Heritage Pointe.

Licensing Program Analysts (LPA) Joseph Alejandre and Taylor Simerly made an unannounced visit to conduct a case management visit. LPAs met with Miguel Silva, Director of Memory Care and Sage and explained the reason for the visit. On July 31, 2026, the Agency received a special incident report (SIR) that Resident 1 (R1) left the facility unattended on July 27, 2026. On July 27, 2026 at 12:58 pm staff observed that R1 was missing. Staff began searching for R1 in the nearby neighborhoods. R1 was found down the street and law enforcement was called. R1 was assessed by paramedics and determined there was no need to transport R1 to the hospital. Paramedics released R1 to facility staff and staff transported R1 back to the facility. R1's family then discharged the resident from the facility that same day around 6pm. A review of records show that R1's last doctor's visit was on June 5, 2026. R1's physician report LIC602A states that R1 has been diagnosed with Dementia and cannot leave the facility unassisted. The Director of Memory Care and Sage reported that they have provided training to their staff and increased safety checks. The Director of Memory Care and Sage stated that the employee who left the gate propped open and allowed R1 to elope was terminated at the start of their next shift the following day. Facility is responsible for R1 and R1 resided in memory care. Staff verified R1 left the facility unattended. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.

Resident R1 was admitted to the facility on September 30, 2013 with a primary diagnosis of hypertension and no initial indication of major neurocognitive disorders at the time of admission. R1 was discharged from the facility on January 9, 2024. Regarding the allegation that Staff neglect resulted in a resident sustaining an injury from multiple falls: Based on the evidence gathered, there have been multiple instances of fall incidents sustained by R1, at least one of which resulted in injury and hospital treatment. The evidence gathered is however insufficient to clearly establish that the falls were attributable to staff neglect rather than to changes in the resident’s condition. The allegation is therefore found to be Unsubstantiated. Regarding the allegation that Staff left a resident unattended while being transported to the hospital, the following has been concluded: After a fall sustained on December 8, 2023, R1 was first transported via EMS to Hoag Hospital in Irvine before being transferred to Hoag Hospital Newport Beach at the neurosurgery department due to a suspicion of a subdural hematoma. A review of the resident records maintained at the facility also allowed LPA to corroborate that the responsible party for the resident had been contacted by the facility staff following the fall. A fax reporting the fall to the resident's physician was also located. Report states that EMS had initially informed the facility that the resident would be transported to Saddleback MemorialCare but was re-routed to Hoag Irvine for unknown reasons which appears to explain why R1’s responsible party had to actively attempt to locate the resident following admission. A copy of R1’s Consent for Emergency Medical Treatment was present and on file. As resident was placed under the responsibility of EMS personnel, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to a facility representative. 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 R1 was admitted to the facility on September 30, 2013 with a primary diagnosis of hypertension and no initial indication of major neurocognitive disorders at the time of admission. Subsequent appraisals were conducted and reviewed, including updates to R1’s plan of care dated June 22 and August 23, 2023. Per a review of available charting notes, over a period starting in May 2023 and ending with the resident’s discharge in January 2024, R1 sustained at least five separate fall incidents. A significant bruise on R1's buttocks was reported to the family and primary care provider on August 25, 2023 with no ability to clearly determine the origin of the bruise. On that day, R1 was sent to Mission Hospital via 911 for generalized weakness and low food/drink intake and diagnosed with acute kidney injury. No report on file submitted to the Orange County Regional Office. Another reported fall occurred on November 7, 2023, with facility staff indicating resident had lost their balance but were assessed to not present any injury or pain. Fall also not reported to the Department of Social Services per a review of Incident Reports on file. R1 sustained another fall on December 8, 2023 and was first transported via EMS to Hoag Hospital in Irvine before being transferred to Hoag Hospital Newport Beach at the neurosurgery department due to a suspicion of a subdural hematoma. A review of the resident records maintained at the facility also allowed LPA to corroborate that the responsible party for the resident had been contacted by the facility staff following the fall. A fax reporting the fall to the resident's physician was also located. Report states that EMS had initially informed the facility that the resident would be transported to Saddleback MemorialCare but was re-routed to Hoag Irvine for unknown reasons which appears to explain why R1’s responsible party had to actively attempt to locate the resident following admission. Finally, another fall incident, this time not resulting in significant injury also appeared to be documented on January 8, 2024 and reported to the resident's primary care physician and responsible party but not to the Department of Social Services. R1 were discharged to their authorized representative on January 9, 2024. Regarding the allegation that Staff did not provide adequate care and supervision to a resident, the following has been concluded: Despite multiple occurrences of fall incidents sustained by R1, the individual needs assessments conducted by facility staff on June 22 and August 23, 2023 fail to document the fact that the resident was at risk for falls. Furthermore, the evolution of R1’s Mild Cognitive Impairment to a documented diagnosis of dementia was not apparent in the physician until after the resident was hospitalized, in spite of signs and incidents occurring in the months leading to the emergency hospitalization. 