Mainplace Senior Living.

Per R2, R1 personally told them they had taken “too much medicine" and forgot to set the breaks on their wheelchair leading to the fall. R2 stated that after R1 informed them of what had occurred, they told "everybody" and R1 “was upset.” R2 denied S1 or S2 ever discussing R1’s fall with them personally and denied having any knowledge of S1 or S2 ever discussing R1 or R1’s fall with other residents. During their interview, R3 denied S1 or S2 ever discussing R1’s fall with them personally and denied having any knowledge of S1 or S2 ever discussing R1 or their fall with other residents. Per R3, it had been R2 who had informed other residents that R1 had sustained a fall because of their drinking. R3 stated they have overheard staff discussing other residents and the care being provided on more than one occasion, however, R3 unable to identify the staff alleged to have been discussing residents or identify residents alleged to have been discussed. During their interview, Staff 1 (S1) denied ever discussing R1 or R1’s fall with R2 or R3 and denied ever informing R2 or R3 that R1 had been drinking or overdosed. S1 denied having any knowledge of S2 or any other staff discussing R1's or any other resident's personal information with other residents. During their interview, Staff 2 (S2) denied ever discussing R1 or R1’s fall with R2 or R3 and denied ever informing R2 or R3 that R1 had been drinking or overdosed. S2 denied having any knowledge of S1 or any other staff discussing R1's or any other resident's personal information with other residents. During their interview, S3 denied having any knowledge of S1 or S2 discussing R1 or R1's fall amongst themselves or with other residents. S3 denied witnessing or having any knowledge of S1 or S2 discussing R1's drinking with R2 or R3. Per S3, residents gossip amongst each other and that is how information about other residents spreads. Due to allegation being uncorroborated during interviews conducted, the Department is unable to determine if Facility staff did not meet the personal rights of the residents. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.

During their interview, two of two staff stated the pharmacy delivers medication to the facility and in the event a resident needs a ride, they can notify staff and rides are offered on Tuesdays and Thursdays. Regarding allegation, Staff did not ensure resident was transported to doctor's appointment, the following was revealed: It is alleged R1 missed a doctor’s appointment due to a mix up in scheduling transportation. During their interview, R1 denied missing a doctor’s appointment and stated staff take them to necessary doctor’s appointments. Five of five additional residents interviewed denied the allegation and stated the doctor comes to visit them at the facility or facility staff will make arrangements. Per R2, the facility also offers rides on Tuesdays and Thursdays. During their interview, two of two staff stated there was an isolated event in which R1 did not notify staff of their appointment. Per both staff, had staff been aware of R1’s appointment, they would have been able to transport them to their appointment and stated rides are also offered on Tuesdays and Thursdays. Regarding allegation, Staff did not ensure residents room wasn't in disrepair, the following was revealed: It is alleged that upon move-in, R1’s room was not ready and still in the process of being remodeled and R1 did not have water or a sink for a few days. During their interview, R1 stated that upon moving into the facility, there were boxes all over the room because it was still being painted, and their television did not work. Resident 4 (R4) and R1 moved into the facility on the same date and were placed in rooms directly next to one another. During their interview, R4 denied anything in their room being in disrepair upon moving in, including their television. Four of four additional residents interviewed denied their room being in disrepair upon moving in and stated their television has been and continues to be operable. During their interview, two of two staff denied having any knowledge of anything in R1’s room or any other resident’s room being in disrepair upon moving in. Regarding allegation, Staff yell at resident, the following was revealed: It is alleged an unknown staff member yelled at R1. During their interview, R1 stated that after staff refused to transport them to the pharmacy, “one lady” looked at them and stated they could “walk over there.” R1, however, was unable to identify the individual or any other staff alleged to have yelled. Five of five additional residents interviewed denied personally being yelled at by staff and denied witnessing or having any knowledge of any other resident being yelled at by staff. Per R3, “on the contrary. They are very friendly and very helpful.” During their interview, two of two staff denied personally yelling or having any knowledge of any other staff yelling at a resident. (Cont. LIC9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Regarding allegation, Staff did not safeguard resident’s food, the following was revealed: It is alleged an unknown staff member threw R1’s food away, which was placed in a facility fridge. During their interview, R1 was unable to confirm or deny the allegation and stated the only food they eat is what is provided by the facility. During their interview, R3 stated that at mealtimes they “eat everything on [their] plate” and have never had leftovers or food that needs to be safeguarded. Four of five additional residents interviewed stated they are provided with meals by the facility and if they have leftovers, the facility provides leftover containers, and they are able to bring them to their bedroom and eat them at their own discretion. Two of two staff denied having any knowledge of staff not safeguarding any resident’s food. Due to allegations being uncorroborated during interviews conducted, the Department is unable to determine if Staff were refusing to transport resident to pick up prescriptions, if Staff did not ensure resident was transported to doctor's appointment, if Staff did not ensure residents room wasn't in disrepair, if Staff yell at resident, or if Staff did not safeguard residents food. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.

