Vila Monte

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Case Management - Legal/Non-compliance inspection. LPA Rai met with Administrator (ADM) Nicholas Inneh and stated the purpose of today's visit. The purpose of the visit is to ensure the facility is adhering to the compliance plan submitted to Community Care Licensing (CCL) after a non-compliance meeting held on 10/23/2024. LPA Rai discussed the non-compliance plan with the ADM to include ensuring that all staff are trained to provide resident care meeting physical, emotional, and social needs; plan for regular observation from the resident and documentation of resident functioning changes; ensuring the facility is kept clean, safe, sanitary and in good repair, addressing bed bugs proactively and promptly; ensuring all incident and death reports are documented and reported to CCL per Title 22; ensuring all staff obtain a criminal record clearance and association to the facility; ensure all residents medical assessments include a TB result prior to admission; ensure all resident’s reappraisals are updated annually; ensure all meals meet dietary and physician ordered nutritional requirements, and ensuring the Administrator provides proper oversight and administration of the facility operations in alignment with Title 22 regulations. During visit, LPA Rai toured the facility to include the resident bedrooms, hallways, bathrooms, dining room, kitchen, and exterior. LPA Rai observed 2 staff members present were observed to be fingerprint cleared and associated to the facility. Continuation on LIC 809-C, Page 1 of 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 Page 2 of 2. LPA Rai entered into all the resident bedrooms. All rooms are currently occupied. There were no observation of bed bugs. ADM states the facility does not have any active cases of bed bugs. ADM states a third party vendor for pest control inspected the facility on 02/10/2026 and no rodent or insect activity was noted at the facility. ADM states a third party vendor for pest control inspects the facility at least twice a month. LPA Rai observed the facility has a weekly cleaning and maintenance log for 03/01/2026 - 03/12/2026. During visit, LPA Rai observed staff cleaning resident rooms and completing the weekly cleaning and maintenance log. LPA Rai at random reviewed 2 staff files (S1-S2). 2 Out of 2 staff were provided 20 hours of training which include the follow topics: 'Assisting resident with ADLs (Activity of Daily Living)', 'Dementia Care', 'Personal Rights', 'Basic Medication Training', 'Reporting Requirements', 'First Aid', 'Emergency Procedures', 'Food Services', 'Nutrition & Hydration', 'Infection Control', 'Observing and Documenting Resident Changes', and 'Communication & Working with Difficult Behaviors'. LPA Rai at random reviewed 3 new resident files (R1-R3) who moved into the facility from June 2025 - December 2025. 3 Out of 3 files contained LIC 602 Physician's Report including TB result and LIC 624 New Admission Appraisal. All 3 residents do not have a special diet per LIC 602 Physician's Report. LPA Rai reviewed Incident Report dated 02/01/2026 for resident R4 and noted no issues. The Administrator was advised regarding the importance of adhering to the facility's corrective action plan that was developed on 10/23/2024 to ensure the facility's stays within compliance of Title 22 regulations. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator (ADM) Nicholas Inneh and a copy of the report was provided.