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 Regarding the allegation that Staff did not properly report incidents involving a resident, the following has been concluded: No reports were made to the Orange County Regional Office during any of the documented fall or hospitalization incidents sustained by R1 in 2023 and 2024. As a result, both allegations are found to be Substantiated, meaning that the preponderance of the evidence standard has been met. Two deficiencies to Title 22 requirements are being cited on an attached form LIC9099-D . An exit interview was conducted and a copy of this report was provided to a facility representative.

On March 11, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Executive Director (ED) Georgianna Mendez was present and assisted on today's visit. LPA observed that Georgianna Mendez has a valid Administrator certificate which expires on December 12, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for two hundred and twenty five residents, all of which can be non-ambulatory, twenty can be bedridden, and has a hospice waiver for thirty. The facility is a two building which consist of assisted living and memory care. Their are resident apartments in both areas, which have bathrooms located in suite. The facility also consist of common areas such as dining rooms in both the assisted living and memory care, activity areas, a commercial kitchen, staff offices, a salon, laundry rooms, a medication room, and a physical fitness center. LPA conducted a tour of the interior portions of the facility. On today's visit, there are ninety six residents in care. LPA observed residents eating lunch in the dining room. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected ten resident bedrooms located throughout the facility and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA tested the call buttons in resident bedrooms and they tested operational. LPA inspected the resident bathrooms in the apartments inspected and observed them to be clean. LPA observed resident bathrooms to be equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 105.6 and 118.5 degrees Fahrenheit. LPA inspected the facility kitchen area and observed it be clean. LPA observed the facility to have a minimum two day perishable and seven day non-perishable food supply on hand. CONTINUED ON 809-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 During a tour of the kitchen, LPA observed one staff preparing food without a hairnet. The staff advised LPA that they did not have any hairnets and that they had to be ordered. LPA observed the facility has a three day emergency food and water supply on hand. LPA observed multiple fire extinguishers to be mounted in the wall across the facility. All fire extinguishers were observed to be charged and serviced as of August 12, 2025. LPA observed that the facility had their most recent Fire Inspection conducted on August 22, 2025. LPA observed that the facility fire sprinklers and smoke detectors tested operational during the inspection. LPA observed the facility conducted their last emergency disaster drill on December 11, 2025. LPA observed the centrally stored medication to be kept in locked medicine carts located throughout the facility. LPA observed first aid kits to be stored in the medication room and they had all the required components. LPA observed all the facility's chemicals and toxins to be stored in a locked storage rooms. LPAnconducted a tour of the exterior portions of the facility. LPA observed the facility has outdoor areas for both assisted living and memory care. LPA observed the exterior to be free of obstructions and hazards. LPA observed shaded outdoor seating areas with furniture for resident use. LPA tested the delayed egress doors located on the exterior portions. One delayed egress door in the memory care portion was non-operational at time of visit. LPA reviewed ten resident files. LPA observed the Reappraisals on file for Resident #2 (R2), Resident #6 (R6), and Resident #7 (R7) were outdated and need to be updated. LPA reviewed residents' medication and medication administration records. LPA observed the facility did not have one medication for Resident #11 (R11) present at the facility, despite R11 having an active order for the medication. LPA observed the facility did not have three medications for Resident #12 (R12) present at the facility, despite R12 having active orders. LPA reviewed ten staff files. LPA observed that Staff #1 (S1) did not have any annual training on file for the year of 2025. LPA observed that Staff #11 (S11), Staff #12 (S12), Staff #13 (S13). Staff #14 (S14), Staff #15 (S15), and Staff #16 (S16), were not criminal background cleared or associated to the facility. Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D pages. Civil penalties will also be assessed in the amount of $3,000.00 for criminal background clearance. An exit interview was conducted with Executive Director Georgianna Mendez. A copy of the report and Appeal Rights were provided.

