Westmont of Morgan Hill

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit and met with Executive Director Michael Fountain (ED) . LPA toured Compass Rose (Memory Care unit) with ED to include 4 apartments (RM #129, #126, #123, #120), bathrooms, activity room, kitchen, dining room, and patio area. All fire exit routes were free and clear of obstruction. LPA checked 2 common restrooms in memory care unit. One delayed egress exit door of memory care unit was observed in working condition and the other one was under repair. LPA observed a caregiver sit outside if the exit door of the memory care unit to monitor. Room temperature maintained between 76 degrees F. Kitchen refrigerator temperature maintained at 40 degrees F. Freezer temperature maintained at 0 degrees F. Hot water temperature measured at 118 degrees F. Chemicals, disinfectants, and medications observed locked in Compass Rose. During visit, resident's observed participating in various activities. 2 resident files in Compass Rose was reviewed. 2 out of 2 resident files were complete and no issues noted. LPA inspected 2 resident's centrally stored medication and records with staff. 2 out of 2 resident medications were complete and no issues noted. LPA entered in the kitchen with the ED. The facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. Items inside the refrigerator and freezer observed covered and labeled. Continue 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 LPA toured Assisted Living with ED to include 4 resident apartments (RM #225, #218, #206, and #243) and common restrooms. Hot water temperature was measured at 118 degree F. LPA checked 2 residents file in Assisted Living was reviewed. 2 out of 2 resident's files were complete. LPA inspected 2 resident's centrally stored medication and records with staff. 2 out of 2 resident medications were complete and no issues noted. 4 staff files were reviewed and observed complete. 4 out of 4 staff members are fingerprint cleared. 4 out of 4 staff have over 20 hours of annual training. Fire extinguishers observed throughout the facility, last service date was 06/26/2025. Facility has carbon monoxide and smoke detectors present. Carbon monoxide detector was tested and was observed functional. Facility has an emergency disaster plan and emergency non-perishable foods. LPA observed the facility has a box that contains emergency supplies to include (but not limited to) flash lights, batteries, radio, reflector vests, and band aids. The last time of the facility emergency drill was done on 1/30/2026. Elevator observed in working condition. LPA observed the facility has a first aid kit. 3 stairwells were observed with an evacuation chairs. LPA toured 2 court yards and side yard with ED. The court yard of memory care unit with 2 delayed opening doors and were observed in operational condition. No citation were cited today. This report was reviewed with Executive Director, and a copy of the report was provided.

Page 2 of 3. Facility staff are not adhering to residents’ care plan. It was alleged residents are being left in their wheelchairs “all day”, staff are not meeting resident’s care needs in memory care and assisted living. On 11/20/2025, LPA Rai interviewed four staff (S1-S4). Three out of four staff (S1-S3) are involved in the resident’s care. Three out of three staff stated the facility has an electronic system to generate residents’ care plan and staff initial as acknowledgment for providing care and supervision to the residents in a timely manner. The staff are able to make notes if the resident was delayed care or if resident refused care services. Three out of three staff stated they do not see residents in their wheelchairs all day as residents are transferred by staff. They stated there is one resident (R1) who sleeps in the assisted living side of the facility but spends the day on the memory care side of the facility for activities and meals. R1 stated the facility staff is able to provide care and supervision to the resident and the residents’ needs and services have been updated. Based on review of at random five resident’s records, LPA Rai reviewed 5 service plans which address resident’s care and attached care plans which show staff’s initials acknowledging providing care and supervision to the residents in a timely manner. LPA Rai reviewed R1’s care plan before and after moving to assisted living unit and the facility staff addressed resident’s care and supervision. On 2/4/2026, LPA Rai interviewed three staff (S5-S7). Three out of three staff stated the facility staff do not leave the residents in the wheelchair “all day”. The facility staff will assist the residents back to their bed for naps or help assist them in the dining room and activity room. Three out of three staff stated they are meeting the residents’ care needs in a timely manner and they acknowledge providing care and supervision by placing an initial in the resident’s care plan for each service for each shift of the day. Three of the three staff stated the facility staff did assist resident R1 in assisted living side and memory care side and they are able to meet the resident’s care and supervision needs. On 2/4/2026, LPA Rai interviewed five residents (R1-R5). Five out of five resident stated the facility staff do not leave the residents in the wheelchair “all day”. Five out of five residents stated the staff are meeting the residents’ care needs in a timely manner and they have no issues of staff not responding to their care needs in a timely manner. 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 3 of 3. Facility staff are not addressing ants in the facility in resident's rooms and kitchen area. It was alleged that there are ants in the kitchen and resident rooms and the facility staff are not addressing the issue. On 11/20/2025, LPA Rai interviewed four staff (S1-S4). Four out of four staff stated the facility staff do address ant issues in the facility. Four out of four staff stated there is a third-party vendor that comes out to the facility twice a month as maintenance care to ensure there are no issues in the facility. Four out of four staff stated the maintenance team at the facility do have commercial spray to address ant issues in the facility right away and if there are repeat issues with the resident rooms, then the third-party vendor will address the issue during the monthly spray schedule. Based on review of facility system of recording maintenance issues at the facility, LPA Rai reviewed 6 incidents between May 2025 to November 2025 wherein there were ants present in resident rooms. LPA Rai did not observe any records wherein there were any incidents recorded of ants present in kitchen area. LPA Rai reviewed the third party vendor services from September 2025 to November 2025 and LPA Rai did not observe any records where technician observed any pests at the facility and technician provided the semi-monthly treatment in the kitchen, resident rooms, and exterior areas of the facility. On 2/4/2026, LPA Rai interviewed three staff (S5-S7). Three out of three staff stated they have brought up issues of ants being present in resident rooms, but the maintenance team has addressed it right away. Three out of three staff stated they have observed the third-party vendor present at the facility addressing the concerns in the kitchen and resident rooms and the facility staff have addressed the ant concerns right away. On 2/4/2026, LPA Rai interviewed five residents who reported incidents of ants in their room between May 2025 to November 2025. Five out of five residents stated they brought up the concerns of ants to the facility staff and they addressed the issue right away by spraying the area or bring in the third-party vendor to address the issue. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Executive Director, Michael Fountain and Resident Service Director, Jmy Ramos and a copy of the report was provided.