R1 stated that there was an incident where she became upset with a facility staff because they ran out of one of her medications, however, they were able to do an emergency refill with the Pharmacy and she has not had any issues since. The Department additionally conducted five resident interviews. Five out of the five residents interviewed denied any issues with their medication and denied staff ever refusing to administer their medication. All five residents interviewed stated that they receive their medication on time and that they do not have any concerns about the staff administering the medication. The Department also conducted four staff interviews. Four out of the four staff interviewed denied ever observing or witnessing a staff refusing to administer medication to a resident. The Department observed that there was an Unusual Incident/Injury Report (UIIR) received by the Orange County Regional Office on June 6, 2023. The UIIR contradicts the complaint allegation and describes R1 being verbally and physically to staff due to her Primary Care Physician (PCP) being unable to order her medications. Based on the evidence gathered during this investigation, the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Wellness Coordinator Ervin Nario and a copy of the report was provided.

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA met with Executive Director (ED) Rhon Hipolito and Clinical Director (CD) Ruby Racca-Magao, and Business Office Manager Briana Garcia and explained the purpose of the inspection. During the inspection, LPA and Staff Abenzer Zeleke conducted a tour of the inside and outside of the facility common areas and resident rooms, and observed the following: The facility consists of a single-story building used for memory care and assisted living and an additional attached two-story building used solely for assisted living. An evacuation chair was observed at the top of every stair way. Select resident rooms were inspected and all were observed to have the required furnishings. LPA observed all resident beds had linens and blankets. Signal system was tested and observed to be operable. There are three courtyards with multiple shaded sitting areas. LPA observed residents socializing in common areas and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 103.4-118.5 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. There is a fire extinguisher located at the end of every facility hallway. Fire extinguishers were observed to be fully charged with service tags dated September 5, 2025. Facility kitchen appliances were inspected and observed to be operable. Laundry washer and dryer were also observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and locked in medication carts. LPA reviewed select resident files and staff files. LPA interviewed eleven residents and four staff. (Cont. 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 Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.