CONTINUED FROM FORM LIC9099-A During the August 2022 visit, licensing staff requested the laundry log for resident R1. A copy of the billed laundry service was provided during the visit. Regarding the allegation that Facility staff did not notify resident's authorized representative of a change in the resident's condition , the following has been concluded: Based on interviews and records reviewed during the investigation, no evidence was found that facility staff had knowledge of a change in R1's dental health prior to multiple broken teeth were found by R1's dentist on June 21, 2021 and surgically extracted on June 29, 2021. The dental care was scheduled and arranged by R1's responsible party, therefore the responsible party gained knowledge of the condition before facility staff did. Regarding the allegation that Facility staff did not ensure that resident had clean clothing , the following has been concluded: a laundry log and billing record for R1 shows 22 individual occurrences of laundry services being provided and billed to the resident's responsible party between the resident's admission in March 2020 and the resident's passing in January 2022. Interviews with facility housekeeping staff determined that initial clarification of the distinction between the linen service and personal laundry had been discussed with R1's family and that the resident regularly declined the service being provided on scheduled laundry days as R1 had already chosen to handle laundry themselves. Regarding the allegation that Resident was given a medical test without a doctor's order , the following has been concluded: the allegation was filed with the Department while the Coronavirus Disease 2019 (Covid-19) State Of Emergency had been declared . As part of the emergency declaration, facilities were operating under a waiver authorizing the use of PCR or antigen testing by facility staff for screening and isolation purposes. Additionally, R1's consent for emergency medical treatment LIC627 was signed by R1's responsible party in June 2019 and copied for the investigation file. No individual doctor's orders were required for testing at the time of the complaint. Regarding the allegation that Facility did not allow resident to use the pharmacy of their choice , the following has been concluded: Based on interviews conducted with staff, it was determined that residents are being provided the option to utilize the facility's preferred pharmacy provider but that individual choice to go through a different provider was possible as well. CONTINUED ON FORM 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 CONTINUED FROM FORM LIC9099-C Per a review of R1's resident records, medication orders dated April 18, 2020 made after the resident was admitted in 2019 show that prescription orders were sent to a CVS location in Orange rather than Guardian which was the preferred provider at the time, thus corroborating that the resident was free to go through a different pharmacy. Regarding the allegation that Facility is charging resident for services that are not in the Admissions Agreement , the following has been concluded: During the investigation of complaint reference 22-AS-20220211164547, the allegation that staff overcharged resident R1 was substantiated after it was determined that tray service had been charged in spit of a temporary suspension due to the coronavirus pandemic. However, the services for which charges have been disputed such as tray service and personal laundry were verified to be listed on Appendix C of the facility's admission agreement. Regarding the allegation that Facility staff is misappropriating facility funds , the following has been concluded: Following a change of facility management, records for the acquisition of religious decorations affixed to each resident's door could not be obtained. However, no actual evidence of misappropriation was provided during the complaint's investigation to corroborate the allegation. As a result, all six allegations mentioned above are determined to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 CONTINUED FROM FORM LIC9099 Regarding the allegation that Facility staff did not notice a change in the residents condition , the following has been concluded: Based on a review of medical records and charting notes, it is confirmed that upon admission R1 was on a regular diet. No issues with the resident dental health are documented in R1's charting notes prior to four broken teeth being extracted in June 2021, after which R1 was moved to a soft mechanical diet. It is therefore confirmed that the change in the resident's dental condition was not observed by staff in a timely manner. Regarding the allegation that Facility staff did not dispense resident's medication as prescribed , the following has already been concluded as part of the investigation of complaint " A review of the records and interviews concluded that the condition of Resident 1 (R1) was re-assessed by their primary care physician to have evolved to require assistance in the time period between yearly evaluations dated June 20, 2019 and August 20, 2020. The initial report indicates that the resident is noted as being able to self-administer their medication without supervision. The