Licensing Program Analyst (LPA) Maria (Mita) Partoza, conducted an unannounced visit for a case management – legal/non-compliance requirement. LPA met with Administrator (ADM), Nicholas Inneh. At the time of arrival LPA was greeted by 2 staff, administrator arrived at approximately 10:00 a.m. The purpose of the visit is to ensure the facility is adhering to the compliance plan submitted to Community Care Licensing (CCL) after a non-compliance meeting held on 10/23/2024. LPA discussed the non-compliance plan with the ADM to include ensuring that all staff are trained to provide resident care meeting physical, emotional, and social needs; plan for regular observation from the resident and documentation of resident functioning changes; ensuring the facility is kept clean, safe, sanitary and in good repair, addressing bed bugs pro-actively and promptly; ensuring all incident and death reports are documented and reported to CCL per Title 22; ensuring all staff obtain a criminal record clearance and association to the facility; ensure all residents medical assessments include a TB result prior to admission; ensure all resident’s reappraisals are updated annually; ensure all meals meet dietary and physician ordered nutritional requirements, and ensuring the Administrator provides proper oversight and administration of the facility operations in alignment with Title 22 regulations. During visit, LPA toured the facility to include the resident bedrooms, hallways, bathrooms, dining room, kitchen, and exterior. LPA observed some wear and tear on the building grounds. ADM stated that there are plans to renovate/remodel the facility, fix the bathrooms, floors, and parking. Page 1 of 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 L PA toured the facility with ADM and most rooms were occupied and residents were there. There are 15 room, 2 of the 15 are single occupancy and 13 are shared. The facility currently has 27 residents. There were no observation of bed bugs. ADM states the facility does not have any active cases of bed bugs. ADM provided a copy of the Clark Pest Control service report dated 12/02/25. Report stated the pest control person, did a visual check and did not notice any rodent and insect(ants, cockroaches, spiders, and bedbugs) activity. There was 1 mice caught in the food closet, replaced the glue boards and the device. They checked the exterior rodent monitoring station and did not notice rodent activity. ADM states the pest control company comes at least 2 times a month. LPA observed the facility has a cleaning and maintenance log. During visit, LPA observed staff actively mopping the floors of the facility. LPA reviewed 5 out 25 resident files and observed the files were updated and complete, including but not limited to Physician's report (LIC 602), Appraisal Needs and Services Plan (LIC 625), Admission Agreement, Personal Rights (LIC 613) and the client's personal valuable (LIC 621). LPA reviewed 2 staff file (S1 and S2). 2 out of 2 staff have current training on record from online (Relias and Community Senior Living). On 4/7/2025, ADM conducted a staff training for the following: Dementia Care - 2 hours, Personal Rights 1.5 hours, Basic Medication Training - 2 hours, Reporting Requirements and Mandated Reporting - 2 hours, Basic First Aid and Emergency Procedures 1.5 hours, Food Service, Nutrition and Hydration - 2 hours, Universal Precautions & Infection Control - 1.5 hours, Observing and Documenting Resident Changes - 1 hour, Resident's Right and Cultural Sensitivity - 1.5 hours, Activities and Social Services - 1 hours, Assisting with Activities of Daily Living (ADLs) - 2 hours, Communication & Working with Difficult Behaviors - 2 Hours. ADM has a valid administrator certificate for ARF and RCFE that would expire on 11/20/2026 (ARF) and 7/20/2026 (RCFE). The Administrator was advised regarding the importance of adhering to the facility's corrective action plan that was developed on 10/23/2024 to ensure the facility's stays within compliance of Title 22 regulations. No deficiencies were cited during today's visit based on California Code of Regulations Title 22. An exit interview was conducted with Administrator Nicholas Inneh and a copy of the report was provided. page 2 of 2 - end of report

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct a case management – legal/non-compliance visit. LPA met with Administrator (ADM), Nicholas Inneh. The purpose of the visit is to ensure the facility is adhering to the compliance plan submitted to Community Care Licensing (CCL) after a non-compliance meeting held on 10/23/2024. LPA discussed the non-compliance plan with the ADM to include ensuring that all staff are trained to provide resident care meeting physical, emotional, and social needs; plan for regular observation from the resident and documentation of resident functioning changes; ensuring the facility is kept clean, safe, sanitary and in good repair, addressing bed bugs proactively and promptly; ensuring all incident and death reports are documented and reported to CCL per Title 22; ensuring all staff obtain a criminal record clearance and association to the facility; ensure all residents medical assessments include a TB result prior to admission; ensure all resident’s reappraisals are updated annually; ensure all meals meet dietary and physician ordered nutritional requirements, and ensuring the Administrator provides proper oversight and administration of the facility operations in alignment with Title 22 regulations. During visit, LPA toured the facility to include the resident bedrooms, hallways, bathrooms, dining room, kitchen, and exterior. 