Kirkwood Orange.

Per monthly statements, it includes the date, description and charged amount. During the interviews with residents, R2-R4 reported that they have not had issues with their billing and/or stated that they are being provided with adequate billing services. During the course of the interviews with staff, Staff 1 (S1) reported that the resident was billed properly for the services she was provided. Regarding the allegation that staff did not ensure resident’s sink was not in disrepair, the following was revealed: During the initial visit on May 16, 2024, and subsequent visit on November 21, 2025, LPA tour R1’s bedroom and observed that the sink was in good repair. During the interviews with residents, R2 reported that she has no issues with her sink and stated that maintenance will help quickly if needed. Per R3, the water goes down her sink properly. R4 stated that he has not had issues with his sink and reported that maintenance will assist the residents the same day. During the interviews with staff, S1 reported that they have a system where staff can open a ticket for repair/work orders. Per S1, staff always ensure that the residents’ sinks are working properly. S3 reported that R1 never complained about her sink being broken or clogged. Regarding the allegation that staff inappropriately installed a sensor on resident’s door , the following was revealed: During the initial and subsequent visits LPA tour R1’s bedroom and did not observe a sensor on the resident’s door. During the interviews with residents, R2-R4 reported that they have never seen a sensor on the residents' doors. During the interviews with staff, S1 reported that the facility never installs sensors on the residents’ doors. Per S2, she has never seen a sensor on the residents' doors. S3 stated that during the morning rounds that staff notice an aerial alarm/ sensor on the resident's door and reported that the next day the sensor was gone. Per S3, the facility staff did not place the sensor on the resident’s door. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegations occurred as reported due to conflicting information. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED. For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations. LPA conducted an exit interview with ED Palposi, and a copy of this report was provided to the facility. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Regarding the allegation that staff are not keeping track of resident's documents , the following was revealed: During the investigation LPA review the Resident file for R1. LPA observed that the file for R1 included the following documentation: Admission Agreement, Medical Assessment, Consent Forms, Identification and Emergency Information, Preplacement Appraisal Information, MAR, Resident Assessment, maintenance work orders, Resident Personal Rights, Safeguards for Property/Valuables and Cash Resources, and monthly billing statements. During the interviews with residents, R2-R4 reported that they have not had issues with their documents and/or reported that their Responsible Party (RP) received a copy of their records. During the interviews with staff, S2 reported that staff keep accurate track of the resident documents. Per S3, staff provided R1's RP with all documentation requested. Therefore, the allegations are deemed UNFOUNDED, meaning the allegations are false, could not have happened and/or are without a reasonable basis. LPA Ramirez conducted an exit interview with ED Palposi and a copy of this report was provided to the facility.

On September 22, 2025, Licensing Program Analysts (LPA’s) Jenifer Tirre and Eboni Bentley conducted an unannounced required visit using the CARE Inspection Tool. LPA’s were greeted by staff and granted entry after stating the purpose of the visit. Director of Health Services Putri Tarigan helped assisted with today’s visit. Executive Director Dan Kashani arrived shortly after and assisted with the facility inspection. The facility is licensed for Sixty six (66) non-ambulatory residents of which eight (8) may be bed ridden with approved hospice waiver for fifteen (15) residents. Currently, there are three (3) Hospice residents present during today’s visit. Facility is a two story building with 58 resident rooms (combined private and shared). Facility has Assisted Living and Memory Care located on both floors. Facility has activities room, Bistro, ice cream parlor, salon parlor, dining rooms located on both levels as well as enclosed outside patios with delayed egress gates. At around 8:50AM, LPA’s conducted a tour of the physical plant accompanied by Director of Health Services Putri Tarigan, and the following was observed: There were no bodies of water on the premises. Resident rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. During visit water temperature inside resident bathrooms and kitchen sinks were tested operational with water temperatures measured between 112.8 to 117.3 degrees F. A comfortable temperature of 74 degrees F. was maintained in the facility. LPA’s observed the facility to be furnished at the time of the visit. Storage areas for toxins, cleaning supplies and sharps objects were stored and not accessible to residents. CONTINUED 809C 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 kitchen was inspected, facility has sufficient two day perishables and seven day non-perishable foods. Facility had supply of emergency food and water. LPA’s observed facility had emergency food kits with servings varying from 12 to 93 per kit. LPA’s observed eight fire extinguishers which were fully charged and mounted. LPA’s reviewed facility has three Evacuation chairs posted on second floor stairwells. A review of the Medication Records Administration (MAR) was conducted, and LPA observed six of six records are in compliance. During the visit, LPA observed the facility's infection control practices. LPA’s observed sanitizing stations in common areas and restrooms. LPA’s observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Facility mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on September 18, 2025. Based on in house documentation from Direct Supply Tels and Champion Fire Solutions Inc facility had operational smoke and carbon monoxide detectors tested and passed on July 10, 2025. The facility has current liability insurance on file effective 7/1/2025 – 7/1/2026. A review of six residents (R1-R6) service files and six staff (S1-S6) personnel files revealed to be complete. The facility has the current administrator's certification on file for Faraz Kashani # 7030587740 - Expiration 5/1/2027. No deficiencies during this inspection visit. An exit interview was conducted with Executive Director Dan Kashani, and a copy of the report was provided.