Per three of three staff, it is facility protocol to empty all toileting equipment, whether it is full or not, two to three times per shift. Regarding the allegation, Staff did not safeguard resident's personal belongings, the following was revealed: It is alleged staff did not safeguard R1’s wheelchair leg supports. Interviews were conducted with eleven facility residents and three facility staff. During their interview, R1 stated that on August 17, 2025, they were wheeled to breakfast by Staff 2 (S2). Per R1, they requested that S2 take their wheelchair leg supports off. S2 complied and the leg supports were placed in R1’s room. Per R1, upon returning to their room, the leg supports were still there, however went missing later the same day. Per R1, after reporting their leg supports were missing, the facility replaced them with "almost identical" ones. Two of ten additional facility residents interviewed were unable to confirm or deny the allegation and eight of ten facility residents denied having anything missing or having any stolen items, including wheelchair leg supports, or any other ambulating assistive device. During their interview, S2 denied the allegation and stated they were not aware R1 had been missing their wheelchair leg supports. During their interview, S3 stated R1’s wheelchair leg supports were immediately replaced upon R1 reporting them missing, however, were later found to have been in R1’s bedroom all along. Regarding the allegation, Staff did not ensure resident’s assistive equipment needs were met, the following was revealed: It is alleged R1’s did not receive a hospital bed with half bed railing, and air mattress. During their interview, R1 stated Kaiser provided them with a hospital bed with bed railings and an air mattress, however these items were never provided to R1 at the facility. During the course of the investigation, Kaiser was contacted, and a Kaiser Representative (KR) confirmed a hospital bed with half side rails and mattress had been ordered for R1 on August 20, 2025. Per KR, these items would have been delivered by third-party vender, Apria. During their interview, Apria Representative (AR) confirmed a hospital bed with half side rails and mattress had been ordered for R1, however stated the order had been received on September 20, 2024, and stated a delivery order for R1 had not been placed by Kaiser in the year 2025. AR confirmed delivery address as that of the facility, however, R1 was not admitted to the facility until August 13, 2025. During their interview, three of three facility staff denied any knowledge of Kaiser providing R1 with a hospital bed with railings and/or an air mattress. Interviews were conducted with eleven facility residents and three facility staff regarding the allegation, Staff did not properly transfer resident. (Cont. LIC9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 During their interview, R1 stated that during transfers they were able help themselves sit up in bed and facility staff would then pull them up by their undergarment and shorts. Per R1, upon staff doing this the thread on their clothing would start to audibly tear and the undergarment cut into the skin on their inner thighs. R1 stated that this did not cause an injury to them but could easily have. Two of ten additional facility residents interviewed were unable to confirm or deny the allegation, five of ten residents denied the allegation and stated staff assist them with transfers in a gentle manner, and two of ten residents stated they are not assisted with transfers and denied witnessing staff assisting other residents with transfers. During their interview, three of three staff stated pulling a resident by their undergarment or shorts is not part of a typical transfer, however, does occur in emergency instances, such as preventing a resident from falling during a transfer. Regarding the allegation, Staff did not assist resident with wound care in a timely manner, the following was revealed: It is alleged R1 was not assisted with wound care in a timely manner leading to wound developing maggots.During their interview, R1 stated they have wounds on their legs due to their medical condition and their wounds are treated and bandaged by Home Health. R1 was unable to provide specifics regarding the dates and times they were seen by Home Health. Per R1, about a week went by and they had not seen anyone from Home Health nor had the facility staff treated or re-bandaged their legs, when they observed a fly on their bandage. Per R1, S3 saw the fly and instructed S1 to open the bandages and maggots came out. R1 stated S3 dressed and cleaned their wounds and made sure there were no more. Per R1, on August 28, 2025, they decided to go to the hospital and was provided with wound care and given anti-biotics. During the course of the investigation, Excell Home Health was contacted, and Excell Representative (ER) stated R1 had been seen by a Home Health Nurses on August 21, 2025 and on August 26, 2025 for wound care. Per ER, R1 had also been seen on August 28, 2025, however, their notes did not specify if wound care had been provided at that time. LPA attempted to contact Home Health Nurse, Witness 1 (W1), who provided wound care for R1 on August 21, 2025 on three separate occasions, however, W1 could not be reached to confirm or deny allegation. LPA attempted to contact Home Health Nurse, Witness 2 (W2), who provided wound care for R1 on August 26, 2025 on three separate occasions, however, W2 could not be reached to confirm or deny allegation. During their interview, S1 stated that on August 28, 2025, they had observed a fly on R1’s leg wound bandage and upon removing it, maggots were observed. Per S1, R1 spent most of their time outside and they believe a fly flew into R1’s bandage sometime on August 27, 2025, which led to the rapid development of maggots. (Cont. LIC9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 During their interview, S3 stated R1 was seen by a Home Health Nurse on August 26, 2025 and was provided with wound care. Per S3, on the morning of August 28, 2025, R1 reported discomfort to the wound on their leg and upon S1 removing the bandage, maggots were observed. R1 was immediately transferred to the hospital. S3 stated a Home Health Nurse had been present at the time, however had not provided wound care due to R1 being transported to the hospital. Per facility progress notes, on the morning of August 28, 2025, R1 was provided with wound care and transferred to a local area hospital for further evaluation. Based on record review of R1’s facility progress notes and due to allegations being uncorroborated during interviews conducted, the Department is unable to determine if Staff did not ensure resident's toileting equipment was emptied in a timely manner, if Staff did not safeguard resident's personal belongings, if Staff did not ensure resident’s assistive equipment needs were met, if Staff did not properly transfer resident or if Staff did not assist resident with wound care in a timely manner. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated. An exit interview was conducted and copy of this report was left at the facility.