LPA Tarin interviewed staff S1 & (Former) Resident Services Director Gladys Desmarais, referred to as S2. S1 stated he/she isn’t aware of any incident of alleged physical abuse from any resident by staff. Staff S2 stated S2 states not aware of any incidents of physical abuse. S2 stated R1 was confused and having hallucinations and believed he/she was drugged and told S2 that he/she believed someone gave him/her date rape drug and someone molested him/her. S2 stated R1 said it was 2 male staff members, and R1 didn’t know their names. S2 stated paramedics came to assess him/her and paramedics called the R1’s responsible party, referred to as FM to inform. S2 stated the paramedic told him/her that FM stated R1 has been making this allegation about being molested for years. On October 30, 2025, LPA Manuel Monter interviewed staff S3-S6. 4 Out of 4 staff are not aware or didn’t observe any physical altercations between staff and or residents on the assisted side of the facility in the past 6 months. LPA Manuel Monter interviewed current Resident Services Director (RSD) Jmy Ramos. RSD stated R1 was not physically assaulted. RSD stated there was no observed bruising, bleeding or marks on R1. RSD stated there were no incidents of residents physically assaulting R1. On November 3, 2025, LPA interviewed Witness W1. W1 stated he/she became aware of the allegations based on his/her conversation with R1’s responsible party, referred to as FM. W1 stated FM stated, that R1 has been stating he/she has been molested for multiple years. W1 stated he/she also spoke to R1, who told W1, that after he/she was given his/her UTI medication, R1 expressed to W1 that he/she was just hallucinating and the assault didn’t occur. On November 10, 2025, LPA Monter interviewed residents R13-R17. 5 Out of 5 residents (R13-R17) stated there are not aware of or have not heard about any physical altercation occurring between residents in the facility. 5 Out of 5 residents (R13-R17) stated they are not aware of or have not heard about any physical altercation occurring between staff and residents in the facility. Page 2 Out of 5 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 Monter interviewed staff S7-S10. 4 Out of 4 Staff (S7-S10) stated there are not aware of or have not heard about any physical altercation occurring between residents in the facility. 4 Out of 4 Staff (S7-S10) stated they are not aware of or have not heard about any physical altercation occurring between staff and residents in the facility. he Department reviewed R1's Service Plan, dated July 23, 2025. Under behavioral expressions, the plan states "resident has a history of hallucinations as a medication reaction." The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Facility did not provide proper care and supervision to resident in care. On August 21, 2025 the Department received a complaint alleging Facility did not provide proper care and supervision to resident in care. It has been alleged that resident R1 was not being given their medication, not being bathed and are not being assisted with escorting. On August 25, 2025, LPA Tarin conducted the initial complaint investigation visit. LPA interviewed residents R2-R12. 8 Out of 11 residents (R2, R4-R6,R8,R9,R11) stated they receive their medications on time and have not had any issues with medications. 4 Out of 11 residents (R3, R7, R10, R12) interviewed stated they don’t need staff assistance with medication administration. 11 Out of 11 residents (R2-R12) stated they don’t have any issues with the care they are receiving at the facility. LPA Tarin (Former) Resident Services Director Gladys Desmarais, referred to as S2. S2 stated to her knowledge, he/she is not aware of any issues with R1 not receiving his/her medications on time. On October 30, 2025, LPA Manuel Monter interviewed Staff S1, S3-S6. 5 Out of 5 staff (S1, S3-S6) stated isn’t aware of any issues regarding medication errors. 5 Out of 5 staff (S1, S3-S6) stated there hasn’t been a time when a resident who needed to be escorted, wasn’t escorted. 5 Out of 5 staff (S1, S3-S6) stated there hasn’t been a time when a resident who needed assistance with showers, wasn’t assisted. Page 3 Out of 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On, October 30, 2025, LPA Manuel Monter randomly audited 4 resident’s medications. LPA audited the medications by cross referencing the medication bottles/ containers and cross referencing with the Centrally Stored Medication Record and Medication Administration Record. No discrepancies were noted during review. On November 10, 2025, LPA Monter interviewed residents R13-R17. 5 Out of 5 residents (R13-R17) stated they have not had any issues with their medication administration. 3 Out of 5 residents (R13, R14, R16) stated they do not need assistance with showers. 4 Out of 5 residents (R13-R16) stated they do not need assistance with escorting. 2 Out of 5 residents (R15, R17) stated they need assistance with showers and there hasn’t been a time when they were neglected their shower. Resident R17 stated he/she does need assistance with escorting and stated there hasn’t been a time when he/she was neglected his escorting needs. LPA Monter interviewed staff S7 – S10. 4 Out of 4 staff (S7-S10) stated they have not heard about or observed a resident who was neglected their shower. 4 Out of 4 staff (S7-S10) stated they have not heard about or observed a resident who was not escorted and neglected. 4 Out of 4 staff (S7-S10) stated they have not heard about or observed any instance of a resident not getting their medication. On November 13, 2025, LPA Monter interviewed Resident Services Director (RSD) Jmy Ramos. RSD stated on care track, they have the days the residents are scheduled to have a shower. RSD stated once it has been completed, it will be updated on care track. RSD stated there hasn't been an instance where a resident was neglected, and not given their shower. RSD stated there hasn't been any instance of R1 being neglected and not escorted. RSD stated in terms of medications for R1, there hasn't been any instance of R1 not receiving their medication and/or the facility not administering R1 medication per physician's order. The Department reviewed R1's Service Plan, dated July 23, 2025. Under Mobility, the service plan states R1 does need escorting to meals as needed / As requested. The Department reviewed R1's Medication Administration Record for the month of July and August 2025. Based on a review, there was no discrepancies noted. Page 4 Out of 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The Department reviewed R1's Care Summary for July October 2025. Based on a review, the summary notes detail all the instances of R1 receiving assistance with his/her bathing needs. LPA did not note any discrepancies. The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. Page 5 Out of 5. END OF REPORT.

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management visit in regards an incident report, which stated a resident had eloped from the facility. LPA's met with Business office director Brianne Merritt. LPA's explained the purpose of the visit. On October 16, 2025, the Department received an incident report from the facility. The incident report stated, on October 15, 2025, around 7:20pm, medtech noticed R1 was not in their bedroom. After double checking the room, medtech alerted staff and initiated a thorough search of the community. The resident was located outside the community by a care giver and was safely escorted back inside. No visible injuries were observed upon return. During the visit LPA interview 4 staff. LPA requested staff schedule for October 15, 2025, and a copy of R1's care plan prior to October 15, 2025. LPA determined this incident requires further investigation. This report was reviewed with Brianne Merritt. A copy was provided.