It was alleged that staff did not keep the facility free from odor (marijuana). LPA De Perio conducted 5 resident interviews, of which 5 out of 5 resident interviews did not corroborate with the allegation and denied any concerns and instances related to this allegation. 2 out of 2 staff interviews conducted, also did not corroborate with the allegation by stating that there have been no issues amongst staff or residents smelling like or using marijuana. LPA De Perio conducted a tour of the physical plant of the facility and selected random resident rooms and did not observe or smell any areas of the facility having an odor from marijuana. LPA De Perio conducted documentation review and observed that staff are required to acknowledge and sign the facility handbook upon hire, acknowledging that staff are prohibited to be under the influence while on the job or company property, and that it is subject to termination. Per documentation review, there were no history of documents It was alleged that staff conduct poses a risk to residents in care. LPA De Perio conducted 5 resident interviews, of which 5 out of 5 resident interviews did not corroborate with the allegation by stating that there were no health and safety concerns present and provided positive feedback regarding staff. 2 out of 2 staff interviews conducted, also did not corroborate with the allegation by stating that all staff undergo training regarding resident care and are not allowed to start working until completed. LPA De Perio conducted documentation review and observed that current facility management will hold meetings with staff if there were any risk concerns while providing care, and that there are ongoing trainings that are held. It was alleged that staff do not provide daily activities for residents in care. LPA De Perio conducted 5 resident interviews, of which 5 out of 5 resident interviews did not corroborate with the allegation by stating that the facility offers activities but is voluntary for residents to attend. 2 out of 2 staff interviews conducted, also did not corroborate with the allegation by stating that activities are offered to both the assisted living and memory care areas of the facility. Upon LPA De Perio entering the facility, LPA De Perio observed that residents were actively participating in an activity led by staff, in the lobby. LPA De Perio conducted a tour of the physical plant of the facility and observed that the facility has an activity schedule posted for both the assisted living and memory care area. Per documentation review, LPA De Perio observed that the facility activities scheduled daily for 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 It was alleged that staff did not keep the facility free from pest. LPA De Perio conducted 5 resident interviews, of which 2 out of 5 resident interviews corroborated with the allegation by stating that they have observed one or two cockroaches in the facility, but stated that the facility attends to the situation by hiring pest control. 3 out of the 5 resident interviews did not corroborate with the allegation by denying of ever observing any pests at the facility. 2 out of the 2 staff interviews stated that pest control is scheduled to come to the facility monthly for maintenance. LPA De Perio conducted a tour of the facility, and of random resident rooms, and did not observe any pests. Per documentation review, facility has hired EcoLab and Optum Pest Management, and both companies have conducted work at the facility since January 2024. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with ED Blacher. A copy of this report was provided and explained.