At this Informal Conference present were Clinical Director Ruby Racca Magao, California Market Leader Ann Zavela, and California Clinical Market Leader Roanne Delos Reyes. Representing the Department were Regional Manager (RM) Marina Stanic and Licensing Program Analysts (LPAs) Claudia Gutierrez and Rose Ruppert. The following was discussed: • Administrative Organization • The Department’s consultation role The following was agreed upon: • Facility will provide the Department updated Administrative Organization (LIC309), Board Minutes, By laws and Articles of Incorporation by Monday, October 20, 2025 An exit interview was conducted and a copy of this report was provided to the end of the Informal Conference.

Per R4, facility management is always available and reported that he has no problems. R5 stated that management staff are available and reported that he can always get a manager to help him. Per R5, he gets helped within one hour. During the course of the interviews with staff, Staff 1 (S1) reported that facility management is always available to the residents and stated that the Medication Technician (MT) is backup when management is in their all-staff meeting. During the interviews AD reported that if he is not available it is usually after hours or at night. AD reported that the management backup is the Business Office Manager and Wellness Director. Per AD, if management is in a meeting the MT will help the residents. Regarding the allegation that food service is inadequate, the following was revealed: During the course of the investigation LPA reviewed documents including the Mainplace Senior Living Menu dated June 3-9, 2024, and September 22-28, 2025. Per menu options the residents are offered a different meal for breakfast, lunch and dinner. During the course of the interviews with residents, R1 reported that the food is terrible. Per R2, the food is good and reported that she is able to get seconds. R4 reported that he has not experienced stomach issues or vomiting. Per R4, the food is great and reported that the food is nutritional. R5 stated that the food service is adequate and reported that he has not had food poisoning or vomiting due to bad food. During the course of the interviews with staff, S1 reported that the food service is adequate and stated that the meals are nutritional and include vegetables and fruit. Per S1, the food is not causing the residents to be ill. During the interviews AD reported that all meals include protein, vegetables and fruit. Per AD, no residents have complained about food poisoning or feeling ill because of the food. AD stated that the residents can order from the alternative menu. Regarding the allegation that facility failed to safeguard resident’s property, the following was revealed: During the course of the interviews with individuals one of seven individuals confirmed the allegation. It was alleged that R1 had several break ins into their bedroom, and their Blood Pressure medication was stolen. During the course of the investigation LPA reviewed documents including the Physician Report (LIC602A) dated February 13, 2020, for R1. Per Physician Report R1 is able to administer and able to store own prescription medications. During the course of the interviews with residents, R1 reported that staff entered her bedroom and stole her personal property; however, R1 could not identify the perpetrator. Per R2, she has never had anything stolen and stated that the facility safeguards the residents' property properly. R3 stated that staff always safeguard the residents' property and reported that staff do a good job by not touching the residents' property valuables. Per R4, no staff member has entered his bedroom without his consent and reported that staff have not steal from him. R5 reported that staff have not entered his bedroom to steal and stated that staff are respectful, courteous and attentive. CONTINUED ON LIC9099-C... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 During the course of the interviews with staff, S1 reported that she has not heard that staff have been entering the residents' bedrooms and stealing. Per S1, each resident has a key to lock their bedroom and stated that staff carry a master key in case of an emergency and/or to do Wellness checks. During the interviews AD reported no staff have stolen property or valuables from the residents. Per AD, R1 manages her own medications and stated that staff are respectful and hard working. Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation 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 Hipolito, and a copy of this report was provided to the facility.