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility's annual required - 1 year inspection. LPA met with Executive Director (ED), Jolie Higgins and Resident Services Director Ria Hernandez. LPA toured Compass Rose (aka Memory Care) with ED to include 4 apartments (RM 138B, 133, 134, and 129), bathrooms, activity room, kitchen, dining room, and patio area. All fire exit routes were free and clear of obstruction. Delayed egress exit doors observed in working condition. Temperature maintained between 72 - 74 degrees F. Kitchen refrigerator temperature maintained at 26 degrees F. Freezer temperature maintained at 0 degrees F. Hot water temperature measured between 109.4 - 111.2 degrees F in RM 133 and 138B. Chemicals, disinfectants, and medications observed locked in Compass Rose. Activities calendar observed posted for the month. During visit, resident's observed participating in various activities. 2 resident files in Compass Rose was reviewed. 2 out of 2 resident files were complete and no issues noted. LPA inspected 2 resident's centrally stored medication and records with staff. 2 out of 2 resident medications were complete and no issues noted. LPA entered in the kitchen with the ED. The facility has at least 2 days worth of perishables and 7 days worth of non-perishable foods. Walk-in refrigerator temperature maintained at 36 degrees F. Walk-in freezer temperature maintained at 0 degrees F. Items inside the refrigerator and freezer observed covered and labeled. LPA observed a menu posted in the Compass Rose and Assisted Living section. 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 toured Assisted Living with ED to include 4 resident apartments (RM 223, 219, 206, and 248). Hot water temperature was measured between 109.4 - 111.5 in RM 219 and 248. 2 residents file in Assisted Living was reviewed. 2 out of 2 resident's files were complete. LPA inspected 2 resident's centrally stored medication and records with staff. 2 out of 2 resident medications were complete and no issues noted. 4 staff files were reviewed and observed complete. 4 out of 4 staff members are fingerprint cleared. 4 out of 4 staff have over 20 hours of annual training. Fire extinguishers observed throughout the facility, last service date was 06/28/2024. Facility has carbon monoxide and smoke detectors present. Facility has an emergency disaster plan and emergency non-perishable foods. LPA observed the facility has a box that contains emergency supplies to include (but not limited to) flash lights, batteries, radio, reflector vests, and band aids. Emergency drills are being completed monthly and the last drill was completed in January 2025. Elevator observed in working condition. LPA observed the facility has a first aid kit. 3 stairwells were observed with an evacuation chair. Activities calendar posted in the elevator in assisted living. Based on resident interviews, the activity calendars are also provided to the residents weekly. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Jolie Higgins and Resident Services Director Ria Hernandez and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's required 1- year annual inspection. LPA met with Executive Director (ED) Jolie Higgins. LPA entered the kitchen with the ED. Refrigerator temperature maintained at 32 degrees F and freezer temperature maintained at 1 degree F. Facility has at least 7 days worth of non-perishables and 2 days worth of perishable foods. Items inside the refrigerator observed covered and labeled. Fire extinguisher last serviced on 05/30/2023. Facility has sufficient amount of silverware and dishes. LPA toured Compass Rose (aka Memory Care) with ED to include 6 resident apartments (RM 137B, 133, 130, 128, 124, and 123), bathrooms, activity room, dining room and exterior. Temperature in memory care maintained at 74 degrees Fahrenheit. Hot water temperature in RM 133 maintained at 110 degrees Fahrenheit. Oxygen in use signs posted in appropriate areas. All chemical, disinfectants, and hygiene items observed secured. Residents observed participating in activities during visit. 1 out of 2 egress doors in the patio observed in disrepair as the egress door does not open or alarm. The facility has another fire exit egress door in the patio area in case of emergency. 1 egress door inside memory care observed in disrepair and does not alarm. Facility initially had a latch lock on the door installed at the very top of the door that is not within arms length. LPA advised to remove the latch lock on the door in case of emergency. Facility staff immediately removed the lock and taped multiple caution tape signs on the door. Facility placed the lock temporarily to avoid resident elopements while they wait for the door to be repaired. The facility scheduled technicians to repair the egress doors this week. 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 reviewed 4 resident files in memory care contained a signed admission agreement, updated medical assessment, TB result, service plan, consent form, and personal rights form. 3 out of 4 residents uses oxygen and has a physician order for oxygen on file. 2 out of 4 residents uses half rails and has a physician's order for half rails on file. LPA reviewed 4 resident centrally stored medication records and centrally stored medication. 1 out of 4 resident was missing 1 PRN medication that was not written in the centrally stored medication record. LPA observed the facility has the physician's order on file along with the PRN log. LPA toured Assisted Living with ED to include 6 resident apartments (RM 247, 239, 236, 229, 226, and 225) bathrooms, and common areas. Temperature maintained at 74 degrees F. Hot water temperature in RM 247 AND 236 observed at 112 degrees F. LPA observed the residents are provided with an activity schedule weekly. 1 stairwell observed free and clear of obstruction with a stairwell chair. LPA reviewed 4 resident files in Assisted Living contained a signed admission agreement, medical assessment, TB result, service plan, consent form, and personal rights form. LPA reviewed 4 residents centrally stored medication records. LPA observed 2 medications were not part of the centrally stored medication records for 2 out of 4 residents. LPA observed the physician's order for each medication. Staff immediately inputted the medication on the centrally stored medication record. 5 residents were interviewed in their apartments. LPA reviewed 6 staff records to include a fingerprint clearance, health screening, TB result, employee rights, and job application. 1 out of 6 staff members had a 1st Aid Certification. Facility has at least one person per shift who has a first aid certification. Facility has a scheduled 1st Aid certification course scheduled on 02/26/2024. LPA reviewed staff training records included training on topics to include but not limited to medication, dementia/Alzheimer, postural supports, and hospice care. LPA recommended to document the hours for each in-service training. Facility has an updated emergency disaster plan. Fire drills are being conducted quarterly with the drills dated on 11/2023, 12/2023, and 01/2024. No deficiencies are being cited per California Code of Regulations, Title 22. Advisory notes provided. This report was reviewed with Executive Director, Jolie Higgins, Resident Care Director, Ria Hernandez and Memory Care Director, Myrene Carasi and a copy of the report was provided.

