Cedars @ Paradise Village.

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by and explained the purpose of the visit with Independent Living Resident Care Coordinator Tara Long. Executive Director Nicole Long arrived during the visit. The facility has a licensed capacity of 150 non-ambulatory residents and has a hospice waiver for 6 residents. During today’s visit, the facility had a census of 113 residents. The Administrator for the facility is William Lawson and their certificate was valid and current. During today’s visit, LPA inspected a random sampling of resident rooms and bathrooms, common areas, kitchen, and outside space. No bodies of water, delayed egress, or secured perimeter were observed on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. LPA observed linens and hygiene products for resident use. The facility’s ambient and water temperature were measured within regulatory requirements at multiple locations. LPA observed locked storage for resident medications and hazardous and/or toxic chemicals, both of which were stored separately from food supplies. According to Nicole Long, no firearms or weapons are stored on the premises. LPA observed a minimum supply of 2-days of perishable food and 7-days of non-perishable food. The refrigerator and freezer temperatures were kept within requirements. Staff present at the facility had criminal background clearance and association. LPA reviewed multiple resident and staff records. No deficiencies were cited on today’s date. An exit interview was conducted with Health Services Director Jeunesse Holmes, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

Review of the resident rosters for the assisted living facility and the independent living buildings revealed that R1 was not a resident of the licensed assisted living building and instead resided in one of the independent living buildings. Facility management confirmed during interviews that R1 was not a resident of the licensed assisted living facility. Additionally, interviews with facility management revealed that tenants residing in the independent living buildings did not receive care from any staff associated to the assisted living facility. Due to the evidence showing that R1 is not a resident of the licensed facility, the Department's investigation determined that the complaint allegation is Unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with Executive Director Nicole Long , whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).