3 staff members present were observed to be fingerprint cleared and associated to the facility. See 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 LPA entered into all the resident bedrooms. There were no observation of bed bugs. Staff and ADM states the facility does not have any active cases of bed bugs. LPA observed staff actively cleaning the facility to include the resident bedrooms, bathrooms, and shower rooms during tour of the facility. LPA observed the facility has completed the cleaning and maintenance log. ADM showed that the pest control company last visited the facility on 05/19/2025. LPA observed bedroom #9 is currently occupied. 2 staff files (S1 - S2) was reviewed. 2 out of 2 staff were provided training by a certified trainer to include topics of assisting resident with ADLs (activity of daily living), dementia care, personal rights, basic medication training, reporting requirements, first aid, emergency procedures, food services, nutrition & hydration, infection control, observing and documenting resident changes, and communication & working with difficult behaviors. Administrator states they continue to implement regular check-in with staff every Friday for deep cleaning parts of the facility, monthly meeting with every staff, and daily meeting with the staff as part of their communication. 3 resident files (R1 - R3) was reviewed. 1 out of 3 residents is a new admissions to the facility as of March 2025. 3 out of 3 files were completed and up to date. ADM states they do not have any residents with a special diet per the physician. The Administrator was advised regarding the importance of adhering to the facility's corrective action plan that was developed on 10/23/2024 to ensure the facility's stays within compliance of Title 22 regulations. During visit, ADM signed the LIC809-D from the annual inspection on 04/24/2025, which was inadvertently amended. A copy of the LIC809-D was provided. On 05/23/2025, LPA emailed the Licensee and ADM regarding the outstanding civil penalty payment due. This was sent to the Licensee on 10/30/2024. During today's visit, ADM was again reminded of the outstanding civil penalty payment due to the Department. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Nicolas Inneh and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct a case management – legal/non-compliance visit. LPA met with Administrator (ADM), Nicholas Inneh. The purpose of the visit is to ensure the facility is adhering to the compliance plan submitted to Community Care Licensing (CCL) after a non-compliance meeting held on 10/23/2024. LPA discussed the non-compliance plan with the ADM to include ensuring that all staff are trained to provide resident care meeting physical, emotional, and social needs; plan for regular observation from the resident and documentation of resident functioning changes; ensuring the facility is kept clean, safe, sanitary and in good repair, addressing bed bugs proactively and promptly; ensuring all incident and death reports are documented and reported to CCL per Title 22; ensuring all staff obtain a criminal record clearance and association to the facility; ensure all residents medical assessments include a TB result prior to admission; ensure all resident’s reappraisals are updated annually; ensure all meals meet dietary and physician ordered nutritional requirements, and ensuring the Administrator provides proper oversight and administration of the facility operations in alignment with Title 22 regulations. During visit, LPA toured the facility with Administrator to include all the resident bedrooms, hallways, bathrooms, dining room, kitchen, and exterior. 3 staff members present were observed to be fingerprint cleared. 1 out of 3 staff members was not associated to the facility. During visit, the Licensee immediately associated the staff to the facility via Guardian website. See LIC809-C for additional information. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA entered into all the resident bedrooms rooms with the ADM. There were no observation of bed bugs. ADM states the facility does not have any active cases of bed bugs. LPA observed staff actively cleaning the facility to include the resident bedrooms, bathrooms, and shower rooms during tour of the facility. Based on the facility's non-compliance plan it states that they will maintain a log for cleaning, maintenance, and pest control treatment. ADM states the cleaning and maintenance log has not been implemented yet but states a plan to implement the cleaning and maintenance log, ASAP. LPA observed bedroom #9 (vacant) and the shared bathroom in bedroom #9 was currently being remodeled. 2 staff files (S1 - S2) was reviewed. 2 out of 2 staff were provided training by a certified trainer to include topics of assisting resident with ADLs (activity of daily living), dementia care, and aging. ADM states they review the facility's policy regarding reporting requirements with the staff during the initial orientation. ADM was recommended to document training with the staff regarding topics listed in the non-compliance plan. Administrator stated understanding. Administrator states they have implemented regular check-in with staff every Friday for deep cleaning parts of the facility, monthly meeting with every staff, and daily meeting with the staff as part of their communication. 3 resident files (R1 - R3) was reviewed. 3 out of 3 residents are new admissions to the facility as of December 2024, January 2025, and February 2025. 3 out of 3 files contained a face sheet, TB result, updated appraisal/needs and services plan or the preplacement appraisal, and progress notes. The Administrator was advised regarding the importance of adhering to the facility's corrective action plan that was developed on 10/23/2024 to ensure the facility's stays within compliance of Title 22 regulation. No deficiencies were cited per California Code of Regulations, Title 22. Advisory note provided. This report was reviewed with Administrator, Nicolas Inneh and a copy of the report was emailed to the Administrator during visit.