On 09/20/2023, 1 staff member and 2 witnesses were interviewed. Based on staff interview, the facility was provided a visitation list signed by the resident (R1) and R1’s POA during admission. The list includes a list of residents who are allowed to visit and not visit R1. The list was maintained at the front desk. It was explained that if a visitor from the list were to arrive to the facility, the Executive Director (ED) would still ask R1 if he/she would like to see the visitor per the resident’s right. ED stated that R1 refused to see visitors. The review of records show that R1 signed a list of visitors who were allowed to visit and not allowed to visit R1. On 08/28/2023, the facility received communication to add another visitor to the “no visit” list. Based on interview with witness (W2), it was R1’s decision to put together a list of people who can visit and not visit R1. The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Jolie Higgins and a copy of the report was provided.

On 07/20/2023, 2 staff members were interviewed regarding the allegation. Based on interview, the facility was only notified of this issue in June 2023 and acted immediately after. Notifications regarding R1's insurance were being sent to R1's responsible party. S1 stated that the facility provided a courtesy service to assist resident (R1) in filing their insurance paperwork every month. S1 states based on their contract this task is not the facility’s responsibility, but is the responsibility of either the resident and/or family. It was stated that R1’s insurance paperwork was delayed for 6 months due to the need of an updated assessment from the insurance company. The Memory Care Director who would have been responsible for filing the insurance paperwork during these months does not currently work for the facility. The review of records does not state a written agreement regarding the facility’s responsibility to file insurance paperwork for resident(s). The Department has investigated the above allegation. Based on interview, record review and observation the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violation did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Jolie Higgins and a copy of the report was provided.

Based on record review of R1's physicians report sign & dated 2/20/2019, R1 does not have a special diet. LPA requested 2020 facility menu, ADM stated facility menu for the year 2020 is not available. LPA interviewed Food Service Director (FSD). FSD stated he/she does not recall complaints or interactions from R1. FSD stated he/she only follows the pre-set menu and has never deviated from the menu. Based on the interviews conducted and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Staff are not responding to resident's call button in a timely manner . The incident occurred on 8/23/2020 and 8/25/2020 where R1's pendent was not answered for over an hour. On 8/10/2023, the Department interviewed ADM. ADM stated the staff need to respond to the resident's call pendent within 12 minutes. Per ADM, the facility changed the signal system to a new model. Per Stanley Healthcare Invoice the facility installed the new call system on 5/25/2022. Per ADM, the facility does not have records from the previous signal system which was used when the incident occurred. Based on interview of S1-S3 who worked at the facility in 2020, 3 of 3 staff members stated the resident's pendent would be cleared within 10 minutes and 2 of 3 staff stated the previous signal system would not clear the call pendent signal after the resident was assisted, which is why the facility replaced the signal systems. Based on the interviews conducted and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Page 2 out of 3 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 Facility failed to maintain resident's room in good repair It has been alleged that the facility does not respond to work orders. LPAs interviewed ADM. ADM stated the facility will assist if the residents notify maintenance via work order. ADM stated, as long as it is requested, the facility will address the issue. ADM stated how quickly they address the work order depends on the priority level. ADM stated if its high priority, like something that may endanger a resident, then it will be address immediately. ADM stated if its low priority, then that will take longer to address. ADM wanted to note that the facility will fix the things the facility is responsible but will not fix the residents personal property. ADM stated that the refrigerators does make a noise which is normal when the refrigerator is functioning properly. ADM stated if there was noise coming from the fridge would be considered a potential health and safety risk for the resident, then the facility would remove the fridge. ADM also stated if the residents fridge is not working, they will replace it the same day. ADM stated maintenance will do rounds one a month, which includes, but not limited to, changing filters and inspecting residents apartments. ADM stated if maintenance sees an issue during the monthly rounds, it will be addressed immediately. LPAs reviewed facility work orders made by R1. R1 work order request made on 08/09/2020 was completed on 8/19/2020. R1's work order on 8/26/2020 was completed on 8/27/2020. R1's work order on 8/27/2020 was completed on 8/27/2020. LPA did not interview maintenance director. The maintenance director who worked during the time period of the complaint no longer works at the facility. Based on the interviews conducted and record review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Page 3 out of 3

Page 2 of 2. During visit, LPAs interview ED. ED stated he/she began his/her employment in 2021 after this complaint was received by the Department. LPAs interviewed Staff S1-S3. During visit, LPAs requested a current roster of staff and residents. LPAs received Stanley Healthcare signal systems invoice 5/25/2023, R1's Narrative Charting from 9/10 - 9/14/2020, and R1's Hospice Visit Communication 9/12-9/14/2020. Staff did not respond to call button in a timely manner . On 8/11/2023, the Department interviewed ED. ED stated the staff need to respond to the resident's call pendent within 12 minutes. Per ED, the facility changed the signal system to a new model. Per Stanley Healthcare Invoice from 5/25/2022, the facility installed the new call system. Per ADM, the facility does not have records from the previous signal system which was used when the incident occurred. Based on interview of S1-S3 who worked at the facility in 2020, 3 of 3 staff members stated the resident's pendent would be cleared within 10 minutes and 1 of 3 staff stated the previous signal system would not clear the call pendent signal after assisting the resident, which is why the facility replaced the signal systems. During today's visit, LPAs pulled the emergency cord in one of the restrooms located on the first floor next to the dining room. LPAs observed facility staff respond to the emergency cord in less than a minute. Based on the interviews conducted with clients and staff, based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited and exit interview conducted with Executive Director, Jolie Higgins and a copy of the report was 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 Page 2 of 3. During visit, LPAs interview ED. EDstated he/she began his/her employment in 2021 after this complaint was received by the Department. LPAs interviewed R1's responsible party. LPAs requested a current roster of staff and residents. LPAs reviewed R1's Admission Agreement, Email Communication, R1's Move Out Notice, and R1's refund check. Facility did not issue a refund. Based on record review of R1’s signed admission agreement by R1's responsible party, on page 12 of 69, the document states “You may terminate this agreement at any time…by giving the executive director thirty (30) days’ prior written notice…You will continue to be responsible for your full monthly fee until the thirty (30) day period has expired." Per interview with ADM, the facility did not have another verbal or documented agreement in place, besides the admission agreement signed by responsible party. Based on record review of email communications between R1’s responsible party and the facility on 9/14/2020 and R1’s responsible party notified the facility he/she wanted to terminate the contract effective the same day and facility accepted the email notification as a 30-Day Notice. Based on record review of R1’s move out notice signed by the responsible party, the form states R1’s responsible party gave move out notice on 9/14/2020. The form also states “by signing and submitting this form you will be giving the required 30-day notice. The last day of your notice will be 10/14/2020.” Based on record review of facility’s copy of R1 refund check. The form states the refund was given on 10/30/2020 and was cashed out on 12/01/2020. On 8/11/2023, LPA interviewed R1’s responsible party. Responsible party confirmed the address on the check was his/her home but could not confirm if check was received. Continuation on Page 3 LIC-9099. 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 3 of 3. Staff did not seek medical attention in a timely manner. Based on record review of R1's Narrative Charting 9/12/2020 at 9pm, the Medication Technician (MT) during the shift reported R1's child was with resident when he/she stated R1 was "having a stroke". MT checked on the resident right away and called the Hospice agency. While MT was connecting with Hospice Nurse, R1's child spoke to Hospice Nurse and describe R1's symptoms. Per R1's Narrative Charting, Hospice Nurse advised R1's child to administer PRN medication after hearing R1's symptoms. Based on record review of R1's Hospice Visit Communication on 9/12/2020, Hospice LVN visited R1 the same to assess the resident at the facility. Per notes, R1's child stated R1 had anxiety attack and was asleep during visit. Based on record review, two subsequent visits were made by the Hospice Nurse on 9/13/2020 and 9/14/2020 wherein R1 was observed to be alert and did not have symptoms of stroke. The Department has completed the investigation of the above allegations. Based on interviews conducted and record reviews, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. No deficiencies cited and exit interview conducted with Executive Director, Jolie Higgins and a copy of the report was provided.