OA1 stated that the facility began "2 hour checks" on R1 and R2. OA1 stated that the facility staff are meeting the care needs for R1 and R2. OA1 stated that the facility calls them "right away" to report any new health or skin conditions for R1 and R2. OA1 stated that from what they have witnessed at the facility OA1 believes the facility had sufficient staff to meet the needs of the hospice residents. OA1 stated that when OA1 is in need of a caretaker OA1 notifies the front desk who then alert the staff and they always arrive quickly. LPA interviewed outside source (OS) who stated that they visit R2 regularly at the facility. OS stated that R2 has resided at the facility for over eight years. OS stated that facility staff often check on R2 but also allow OS to visit with minimal interruption. OS stated that R2 had a pressure sore on their foot which was being monitored by staff. OS stated that they are satisfied with the care that the staff are providing for R2. OS believed that the facility had sufficient staff to meet R2's care needs. LPA interviewed Staff 1 (S1) at the facility. S1 stated that they work directly with R1 and R2 and informed LPA that R3 passed away. S1 stated that they check both residents every two hours. S1 stated that due to the recent changes in management in the last few months their were some issues with communication between staff but now "it's all in place."S1 stated that the facility has an in-service training every month to address various topics including; catheters and hoyer lifts. S1 stated that when a hospice resident with an advanced stage wound is soiled the staff immediately advised hospice who then comes to the facility to clean the wound, change the dressing and change the soiled brief. S1 stated that although it is struggle at times with staffing due to "call outs" or resignations, they still manage to complete their tasks including; repositioning R1 and R2, checking if R1 and R2 are soiled and checking if R1's wound dressing is in tact. LPA interviewed Staff 2 (S2) at the facility. S2 stated that they believe the staff are meeting the care needs of R1 and R2. S2 stated that they immediately advise the med nurse when they see any issues with the hospice residents such as wound dressings that needs to be changed. S2 stated that although the requirement is that they check on R1 and R2 every 2 hours, S2 likes to check them every hour or hour and a half. S2 stated that during the check in's they reposition both residents and check if they are soiled or need their wound dressing changed. S2 stated that they believe their is sufficient staff to meet the needs of R1 and R2 as well as the other hospice residents. S2 stated that they usually get another staff member to cover the shift if someone "calls out." S2 stated in general their are two med-techs, four caregivers and one "floater" caregiver that work during the morning shift. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA interviewed Staff 3 (S3) at the facility. S3 stated that although they do not work directly with the hospice residents they work along side the staff that do work with them. S3 stated that they believe the staff are providing proper care for R1, R2, R3 (before their passing) and all of the hospice residents. S3 stated that staff are required to check on R1 and R2 every two hours and they log their initials every time they do so. S3 stated that the facility has sufficient staff to meet the care needs of R1 and R2. S3 stated that although staff call out sick at times, they still manage to meet the needs of the residents in care. LPA interviewed Executive Director who stated that they fill staff assignments based on resident needs. ED stated that caregivers are assigned equally based on equity. ED stated that they make sure their is always coverage to meet the care needs of the residents. ED stated that if needed management step in to provide and fulfil resident care needs. ED further stated that at times the resident service director would assist with "med pass" to support the staff. Review of R1's service plan dated December 21, 2024 revealed staff were to provide R1 assistance every 2-3 hours for continence management. Service plan further revealed that R1 required assistance to turn and reposition in bed. Review of R2's service plan dated March 10, 2025 revealed staff were to provide R2 assistance with continence management every two hours during waking hours. Service plan further revealed that R2 required assistance to turn and reposition in bed. Review of R3's service plan dated March 10, 2025 revealed safety checks were to be completed during shift every 2-3 hours. LPA reviewed staff scheduling for the months of April and May 2025. On average the staffing for the AM shift included two medtechs and four to five caregivers. The PM shift included two med-techs and four to five caregivers. The NOC shift included one med tech and two caregivers. It should be noted that the facility staff oversee four floors in the facility. LPA also reviewed 29 staff time cards for the month of April 2025 and found that their was sufficient staff during each shift to meet the needs of the residents in care. LPA reviewed internal facility notes for R1 and R2 dated April 2025 and May 2025. Records review revealed the continence management task for R1 was originally set as every 8 hours but was modified to 2-3 hour checks effective April 15, 2025. Records review revealed on average R1 received continence management and repositioning every 2 hours from April 15, 2025 through May 20, 2025. Records review revealed on average R2 received continence management and repositioning every 2 hours from April 1 2025 through May 20, 2025. Records review revealed on average R3 received regular 2 hour check ins. R3's repositioning task began on May 1, 2025 and it was documented that R3 was repositioned every two hours. 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 It should be noted that although one outside source was not pleased with the care that was given to R3, the majority of the evidence obtained including records review, outside source interviews, outside agency interviews and staff interviews all corroborated that the facility provided the care that was needed for the hospice residents and the staffing was sufficient. It should also be noted that the facility conducted multiple in service training's regarding charting of staff duties for residents from June 2025 through July 2025. Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met. An exit interview was conducted with Nicole Long. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Nicole Long whose signature below verifies receipt of both.

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Case Management Visit. LPA met with Executive Director Zoe Reza, and we discussed the purpose of the visit. Today's visit is in response to the self reported AWOL of Resident 1 (R1 - see LIC811 Confidential Names List). LPA conducted a wellness check at the facility, and no health or safety issues were identified. Facility records were obtained No deficiencies were cited or observed on this date. An exit interview was conducted with Health Services Director Julia Meilan . LPA provided a copy of appeal rights (LIC9058 03/22), along with a copy of this report.