An interview with 3 additional staff members were conducted. 3 out 3 staff members denied making inappropriate comments towards staff or hearing others make inappropriate comments. An interview with 5 residents were conducted. 5 out of 5 residents deny that staff make threatening comments towards others. Based on the information gathered, it is unclear if staff did not prevent residents from making threatening comments towards another resident. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

An interview with R1 was conducted regarding this incident and LPA was unable to obtain additional information due to the lapse in time from the time of the incident to the visit conducted on 10/12/2024. An interview with 6 residents were conducted. 6 out 6 residents state that they have not been harmed by another resident or have seen any staff harm other residents around them. Based on records review, it was found that R2 has history of aggressive behavior however was not found to hurt other residents at the time of their residency at the facility. Based on the information gathered, it is unclear if the facility failed to prevent resident from being harmed by another resident. Allegation: Staff failed to safeguard resident’s money. It was alleged that the facility staff failed to safeguard resident’s money. During the course of the investigation, LPA conducted interviews and reviewed facility documentation. Based on interviews conducted it was learned that that facility does not currently manage any resident funds. It was found that many residents obtain Payee services in which they received their own money via mail or through debit services. A review of the facility records were conducted which confirm that the facility does not have a current surety bond to manage resident funding. An interview with 6 residents were conducted, 6 out 6 residents state that they have their own money and the facility does not handle any financial assets. Based on the information gathered, it is unclear if the facility staff failed to safeguard the resident’s money. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

The facility attempted to provide R1 other options however all R1 wanted was a small amount of rice and mashed potatoes as the resident’s throat continued to hurt. In addition, the facility conducted a care conference with the R1’s case manager to find the next steps to help support R1. Based on the information gathered, it is unclear if the facility did not follow a physician’s order for a special diet. Allegation: Resident was yelled at in the facility. It was alleged that facility residents were yelled at in the facility. During the course of this investigation, LPA conducted resident and staff interviews. Based on 3 staff interviews, it was denied that staff yelled at a resident in the facility. 3 out 3 staff members deny that they have witnessed any other staff members yelling at residents during their shifts. An interview with 5 residents were conducted, 5 out 5 residents state deny that they have been yelled at by staff members or any other residents. 5 out 5 residents deny that they have yelled at or have heard any other residents yell at each other. Based on the information gathered, it is unclear if the resident was yelled at in the facility. Allegation: Resident did not feel safe at the facility. It was alleged that the facility residents did not feel safe at the facility. During the course of this investigation, LPA conducted resident and staff interviews. Based on 5 resident interviews. 5 out 5 residents state that they feel safe at the facility. 5 out 5 residents state that staff make them feel safe and do not report any issues at this time. Based on the information gathered, it is unclear if the facility residents do not feel safe at the facility. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

Allegation: Staff used inappropriate language with resident It was alleged that facility staff used inappropriate language with resident During the course of this investigation, LPA conducted resident and staff interviews. Based on 3 staff interviews, it was denied that staff used inappropriate language with the resident in the facility. 3 out 3 staff members deny that they have witnessed any other staff members using inappropriate language with residents during their shifts. An interview with 5 residents were conducted, 5 out 5 residents state deny that staff use inappropriate language with them. 5 out 5 residents deny that they have yelled at or have heard any other residents use inappropriate language with each other. Based on the information gathered, it is unclear if the staff used inappropriate language with the resident. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.