On 05/07/2021, the Department interviewed the prior Executive Director (PED). PED stated during a transfer, R1 became excited and anxious, threw himself/herself onto the chair, and obtained bruises on R1's forearm. PED also stated R1 has resisted care before, and usually moves around during transfer. On 8/11/2023, around 10:50AM, LPAs interviewed ED. ED stated ED knew R1 at another facility. ED stated R1 was easily get excited and moved around the two hands. ED stated R1 obtained bruise during transfer at another facility. On 8/11/2023, around 11:30 AM, LPAs interviewed S1. S1 stated R1 needed two care givers to move/transfer, S1 stated R1 resisted during the care or transfer. S1 stated R1 moved two arms while transfer. LPAs interviewed S2. S2 stated R1 needed two caregivers to move/transfer. S2 stated it was tough to take care of R1. S2 stated R1 resisted the care provided by caregivers, sometimes R1 combated with the caregivers when caregivers provided the care or transfer. LPAs interviewed 2 caregivers (S3, S4), and both of them stated R1 resisted care and got excited when caregivers to provide the care and to transfer. Based on the documents reviewed and interviews conducted, there is no evidence shows R1 obtained bruise due to staff's careless. Based on record review of R1's physician report signed and dated 2/20/2019, R1 requires toileting assistance every 3-4 hours. The physician report also states R1 is a fall risk. The Department has investigated the above allegation. Based on interviews, and record review, the department has found the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid, there is not a preponderance of evidence to show the alleged violations did or did not occur. No citations were cited per California Code of Regulations, Title 22. This report was reviewed with ED. A copy of the report was provided to ED.

On 8/11/2023 around 1:00PM, LPAs interviewed ED. ED stated the facility staff checks incontinent residents every two hours to assess if the resident needs assistance. ED stated residents on incontinence service program can call for assistance as needed. ED stated R1 participated the incontinence service program. LPAs reviewed R1's care plan, R1 participated the facility incontinence service program. Around 1:20 PM, LPAs interviewed Resident Service Director (S1). S1 stated caregivers check incontinent residents every two hours including the bed time and as needed. S1 stated resident can call staff if assistance is needed. Based on record review, facility stated they were tracking R1's incontinence needs but the facility staff could only produce records for two weeks. The Department has investigated the above allegation. Based on interviews, and record review, the department has found the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid, there is not a preponderance of evidence to show the alleged violations did or did not occur. No citations were cited per California Code of Regulations, Title 22. This report was provided to ED for review. A copy of the report was provided to ED.

Based on interview, 5 out of 5 staff state the facility has a cell phone that is provided for residents to make telephone calls. Staff (S5) states the cell phone is used to make calls to family along with receive calls from family. LPA observed the cell phone is capable of telephone calls and video calls. Staff (S4) states the staff assist the residents with telephone calls and/or video calls when needed. Telephone calls to family members are not scheduled and based on request of the family member. The residents are able to receive calls anytime throughout the day. The Department has investigated the above allegations. Based on interview, record review and observation the above allegations are unfounded. An unfounded finding means the allegation is false, could not have happened and/or without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director (ED) Jolie Higgins and Resident Service Director (RSD) Ria Hernandez and a copy of the report was emailed to ED and RSD due to technical difficulties.

Three hospice care staff were interviewed. Based on the interviews, R1 was being visited by Hospice between three to five times a week. When asked a routine question on the status of the resident’s condition, facility staff stated R1 would eat almost 100% of all their meals. R1 had a behavior in opening their mouth constantly, regardless if food or drinks were offered. It was undetermined whether this was related to R1’s medical diagnosis or hunger. When given water during a hospice care visit, R1 observed to finished two full glasses and appeared to be thirsty. According to the interviews, there was no indication that facility staff had neglected R1 or refused to provide food or fluids to R1. Based on record review, R1 was dependent for all Activities of Daily Living (ADLs). R1 was being administered multiple medications in which one of side effects may be constipation. Throughout December 2021, R1’s main medical concern was constipation with no mentions or signs of dehydration. In January 2021, notes indicated that R1 was eating well. R1’s doctor instructed facility staff to encourage fluids daily as tolerated to promote bowel movement. In January 2021, there was no mention of R1 showing signs of dehydration. Given R1’s medical diagnosis, R1 remained at risk for multiple medical issues which included dehydration. Based on record review, a home health aide (HHA) from the hospice agency informed staff that prior to the hospice nurse visiting R1, HHA had also offered fluids and applesauce but R1 refused and spit it out. The Department has investigated the above allegation. Based on interviews and record review the Department has determined that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Executive Director, Jolie Higgins and a copy of the report was provided.