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Executive Director Zoe Reza. The facility serves one hundred fifty (150) non-ambulatory elderly residents age sixty (60) and above; of which six (6) may be bedridden and may use designated rooms. There is an approved hospice waiver for six (6), of which all must be ambulatory. Current facility census is eighty-eight (88). LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected a sample of resident rooms. The facility was clean, sanitary, and in good repair. Client bedrooms contained the required furnishings. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water on the premises. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff/residents and reviewed multiple staff and client records/files. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Reza, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Executive Director Zoe Rez. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 10/23/2024), involving Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1.]. R1 had an un-witnessed fall that resulted in a fracture. Paramedics were called and responsible party was notified. During today’s visit, LPA performed a facility tour, collected pertinent records, and interviewed relevant staff. No deficiencies were cited during today’s visit. Technical Violation was issued for reporting requirements. An exit interview was conducted with Reza, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Senior Executive Director Bill Lawson. Executive Director Zoe Reza later arrived to meet with LPA. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office. According to the LIC624: on 6/29/24, Resident #1 (R1) eloped from the facility (left without staff supervision). [See LIC 811 Confidential Names List for a description of R1.] R1 returned to the facility unharmed the same day. During today’s visit, LPA performed a facility tour / welfare check, collected records, and interviewed staff and client. According to R1’s latest LIC602 Physician’s Report their doctor determined that R1 is able to safely leave the facility unassisted. Interviews and records showed that Licensee had a written Absentee Notification Plan as part of R1’s record of care, and that staff followed this plan. No deficiencies were cited for this incident. No deficiencies were observed or cited during today's visit. An exit interview was conducted with Reza, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

S1 stated that managers did not always help when there was a shortage of staff but the Med Techs would help if it was really "hectic." Interview with Staff 2 (S2) revealed S2 had been working at the facility since February 2020. S2 stated that caregivers were generally assigned to one floor for each shift. S2 stated that they sometimes got overwhelmed with the amount of pendant calls because they were the only staff member on the floor. S2 stated that they generally tried to respond to pendant calls within 10 minutes but within the last couple of months it had taken longer. S2 could not recall any instances in which residents were injured due to slow response times. S2 stated that they did not assist with meal service but heard of residents not getting their meals on time. Interview with Staff 3 (S3) revealed that S3 had been working at the facility for approximately 2 years. S3 stated that their was not enough staff at the facility sometimes and that it was overwhelming with just one caregiver per floor. S3 stated that in the past few months, there had been more caregivers calling out sick. S3 could not recall any notable incidents of residents falling or getting injured due to slow response times from staff. Interview with Executive Director (ED) revealed the facility had 4 floors with approximately 25 rooms per floor. Each floor was assigned one caregiver and one other staff member that only bathed the residents, but would help out if necessary. ED stated that some of the residents did not need much assistance with Activities of Daily Living (ADL's) but there were some that required a higher level of care. If a staff member was preoccupied with another resident when another pendant call came in, they could radio another staff member for help. There were 2-3 Med Techs in the AM shift, two Med Techs in the PM shift and one Med Tech in the overnight shift. Med Techs were generally assigned two floors each and were cross trained. ED stated that pendant calls were generally responded to within "10-13" minutes by care staff. ED stated that in March and April 2020 many staff members were calling out sick or resigning, possibly due to COVID-19 concerns. ED stated that the dining room opened on August 10, 2020 and approximately 85% of the residents utilized it. The remaining 15% were still opting for tray service to their rooms. The residents could choose when they wanted their meals delivered and make adjustments as needed. Culinary staff delivered the meals directly to the residents. 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 ED stated that some residents attempted to change their meal delivery time on the same day, which caused some scheduling confusion for the culinary staff. ED believes this was the main reason why some residents received their meals later then expected. LPA review of records revealed the facility had 80 active employees from July 2020 though December 2020. Records review also revealed that the facility was actively recruiting new staff from January 2020 through November 2020. A total of 25 staff members were hired during the time period of July 2020 through December 2020. These new hires included; caregivers, Med-Techs, wait staff, kitchen staff, etc. LPA determined that although several staff members were overwhelmed during this covid-19 time period, the facility did employ sufficient staff to meet the needs of the residents including food service needs. Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. An exit interview was conducted with Bill Lawson. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Bill Lawson whose signature below verifies receipt of these rights.

