did not observe the presence of bed bugs. LPM & LPA also reviewed 8 random residents Personal and Incidental (P&I) records with Michalene Johnson. No violations of Title 22 Regulations were observed and cited during todays visit. An exit interview was conducted and a copy of this report was provided to Administrator Eleanor Barrientos.