Based on interview, 6 out of 6 residents states to be receiving all services. 6 out of 6 residents states the facility was supplying the residents with water bottles but that service had been discontinued recently. Residents are informed they are now responsible in supplying their own water bottles, if preferred. 6 out of 6 residents states the facility does provide drinking water. The facility held a requested resident council meeting on 08/31/2022 and resident council meeting on 09/06/2022 to discuss the discontinuation of water bottles. Residents were informed of the discontinuation of the supply of water bottles through a resident council memo that was placed in the resident's mailbox on 09/06/2022. LPA interviewed the Executive Director, who states the supply of water bottles were a courtesy to the residents during outbreaks of communicable diseases. The purpose of supplying the residents with water bottles were to reduce the spread of the communicable disease. Based on records review, the supply of water bottles is not part of the resident’s services. The discontinuation of the water bottles were part of the resident council minutes that was provided to each resident. LPA observed the facility to have multiple hydration stations that are readily available to the residents. The Department has investigated the above allegation. Based on interviews and records review, the Department has determined that the above allegations is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Jolie Higgins and a copy of the report was provided.

Licensing Program Analyst (LPA) Christine Dolores conducted a scheduled technical assistance visit and met with Jeeteeh Gigliotti, Resident Service Director (RSD) and Jocelyne Bailon, Compass Rose Resident Service Director (CRRSD). During visit, LPA conducted a Facetime tour of the inside and outside of the facility with PCC Helen Shi and LPM Jackie Jin. The purpose of the visit was to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility. The RSD reports that there are currently 8 COVID-19 positive residents and 2 COVID-19 positive staff. During today's tele-visit, the following recommendations were made to the facility by PCC Helen Shi: 1. Place foot operated trash bin with lid outside each isolation room in Assisted Living 2. Remind staff to change their N95 mask after stepping out of each isolation room 3. Limit the staff who goes into the isolation rooms in Assisted Living 4. Memory Care staff to discard PPE (N95s and wipes) inside a plastic bag after exiting each isolation room and then discard plastic bag in designated trash bin 5. Coordinate with staff, management and family in Memory Care to provide additional services for COVID-19 positive resident's prone to wandering The Department will provide additional PPE supplies. No deficiencies were cited as per California Code of Regulations, Title 22. This report was reviewed via telephone with Jeeteeh Gigliotti, RSD and an email copy will be provided for signature.

On 01/28/2020, (LPA) Karen Taku and Licensing Program Manager (LPM) Romeo Manzano conducted a subsequent visit, and interviewed the Executive Director, Resident Services Director in Memory Care, and Assisted Living Director, and 5 direct staff and obtained copies from R1's facility records such as Physician's report, Incident reports, appraisal needs and services and centrally stored medication log. On 10/19/2020, LPAs Karen Taku and Grace Davis conducted an unannounced subsequent Complaint Investigation Tele-visit. During visit, LPAs requested resident records and interviewed staff. LPA interviewed 8 facility staff. 4 Out of 8 staff (S1-S4) are not familiar with R1's large mass on R1's left breast while 4 staff (S5 -S8), who stated that have observed R1's swollen left breast. Staff denied allegations of abuse and no incidents occurred prior to the observation of the mass. S5 stated S5's observed R1's bump on R1's chest and two hours later, the bump had grown in size, which resulted in emergency services being called (911) and R1 being transferred outside of the community. S6 stated S6 was aware of R1's swollen breast that resulted into R1's hospitalization. S6 stated that there were no incidents of abuse reported to S6 by staff, nor R1 was physically abused during R1's residency in the memory care. Based on review of R1's Internal Incident Report on 11/10/2019, S5 was notified by staff that R1 had a large mass on left breast which grew in size in about 2 hours resident complained of severe pain. R1 was sent out to be evaluated through 911 call. R1's primary care physician (PCP) was notified on the same day and R1's responsible parties. R1's PCP was also notified on same day that R1's left hand was still and pushes against R1's breast which causes bruising and there was also a tight hard mass on the upper part of R1's breast. Based on review of R1's Med Tech to Med Tech Communication Log between 10/9/2019 to 11/10/2019, staff noted on the following days R1's incidents: 10/9/2019, R1 was agitated wherein R1's responsible party was notified; 10/11/2019, R1 had an aggressive behavior, 10/18/2019; R1 noted to have skin discoloration on left breast and side area with no complaint of pain or discomfort; 11/1/2019 R1 complained of pain and discomfort on bottom wherein refused pain medication; 11/2/2019 R1 had a bruise under left arm and provided pain medication and on 11/10/2019, R1's swollen left breast with severe pain noted. Page 2 of 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On 11/21/2019, LPA Shugan interviewed the Resident Service Director (S9) who stated awareness of R1's bruise, hard mass and complaints of severe pain but no mention of staff having caused the injury to resident. Staff denied allegation of abuse wherein R1 was pushed by staff resulted in R1 sustaining a left breast bruise and swelling. On 04/22/2021, S9 stated that there was no medical records findings received from the hospital. R1 was not interviewed. R1 did not return to the facility after R1's hospitalization in 11/10/2019 and no longer resides at the facility. The department has investigated the above allegations. Based on the record review and staff interviews the Department has found that the above allegations are UNSUBSTANTIATED . An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. Exit interview conducted with Executive Director, Jolie Higgins. A copy of this report was provided. Page 3 of 3.

On 04/11/2020, R1 was noted by facility staff to have green pus, foul odor and blood when changing R1's undergarment. R1 complained of leg pain and burning sensation. This incident was reported and R1 was taken to the hospital. R1 was interviewed. Despite R1's neurocognitive disorder, R1 does not remember going to the hospital on 04/11/2020 but does remember being admitted to the hospital for urinary tract infection (UTI). R1 denied recent sexual activity and being mistreated or sexually abuse by any staff members. R1 states feeling safe at the facility. Based on records review, R1 was admitted into the hospital on 04/11/2020 wherein R1 was indicative of a sexually transmitted infection and result of tests were negative. Test results revealed that R1 had inflammation of the bladder and subsequently treated for urinary tract infection (UTI). R1 has a history of UTI in 2019 and 2020. This Department has investigated this allegation. Based on interviews conducted, records reviewed, and LPAs observation, the Department has found that this allegation is UNFOUNDED , meaning that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted with Executive Director, Jolie Higgins and a copy provided. Page 2 of 2.