Licensing Program Analysts (LPAs) Amy Rodgers and Juliana Barfield, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPAs Rodgers and Barfield were granted entry into the facility by Exevcutive Director, Nicole Long, after identifying themselves and stating the purpose of the inspection. The facility serves one hundred fifty (150) non-ambulatory elderly residents age sixty (60) and above; of which six (6) may be bedridden and may use designated rooms. There is an approved hospice waiver for six (6). This is a four-story complex, with marked entry and exit door on first floor. Elevators are available for residents to use to access all floors. LPA was accompanied by the Executive Director, Nicole Long during a tour of the facility. Tour was conducted inside and out and included a sample of resident units, the dining area, recreation rooms, and food storage areas. Signal systems are in place and operational. The last disaster drill was conducted in October 2023. PPE supplies are onsite. No bodies of water are on premises. Passageways were free from obstructions. According to Executive Director, Nicole Long, there are no weapons and/or ammunition stored on the premises. All doors were operational. Each resident had clean and sufficient bed linens. All extra linens, towels, and washcloths are all accessible in rooms or in locked hall closet. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Hot water temperature in residents’ bathrooms were compliant. [CONTINUED ON LIC 809-C] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 [CONTINUED FROM LIC 809] Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. There is an emergency supply of drinking water. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closed room. Medications were labeled, as required, and stored in locked areas. Staff records review verified that all staff records are complete and compliant. All direct care staff have First Aid certificates and First Aide/CPR certificates, and staff training .Resident records reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. LPAs conducted a thorough review of In-service training procedures. Transportation procedures are compliant. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. An exit interview was conducted, this report was discussed with Executive Director, Nicole Long. The report along with Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to the by Executive Director, Nicole Long.

The complainant further noted that the facility is not maintained clean and sanitary, with several reports of foul odors in the residents' rooms. Furthermore, it was reported that the facility staff is not meeting the residents' laundering needs and is not providing them with food and water at night. During the investigation, it was observed that the facility sufficient number of staff members available, which did not affect their ability to provide adequate care to the residents used the registry for additional staffing needs. The staff-to-resident ratio is 22:1 depending on census. Interviews conducted with staff members revealed that there were not any instances where unqualified individuals were assigned to provide care to residents. An onsite inspection of the facility did not confirmed the complaints about the lack of cleanliness. Several areas, including residents' rooms, bathrooms, and common areas, were found to be adequately maintained, with no visible dirt, dust, and odors present. Residents laundering needs are done once a week, with beds made daily. Moreover, residents have refrigerators in their rooms and snacks are provided on the second floor of the facility as well as in the kitchen after hours. Resident can also leave the facility and bring food in. Residents' records did not indicate any discrepancies or inaccuracies in documentation, suggesting a lack of attention and diligence on the part of facility staff. Furthermore, training's for staff are done online and on a monthly basis. Response time on average is between 15-20 minutes for staff to respond to pendent calls. There were no reported instances where facility staff removed and hid resident's emergency call pendants, limiting their ability to seek help when needed. 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 There was insufficient evidence found to support the allegations that Facility does not have sufficient staff to meet the needs of the residents; Unqualified staff are providing care to residents; Due to lack of sufficient staff, residents are made to wait an excessive amount of time for assistance; Staff does not maintain facility clean and sanitary; Facility staff does not maintain residents' rooms free of odors; Facility staff are not meeting residents' laundering needs; Facility staff are not providing residents food and water at night; Facility staff are not accurately maintaining residents' records; Facility staff are not adequately trained; Facility staff removes and hides residents' pendants; Facility staff does not ensure that residents are adequately fed; Facility staff did not serve appropriate food for resident resulting in resident choking; Due to a lack of evidence, the allegations are deemed to be Unsubstantiated. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Katrina Jimenez, Resident Services Director. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Resident Services Director and her signature on this report confirms receipt of the Licensee Rights.