following physician report indicates however that the resident is no longer able to self-administer without supervision. Despite this change in condition, the resident was not transitioned to medication management status by the facility and formally assisted by facility staff until December 11, 2021 as documented in staff interviews as well as in printouts from the Medication Administration Records provided by the facility. (...) These elements confirm that the resident was left to manage her own medication with no formal assistance by the facility for a period of 16 months after a transition to Medication Management was ordered by the physician ". A deficiency for the same resident and circumstances was already cited on January 18, 2023 and is therefore not issued a second time. Based on the evidence gathered during the investigation, the two allegations listed above are deemed to be substantiated, meaning that the preponderance of evidence standard has been met. One cited deficiency per Title 22 Division 6 of the California Code of Regulations is detailed in the attached form LIC9099-D. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.

CONTINUED FROM FORM LIC9099-A Additional witness interviews were conducted during the investigation. Regarding the allegation that Facility failed to ensure oxygen tanks were in working order , the following has been concluded: Witness and resident interviews conducted evidenced that the equipment used by R1 for supplemental oxygen was functioning correctly. However, due to poor vision documented in R1's assessment and evidenced in interviews, R1 would occasionally require staff assistance to operate her small oxygen tank, with occasional excessive waiting times. Issues with oxygen seem to have been solved by the provision of a concentrator. Based on the evidence gathered, the allegation is found to be Unsubstantiated, meaning that 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. An exit interview was conducted and a copy of this report was provided to facility representative. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 CONTINUED FROM FORM LIC9099-A Additional witness interviews were conducted during the investigation. Regarding the allegation that Residents alerts are not operating while in care , the following has been concluded: Licensing staff conducted multiple visits during which the facility's call system was observed to be in operation. Staff and resident interviews conducted during the investigation did not evidence any period of time during which the call system was not in operation. Additionally, the vendor for the facility provided records of all pendant and pull cords activations for the period of January 2022 corresponding to the allegation being made. A review of the records provided confirmed the statements made indicating an absence of technical issues with the call system. As a result, the allegation is found to be Unfounded, meaning that t he allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided to a facility representative. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 CONTINUED FROM FORM LIC9099 Additional witness interviews were conducted during the investigation. Regarding the allegation that Staff are not providing adequate care and supervision to the residents , the following has been concluded: Based on interviews conducted and records reviewed, it was confirmed that on January 28, 2022 at approximately 10:30pm, staff was alerted by another resident's family of an ongoing episode. Staff notes from facility LVN Tiffany Kennebrew are reviewed as follows " Care staff and another resident's family reported that resident was yelling out in hallway. Nurse on duty checked on resident and noted that the resident had increased agitation and oxygen level was below 90%. 911 called to evaluate resident. EMT's reported that resident was having [signs and symptoms] of panic attack [due to] not being able to work portable oxygen machine. Resident refused hospital transport and EMT's educated resident on how to properly work machine. [Daughter] Sherri notified and this nurse asked [daughter] to look into getting a concentrator for ease of use of oxygen therapy ". Due to the resident's assessed vision issues and response delay, facility staff appears to have failed to meet the requirement to ensure the resident could safely operate their oxygen equipment. Regarding the allegation that Staff did not accord resident's with dignity , the following has been concluded: A review of the facility's records for pendant pushes on January 28, 2022 demonstrates that the initial activation made by R1 is timestamped as follows: " 1/28/2022 21:49 [...] Alpers, Helene (lives in Apt 255) 244-2033 from Receiver by 154, [...] Announced 9 times. Healthcare Wristlet 150CD responded at 10:32 p (43 mins). " As R1 was experiencing difficulty in operating their oxygen equipment, R1 had to wait 43 minutes to receive assistance from staff and was observed being agitated in the hallway. As a result, both allegations are found to be Substantiated, meaning that the preponderance of evidence standard has been met. An exit interview was conducted and a copy of this report along with appeal rights was provided and left at the facility.