LPA Ng interviewed RP and confirmed the story that was provided on the initial complaint. LPA was able to interview S1 and it was stated that the facility used a different insurance, an in-house medical insurance provider. RP stated R1's insurance got changed without any apparent reason. S1 tried to fix it, and later found that a family member (F1) changed the insurance without notifying S1 and the staff. F1 somehow told S1 that he/she wanted to use some other insurance. S1 explained to F1 that if he/she used some other insurance, then R1 could not use the insurance, that sent physician and nurse to the facility. If R1 used other insurance, then R1 had to travel to clinic or hospital to receive medical assistance. It would not be ideal since R1 was in wheelchair, that R1 might have to travel by taxi to see the doctor. That was why S1 tried to persuade F1 to use the insurance instead. There was no lapse that R1 did not have a time that there was no insurance to receive medical assistance. LPA Ng also interviewed three residents. Two out of three (R2 & R3) mentioned that they had no problem with insurance that it was not changed. R1 stated he/she was not aware that the insurance was changed or his/her representative not being notified. For the residents medical care, R1 stated he/she saw the doctor recently but did not have any note from the doctor. R2 stated he/she got assisted getting medical care from the facility. R3 stated he/she had his medical visit about 2 weeks ago and also got medicine prescribed. A staff member (S2) was also interviewed and stated that if a resident did not have insurance, the facility would help that resident to find one. So no insurance, no issue. S2 also shared that he/she was not aware of any resident not being assisted in the facility because of insurance or any other kind of problem. Based on interviews, the department has determined that although the allegations 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. Report is reviewed and copy is provided. page 2 of 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 When S1 was interviewed, S1 stated he/she had every residents' money including R1's money in his possession. S1 mentioned that F1 stopped sending money to R1 recently. R1 currently used the Life Freedom Card that was managed by BMC (Benefits Management Corporation) to buy the things R1 needed. According to the LIC 405 (Record of Client’s/Resident’s Safeguarded Resources) for R1, the logs shows that from 10/9/2017 to 1/11/2019, R1 was receiving $100. Starting from 2/14/2019 to 7/20/2021, different amounts have been received ranging from $37-$161. This was also audited by LPA Ng and it didn’t have any discrepancy. The document also shows how much money was given to R1 upon request and countersigned by S1 and R1. Based on interviews & records review, the department has determined that that the allegations were false, could not have happened and/or is without a reasonable basis, therefore the allegations are UNFOUNDED. Report is reviewed and copy is provided. page 2 of 2

On 10/23/2024 San Bruno Regional Office - San Jose Unit conducted a non-compliance conference meeting with Licensee Cyril Inneh and Administrator Nicholas Inneh. Present in the meeting were Regional Manager Vivien Helbling, Licensing Program Manager Jackie Jin, and Licensing Program Analyst Christine Dolores. During the non-compliance meeting, the following serious violations were discussed: 87411(a) Personnel Requirements – General, 87466 Observation of the resident, 87303(a) Maintenance and Operations, 87211(a)(1)(A) Reporting Requirements, 87355(e)(2) Criminal Record Clearance, 87458(b)(1) Medical Assessment, and 87405(d)(2) Administrator - Qualifications and Duties. During this meeting, the compliance plan was developed and discussed with the licensee which includes more frequent monitoring inspection visits to ensure compliance with this compliance plan and Title 22 Regulations for 2 years. Licensee was provided the link below for resources and guidance to improve facility operations: https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers . During this meeting, the LIC809 and LIC809D from 10/22/2024 was amended and report was provided to the Licensee and Administrator. This report was reviewed with Licensee Cyril Inneh and Administrator Nicholas Inneh and a copy of the report was provided.

Page 2 of 2... S1 placed sticky traps inside R1's bedroom. S1 reminded the residents to not eat or store food in their rooms and to take out the trash to prevent rodents from entering in the facility. S1 states R1 did not complain of any observations of a rat inside R1's bedroom since 10/10/2024. S1 was made aware a second time of a mouse inside resident (R2)'s bedroom on 10/18/2024. S1 states to have spoken with R2 and cleaned out R2's bedroom to include underneath R2's bed, clothes and trash. S1 did not locate any rodent. S1 states R2 did not mention anything to S1 sooner. S1 states they did not yet contact a pest control company and had plans to contact a pest control company today (10/22/2024). S1 states on 10/21/2024, the police were called to the facility regarding a rat infestation. S1 stated they police inspected the facility and left. S1 denied a rat infestation. On 10/22/2024, 2 residents were interviewed. Based on resident interview, R1 stated that the facility staff has placed sticky traps in the facility. R1 states that they also asked him/her to clean out his/her closet and reminded the residents to not eat in their room. R2 stated that the staff have placed sticky traps in the kitchen and have cleaned out their room. R2 states that the staff have also reminded the residents that they cannot eat in their rooms. On 10/22/2024, LPA Dolores entered into R1 and R2's bedroom and did not observe any rodent or rodent droppings. LPA Dolores entered the kitchen and observed sticky traps inside the pantry. Based on staff interview, 2 out of 2 staff denied the observation of mice or rats in the facility and kitchen area. 2 out of 2 staff stated the sticky traps were placed about 2-3 weeks ago and there were no mice or rats that were found on the traps. The Department has investigated the above allegation. Based on interview and observation, the above allegation is unfounded meaning the allegation is false, could not have happened and/or is without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Nicholas Inneh and a copy of the report was provided.