Based on review of the facility monthly calendar, there were daily activities in the facility from morning to afternoon and sometimes nighttime. For example, on 7/3/2019 the facility had morning exercise starting at 10:00 AM, BBQ in courtyard starting at 11:30 AM, and afternoon stretch, sponge art, bingo, and documentary starting at 1:15 PM. Another example, on 7/26/2019, the facility had morning exercise and daily chronicle with coffee starting at 10:00 AM, exercise with James, name that tune, sensory hand washing starting at 10:30 AM, sightseeing, bingo, and movie night starting at 1:00 PM. On 7/25/2019, LPA Ng interviewed 2 residents with null result. On 7/25/2019, LPA Ng interviewed 1 visitor of the resident. 1 out of 1 visitor stated the family had adequate food and water upon request. 1 out of 1 visitor stated the toileting need of the resident was met. On 7/25/2019, LPA Ng toured 2 residents’ rooms in the facility. 2 out of 2 residents needed assistance in toileting needs. Based on observation, LPA did not smell any foul odor inside the room. Thus, LPA did not observe any residents’ toileting needs were not met. On 9/17/2019, LPA Ng toured 1 resident’s room in the facility. 1 out of 1 resident needed assistance in toileting need. Based on observation, LPA did not smell any foul odor inside the room. Thus, LPA did not observe any residents’ toileting needs were not met. On 9/17/2019, 8 residents were interviewed with 5 results. 5 out of 5 residents stated that they did not feel the food and water were not adequate for them. 5 out of 5 residents stated their toileting needs were met. 5 out of 5 residents were not aware any resident’s food, drink, and toileting needs were not met. On 9/17/2019, 1 visitor of the resident was interviewed. 1 out of 1 visitor stated the family had adequate food and water upon request. 1 out of 1 visitor stated the toileting needs of the resident was met. On 9/17/2019, LPA interviewed 1 staff who was responsible to address the toileting needs of the residents. 1 out of 1 staff stated the residents in need, were checked at least 4 times per shift, 2 times per night, at least 8 times per day. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On 10/18/2019, LPA interviewed 4 residents. 4 out of 4 residents stated there were adequate food and water in the facility. Based on observation, LPA did not smell any foul odor from the 2 out of 4 residents who needed assistance in toileting needs. Thus, LPA did not observe any resident’s toileting need was not met. On 10/18/2019, LPA interviewed 1 staff who was an activity director. 1 out of 1 staff stated many residents who were in memory unit liked to watch old television based on her professional experience. Showing modern television shows irritated some residents. Beside television shows, the entertainment system in the facility could also act as a karaoke, and gaming machine to entertain the residents. Due to physical and health condition, the family of R1 refused the facility to have R1 to participate the activities with other residents. On 10/18/2019, LPA interviewed 2 staff. 2 out of 2 staff stated care staff developed a system to check the residents in need routinely in order to make sure the residents’ needs were being met. Based on observation, LPA observed there were activities provided to residents who participated. LPA observed residents had their meals and observed staff assisting residents in eating and drinking. Also, LPA did not observe any residents’ toileting needs were not met. It was alleged that a med tech would serve R1 24 hours a day, that at least 3 staff available at all times, and the resident would be checked on every 10 minutes. Although it was alleged that it was agreed to provide a copy of admission agreement to LPA, LPA did not receive it when requesting it on 7/24/2019, and on 9/10/2019. No document was provided to support the allegation. Based on record review, LPA obtained a copy of the R1’s admission agreement documents from the facility. In reviewing the documents, the terms and agreements on services wherein the facility failed to provide to R1 are not mentioned. This Department has investigated the above allegations. Based on observations, interviews conducted and records review, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the allegations did or did not occur. This report was reviewed with Executive Director and a copy of this report was provided.

On 9/17/2019 and 10/18/2019, 12 residents (R1 to R12) were interviewed with 9 successful interviews. 8 out of 9 residents (R1 to R3, R7 to R9) stated there was no concern about the temperature of the facility. R1 stated the temperature in the common area was okay, not hot, not cold. R2 stated that it was not too hot or too cold in the common area. R3 stated okay when being asked about the temperature. R4 refused to be interviewed. R5 refused to be interviewed. R6 refused to be interviewed. R7 stated the temperature was good and comfortable. R8 stated that the temperature was too hot nor too cold. R9 stated the temperature in public area was awful that sometimes it was too hot, sometimes it was too cold. R10 stated that there was no complaint regarding the temperature in the common area. R11 stated there was no complaint about the temperature in the facility. On 9/17/2019, 1 visitor (V1) was interviewed. 1 out of 1 visitor stated there was no concern about the temperature of the facility. V1 stated it was not too cold or too hot in the common area. On 9/17/2019, 1 staff (S1) was interviewed. 1 out of 1 staff stated there was no concern about the temperature of the facility. S1 stated anyone could adjust the direction of the vent so that the wind would not blow directly to the residents. On 10/18/2019, LPA observed the temperature inside the dining room and activity room in assisted living to be 79- and 80-degrees F respectively. According to regulation section 87303(b)(2) Maintenance and Operation: “the facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature.” It was evidenced that the temperature of the facility was within the regulation. This Department has investigated the above allegation. Based on observations, interviews conducted, and observation, the Department found that the above allegation is UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur. This report was reviewed with Executive Director . A copy of this report was provided.

Licensing Program Analysts (LPAs) Christine Dolores and Marybeth Donovan conducted an unannounced Case Management Visit. LPAs met with Billy Mitchell, Executive Director (ED), Jocelyn Bailon, Compass Rose Resident Service Director, and Jeeteeh Gigliotti, Resident Service Director. LPAs explained the purpose of the visit to obtain additional information related to 4 incident reports received for the period 7/18/2021 to 7/25/2021 involving resident (R1). 911 was called for each of these incidents. LPAs toured the facility in part to include the lobby, dining room and Compass Rose Memory Care area and outdoor courtyard. LPAs interviewed ED and two staff LPAs reviewed resident (R1's) records to include physician reports, health and services evaluation reports, service plan and physician communications. R1 transitioned from Assisted Living to Memory Care unit on 7/15/2021. R1 exhibited exiting behaviors from the Memory Care unit. Staff were monitoring R1's transition. Family and primary care provider (PCP) were notified of changes in condition. Care conference was held to discuss plan of care. Staff directed to contact 911 in the event of emergency and for safety of residents in care and staff. No citation issued per the California Code of Regulations Title 22. Reviewed the report with Billy Mitchell, Executive Director and a copy provided.