CONTINUED FROM FORM LIC9099-A During the follow-up to the investigation, LPA was provided with a recording of all activity related to pendant pushes for the period of December 23, 2024 until January 22, 2025. Staff records for staff member S1 were also provided during the March 18, 2025 visit and added to the investigation file. Regarding the allegation that Staff handle residents in a rough manner , the following has been concluded: Complaints of inappropriate staff interactions made during staff and resident interviews mostly described verbal interactions on behalf of staff member S1 rather than inappropriate or rough direct physical handling. No specific instances of rough handling were evidenced during the investigation. No specific acts were described by interviewees either during the present investigation. As a result, the allegation is found to be Unsubstantiated, meaning that 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. An exit interview was conducted and a copy of the report provided. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 CONTINUED FROM FORM LIC9099 During the follow-up to the investigation, LPA was provided with a recording of all activity related to pendant pushes for the period of December 23, 2024 until January 22, 2025. Staff records for staff member S1 were also provided during the March 18, 2025 visit and added to the investigation file. Regarding the allegation that Staff does not ensure residents are spoken to in an appropriate manner , the following has been concluded: Multiple staff members interviewed during the investigation related incidents they witnessed and/or reported to their supervisor involving inappropriate behavior from facility staff S1. Incidents described included ignoring calls for assistance, being short with residents requesting assistance, throwing medication across a table. Per a review of S1 staff files and interviews conducted, S1 was hired at the facility in 2011 and was terminated prior to the March 18 visit taking place due to inappropriate behavior. Regarding the allegation that Staff does not respond to call signal system for residents in a timely manner , the following has been concluded: Based on resident interviews and a review of pendant pushes over a period of 30-days, it was established that approximately three daily occurrences of pendant pushes requiring upwards of forty-five minutes to be addressed were recorded. While a wide majority of pendant pushes are addressed timely, these occurrences demonstrate that timely response is not guaranteed. As a result, both allegations are found to be Substantiated, meaning that the preponderance of evidence standard has been met. Two type B deficiencies are being cited per California Code of Regulations Title 22. An exit interview was conducted and a copy of this report and appeal rights were provided.

A review of R3’s prescribed medication revealed two routine medications for April 10th and 11th of 2025 were no longer present in the prescription bubble pack issued by the pharmacy. During their interview, S1 stated they were aware the medication for the two days was missing, but stated they were unsure of how the discrepancy occurred. Three additional staff interviewed denied any knowledge of the missing medication. A review of R4’s prescribed medication indicated two routine medications for April 10th and 11th of 2025 were no longer present in the prescribed bubble pack issued by the pharmacy. During their interview, S1 stated they were aware the medication for the two days was missing, but stated they were unsure of how the discrepancy occurred. Three additional staff interviewed denied any knowledge of the missing medication. A review of R5’s medication indicated three routine medications were not administered on March 30th, 2025, as they were still present in the prescription bubble pack issued by the pharmacy. Upon review of MAR, it was observed it had not been signed by staff to indicate why it had not been administered or otherwise. A review of R6’s medication indicated one routine medication was not administered on March 23rd, 24th, and 29th of 2025, as it was still present in the prescribed bubble pack issued by the pharmacy. Upon review of MAR, it was observed it had been signed by staff to indicate it had been administered despite it still being present in the prescription bubble pack. Regarding allegation Staff did not ensure resident records were properly managed, the following was reviewed: Upon review of MARs for select residents, LPA observed discrepancies in four of nine resident records. Upon review of R1’s MAR, it was observed it had not been signed by staff on March 29th, 30th, and 31st of 2025 to indicate why six routine medications had not been administered or otherwise. Upon review of R2’s MAR, it was observed it had not been signed by staff on March 29th, 2025 to indicate why one routine had not been administered or otherwise. Upon review of R5’s MAR, it was observed it had not been signed by staff on March 30th, 2025 to indicate why three routine had not been administered or otherwise. Upon review of R6’s MAR, it was observed one routine medication had been signed by staff on March 23rd, 24th, and 29th of 2025 to indicate it had been administered despite it still being present in the prescription bubble pack. Regarding allegation Staff did not ensure reporting requirements were followed: LPA conducted a record review of Incident Reports (LIC624) submitted by the facility to Community Care Licensing (CCL) and did not observe any incidents reports for the medication errors listed above. During today’s visit, LPA was provided with an incident report for medication errors. (Cont. 