Licensing Program Analysts (LPAs) Christine Dolores and Simi Rai arrived unannounced to conduct a case management - other visit. LPAs met with Administrator (ADM) Nicholas Inneh. The purpose of the visit is to hand deliver an exclusion letter for staff member (S1). The letter was handed to the Administrator. Staff (S1) was present during visit. LPA Dolores explained the exclusion letter to S1. S1 refused to take the letter. S1 was immediately released from work. LPAs observed another staff (S2) replace S1. No deficiencies were cited today per California Code of Regulations, Title 22. This report was reviewed with Administrator, Nicholas Inneh and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - other visit. LPA met with Administrator (ADM), Nicholas Inneh. During visit, LPA obtained photographs of the facility's dining room area using LPA's state issued cell-phone. LPA obtained a copy of a staff member's CPR certification. LPA interviewed 1 staff member. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Nicholas Inneh and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Dolores arrived at the facility unannounced to conduct a case management visit to follow-up on a visit from 11/02/2023. The visit was regarding an incident that occurred at the facility on 10/12/2023 pertaining to resident (R1). LPA met with Administrator, Nicholas Inneh. On 10/26/2023, LPA Dolores visited the facility unannounced and was made aware of a resident (R1) who passed away. Based on investigation, it was found that on 10/12/2023, staff noticed R1 was choking on food during dinner time. Staff immediately called 911 and began CPR and First Aid (Heimlich Maneuvers) until the paramedics arrived. R1 was transported to the hospital and pronounced deceased on 10/13/2023. Based on record review, R1’s cause of death was due to lack of oxygen to the brain from choking on food. It was also noted that R1 had a throat condition. Based on staff interview, for dinner that night R1 was served a chicken burrito that was cut into three pieces by the staff. R1 was provided a regular diet. It was stated by staff that R1 has had a history of choking on food. Prior to R1’s passing, staff did observe something in R1’s throat. The observation was stated to be brought to the attention of the Administrator. The staff also informed R1’s doctor, however, R1’s doctor did not provide a change of order to R1’s diet. Based on review of records, there is no documentation of the staff’s observation regarding R1’s throat condition. There is also no documentation that R1 was seen by the doctor in the year 2023 regarding R1’s throat condition. SEE LIC809-C. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The review of R1’s records showed that R1 was at the hospital in October 2020, and it was noted R1 was diagnosed with a throat condition. In the discharge summary, it was noted there was an order for small portions. Based on interview, it was stated that during that time, R1 was being fed a regular diet. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. An immediate civil penalty of $500.00 is being assessed against the facility today for violation resulting in the death of a resident in care. An additional Civil Penalty for a violation resulting in the death of a resident is pending review. A plan of correction was developed with the Administrator, Nicholas Inneh. A copy of the report and appeal rights were also provided to the Administrator, Nicholas Inneh.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - other visit. LPA met with Administrator, Nicolas Inneh. During visit, LPA advised the facility regarding the use of their video surveillance system in the common areas. Based on interview, the Administrator states they are unsure where the video footage are being stored and who has access to the video surveillance system. It was stated that the video surveillance system was already implemented prior to the Administrator start at the facility in 2022. The individual who may have knowledge of the video surveillance system does not work in the facility and the facility does not have contact to the individual. Based on observation, the video surveillance monitors different locations of the facility to include the hallways, kitchen, dining room, and parking lot. The location of the video surveillance monitor is in the Administrator's office. LPA observed the video surveillance does not have audio component. The Administrator states plans to install another video surveillance system only in the facility's common areas by next week. The new video surveillance system will include access to the video files. LPA advised to disconnect the video surveillance unless the facility knows where the video surveillance records and files are being stored. No deficiencies are being cited per California Code of Regulations, Title 22. Advisory note provided. This report was reviewed with Administrator, Nicholas Inneh and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - other visit. LPA met with Administrator, Nicolas Inneh. During visit, LPA delivered an amended report for complaint control number 26-AS-20231101121001. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Nicolas Inneh and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - other visit. LPA met with Administrator, Nicolas Inneh. During visit, LPA interviewed 1 staff member regarding a death report the Department received for resident (R1). No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Nicolas Inneh and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Dolores arrived to the facility unannounced to conduct a case management – incident visit regarding an incident that occurred at the facility on 10/12/2023. LPA met with Administrator, Nicholas Inneh. On 10/26/2023, LPA Dolores was made aware of a resident (R1) who passed away. On 10/12/2023, staff noticed that R1 was choking on food and immediately called 911 and began CPR and First Aid (Heimlich Maneuvers). R1 then lost consciousness and staff began chest compressions until EMT arrived. R1 was transported to the hospital and pronounced deceased on 10/13/2023. Based on interview and review of R1’s records, R1 did not have a special diet. For dinner that night, the residents were served chicken burritos. ADM states the resident did not have any issues with swallowing food or medical conditions regarding his/her throat. ADM is not aware of any history of R1 choking on food. After the incident, the ADM immediately informed R1's case manager, conservators, and physician. The staff who provided CPR has an active CPR/First Aid Certification. ADM stated on the morning of 10/13/2023, R1's case manager arrived to the facility and informed the facility staff that R1 had passed away at the hospital. LPA requested for R1’s death certificate. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Nicholas Inneh and a copy of the report was provided.

Upon discovery of cash discrepancy, former Administrator Donald Windham (FA), went to a safe, collected four dollars, and resupplied resident's cash resources. FA indicated that the facility always has cash on hand just in case there is a discrepancy. FA stated that he was unsure why there were light discrepancies in the cash reserves of 12 residents. The audit report indicates that, despite the difference in ledger amount listed and amount of cash counted, the cash count ultimately did not result in any evidence of financial abuse. During the investigation, the department attempted to interview suspected victim of financial abuse in multiple instances. In every attempted interview, suspected victim stated that they did not want to speak on the matter and requested that the investigation be shut down. Audit report indicates that there were no other residents identified as potential victims of financial abuse during the course of the investigation. Audit report concludes that there is no evidence to substantiate the claims of financial abuse. This Department has investigated the above allegation. Based on records review, interviews, and observation, the Department has determined that the allegation was 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. Exit interview conducted. This report was reviewed with Administrator Nicholas Inneh and a copy was provided.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a required 1-year annual inspection to focus on infection control. LPA met with Administrator Nicholas Inneh. During visit, LPA toured the facility inside and outside to include the hallways, resident rooms, kitchen, bathrooms, storage, and exterior. All fire exit routes were free and clear of obstruction. Facility observed to have a designated entry point to sign in for all visitors and residents. LPA advised to create a list of COVID-19 symptoms and questions to have at the designated entry point. Hand sanitizer available throughout the facility. Bathrooms observed to be supplied with hygiene products and paper supplies. LPA advised to place hand washing signs in all bathrooms. The following posters were observed to include: symptoms of COVID, social distancing, required mask, and stop the spread of germs. Facility cleans and disinfect multiple times daily and as needed. Facility has a designated visitation area. LPA observed supply of Personal Protective Equipment (PPE) and advised to keep a sufficient amount of PPE supplies in the facility. All staff observed to be wearing a face mask. LPA reviewed facility's policies and procedures to isolation and infection control training. LPA advised to have staff N95 fit tested. LPA informed the Administrator to review PIN 22-13-ASC and submit Infection Control Plan to CCLD by 06/30/2022. The following documents were requested to include an updated LIC610E and Administrator Certificate by 04/20/2022. Administrator will send LPA documents for the facility's change of Administrator by 04/29/2022. No citations were issued per the California Code of Regulations, Title 22. Advisory notes provided. This report was reviewed with Nicolas Inneh and a copy of this report was provided.