LPA Marrufo obtained copies of staff training logs related to resident care and abuse for staff S1-S8. LPA Marrufo also obtained a memory care activities calendar and Physician and Medical Visits Policy. 5 out of 7 interviewed residents stated the facility is meeting resident needs. 2 out of 7 declined to give a response. 10 out of 10 interviewed staff stated the facility is meeting resident needs. 4 out of 4 witnesses stated the facility is meeting resident needs. LPA Marrufo toured the living units of residents R1-R5. During interviews, facility staff and family members stated that resident R1 has a habit of hiding and losing R1’s dentures. LPA reviewed Daily Logs for R1 and observed there to be entries on 03/19/2021 and 07/06/2021 in which facility staff communicated to R1’s medical Power-of-Attorney (POA) stating that R1’s dentures had been lost. LPA Marrufo toured R1’s living unit and observed R1’s emergency call button to be located on top of R1’s dresser. LPA Marrufo observed the emergency call button did not have a lanyard attached to it. During visit, LPA Marrufo requested facility staff to attach the lanyard to the emergency call button and hang it over R1’s neck. During interviews, a facility staff and a witness stated that R1 has a habit of keeping R1’s walker brake’s locked, which wears down the brakes on the walker. Both staff and R1’s POA stated that R1’s POA is responsible for providing a replacement walker. 4 out of 7 interviewed residents stated facility staff prevent resident to resident altercations. 3 out of 7 interviewed residents declined to answer. 10 out of 10 interviewed staff stated facility staff prevent resident to resident altercations. 4 out of 4 interviewed witnesses stated facility staff prevent resident to resident altercations. See LIC9099-C for more information. Page 2 of 4. 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 3 out of 7 interviewed residents stated facility staff do allow residents to have visitors. 1 out of 7 interviewed residents stated facility staff do not allow residents to have visitors. 2 out of 7 residents declined to answer. 10 out of 10 interviewed staff stated facility staff do allow residents to have visitors. 4 out of 4 interviewed witnesses stated facility staff do allow residents to have visitors. 3 out of 7 interviewed residents stated facility staff assist residents with medical and dental appointments. 1 out of 7 interviewed residents stated facility staff do not assist residents with medical and dental appointments. 2 out of 7 residents stated they did not know if staff assist residents with medical and dental appointments. 2 out of 7 residents declined to answer. 10 out of 10 interviewed staff stated facility staff assist residents with medical and dental appointments. 4 out of 4 interviewed witnesses stated facility staff assist residents with medical and dental appointments. LPA Marrufo reviewed a copy of the Physician or Medical Visits policy, dated 10/19/2019. The policy states that if a resident is unsafe to be left without an escort to a physician or medical visit, the facility will arrange for a staff member to accompany the resident. During interviews with 3 out of 3 facility drivers, the drivers stated that it is the procedure of the facility to either meet a resident’s family member at a physician or doctor’s visit or escort the resident to the doctor’s visit and check the resident in to the appointment. 4 out of 7 interviewed residents stated the facility serves food of good quality. 1 out of 7 interviewed residents stated to not be sure if the facility offers food of good quality. 2 out of 7 residents declined to respond. 10 out of 10 interviewed staff stated the facility serves food of good quality. 4 out of 4 interviewed witnesses stated the facility serves food of good quality. See LIC9099-C for more information. Page 3 of 4. 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 Marrufo observed the facility kitchen as meals were being prepared, the food cart that takes meal trays to the facility memory care unit, and the kitchen and dining area in the facility memory care unit. LPA observed food to be warm and stored in ovens. During meal service, LPA interviewed 4 residents while they were being served lunch and all 4 residents stated they thought the lunch was of good quality. LPA attempted to interview a 5th resident during meal service, but the resident declined to be interviewed. LPA observed the food storage areas in the assisted living and memory care areas. LPA checked canned foods in the pantry and perishable foods in facility refrigerators and did not observe any expired foods or any unsealed foods. 4 out of 7 interviewed residents stated the facility safeguard’s resident’s personal property. 1 out of 7 interviewed residents stated to not know if the facility does not safeguard resident’s personal property. 2 out of 2 residents declined to respond. 10 out of 10 interviewed staff stated the facility safeguard’s resident’s personal property. 4 out of 4 interviewed witnesses stated the facility safeguard’s resident’s personal property. Based on information from interviews conducted with staff, residents, and witnesses, review of records, and observations, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An Advisory Note was issued. See LIC9102 for more information. No Deficiencies were cited under California Code of Regulations Title 22 This report was reviewed with Executive Director Billy Mitchell and a copy of the report was provided. Page 4 of 4.

Licensing Program Analyst (LPA) Karen Taku conducted an unannounced Case Management visit today. LPA met with the Executive Director (ED) Billy Mitchell and the Resident Services Director (RSD’s) of Assisted Living -Jeeteeh Gigliottii and Memory Care-Jocelyne Bailon. The purpose of today’s visit is to conduct a welfare check on a resident (R1) who resides in Memory Care. Per the ED and RSD’s, R1 is doing and eats well. R1 had a couple falls last week and sustained no injuries. Per RSD, R1 wants to remain as independent as possible, but due to R1’s health condition (Alzheimer Dementia w/Behavioral Disturbances), R1 doesn’t realize assistance is needed. Per RSDs, to minimize additional incidents, R1 was given a pendant to call for assistance and Occupational Therapy, to ensure R1 knows how to properly transport using a walker and wheelchair. R1’s Physician's Report, Assessment, and Care Plan were reviewed during today's visit. At 11:18am, LPA observed R1 having a snack and speaking to staff. R1 appeared to be in good spirts. At 11:25am, LPA attempted to speak with R1. R1 was sitting in wheelchair with eyes slightly closed and vocal. R1 stated, doing okay and didn't have any concerns. Per Lifestyle Director, R1 is fairly involved in activities. R1 enjoys being read to, coloring, and the weekly scenic drive. No deficiencies cited during today’s visit. This report was reviewed with the ED and a copy was provided.