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 Based on staff interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was provided at the end today's inspection.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA was greeted and granted entry by front desk staff after introducing himself and stating the purpose of the visit. Interim Executive Director Marjorie Silberman was notified and assisted with the visit. LPA reviewed the facility's resident census, staff roster, Emergency and Disaster Plan, Infection Control Plan, staff schedules. A sample of ten staff records and ten resident records were reviewed during the visit. The facility is a two-story building divided in three sections (Assisted Living, Sage Living and Memory Care) around a central courtyard with a secure swimming pool. LPA accompanied by administrator conducted a tour of the interior and exterior of the physical plant. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide, and auditory exit alarms were operational. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Hot water was measured at 115 degrees Fahrenheit in memory care and 109 degrees Fahrenheit in Sage living resident bathrooms. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies, and sharp items were inaccessible to residents in care. LPA reviewed the physician orders and contents of one of the facility's medication cart. Fire extinguishers were mounted and charged. For the exterior portion, facility has several patio furniture sets with umbrellas for shade and the grounds and routes of egress were free of tripping hazards. One type B deficiency was cited per Title 22 Division 6 of the California Code of Regulations and three Technical Assistance Advisory Notes were provided. An exit interview was conducted and a copy of this report along with appeal rights was left at the facility.

CONTINUED FROM FORM LIC9099-A Regarding the allegation that Facility overcharged resident. , the following has been concluded: Based on a review of email exchanges between facility staff and R1's authorized representatives along with staff interviews and a review of R1's billing records for the period of November 2021 until February 2022, it was confirmed that additional charges for tray service were charged to the resident in spite of the ongoing policy to waive the fees in question during the occurrence of outbreaks of COVID-19 as well as during periods of illness experienced by the resident. The allegation is therefore found to be Substantiated, meaning that the preponderance of evidence standard has been met. A Type B citation is issued on the attached form LIC9099-D An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 CONTINUED FROM FORM LIC9099 Regarding the allegation that Facility did not provide resident's records to resident's responsible party, the following has been concluded. At the time of the follow-up visit conducted on April 21, 2022, the authorized representative for R1 had been provided with the requested documentation as confirmed by a review of written exchanges along with interviews with involved parties. Therefore the allegation is found to be Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. The complaint allegation is therefore dismissed.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting a case management inspection. During the investigation of complaint 22-AS-20230911091528, LPA conducted a review of the resident records for resident R1 and conducted an interview with the resident. During a visit conducted on September 14, 2023, R1 was observed to be independently managing their own medication. However, a review of R1's resident records conducted during the investigation evidenced that the resident had been assessed to require assistance with the administration of their own prescribed medication as documented in the most recent physician report on file. Report is dated August 13, 2021. Based on staff interviews and observation made during the visit, as of the first visit conducted on September 14, 2023, the resident had not been placed under Medication Management by the facility and was still handling her own prescribed treatments autonomously without receiving the required assistance. A type B deficiency is being cited as a result, with the assessment of an immediate civil penalty due to a repeat offence. An exit interview was conducted and a copy of this report along with appeal rights were provided to the facility representative.