Facility pre-placement appraisal for R1 dated December 6, 2022, documented that R1 ambulated independently, can walk without physical assistance, are active with no physical assistance required and are able to go up and down stairs easily. R1s appraisal also stated that R1 did not need help with moving about the facility. The appraisal was signed by R1s authorized representative on December 6, 2022. LPA observed R1s service plan with an initiation date of December 28, 2022, stating that R1s mobility is marked as assistance as needed, ambulates independently, transfers independently and is ambulatory. The service plan also states that R1 is occasionally forgetful with reminders. Progress notes done by facility staff covered the dates of March 4, 2024, to April 4, 2024. The progress notes stated that there have been no changes to R1s activities of daily living or care needs in the past month. LPA observed an incident report dated April 18, 2024, stating that staff was inside the memory care dining room when they heard R1 scream. Staff immediately checked on R1 and observed a bump on R1s forehead and R1 complained of pain on their right arm. R1 stated they lost balance and fell due to someone bumping into them. The incident report stated that paramedics were called and R1 was transported to the hospital for further medical assessment and treatment. During interviews it was revealed that six of six staff stating R1 was independently ambulatory and was able to move around the facility with no assistance. Six of six staff stated that R1 did not use assisted devices when walking, such as a cane or walker. Three of six staff stated that R1 did not have a history of falls. Three of six staff stated that the memory care unit always has staff in one of the common areas of the unit. It was reported to two of six staff that on April 13, 2024, via phone call that R1 fell in the tv room outside of the dining room as the incident occurred over the weekend on their days off. It was reported to two of six staff that the closest staff was in the dining room overseeing dinner service next to the tv room when the incident occurred. It was reported to staff #1 (S1) that the resident had left the dining room during dinner service and was seen walking towards the tv room before the incident occurred. Two of six staff informed LPA that facility staff called 911 and R1 was sent to the hospital for further evaluation due to R1 hitting their head. R1 was admitted to the hospital and was diagnosed with a hip fracture. LPA attempted to contact R1s responsible party but was unsuccessful. Continue on 9099-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 Although R1 sustained a fall at the facility, it remains unclear if the fall occurred due to a lack of care and supervision. Based on information gathered during the investigation the department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with ED Rhon Hipolito And a copy of this report was provided at the time of the investigation.

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of following up regarding Death Report received by Community Care Licensing (CCL) for Resident 1 (R1) on August 28, 2025, and to conduct a Health and Safety inspection. LPA met with Business Office Manager (BOM) Briana Garcia and explained the purpose of the visit. During the inspection LPA and BOM conducted a tour of the facility and observed the following: Resident bedrooms were observed to have the required furnishings. LPA observed resident beds had linens and blankets. LPA observed the facility has electricity, gas, water, internet and phone service. Medication was observed to be centrally stored in locked medication carts. Fire extinguishers are located in every facility hallway and were observed to be fully charged with service tags dated October 14, 2024. LPA tested signal system in select resident bedrooms and observed signal system to be operable. There are three courtyards, each containing a shaded sitting area, and no obstacles or hazards were observed. LPA observed residents resting in their respective bedrooms and engaging in leisure activities, such as board games and socializing amongst each other. LPA did not observe any immediate threats to the health or safety of residents in care. Based on observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to the facility.

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced case management visit for the purpose of following-up regarding an incident report received by Community Care Licensing (CCL) on June 18, 2025 and to conduct a Health and Safety inspection. LPA met with Administrator in Training (AT) Monica Guardian, Business Office Manager Briana Garcia, and Clinical Director Ruby Racca-Magao and explained the purpose of the visit. During the inspection LPA and AT conducted a tour of the facility and observed the following: Resident bedrooms were observed to have the required furnishings. LPA observed resident beds had linens and blankets. LPA observed the facility has electricity, gas, water, internet and phone service. Water temperature tested at 113.9 degrees Fahrenheit, and faucets and toilets were operational. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Fire extinguishers are located in every facility hallway, and were observed to be fully charged with service tags dated October 14, 2024. There are three courtyards, each containing a shaded sitting area, and no obstacles or hazards were observed. LPA observed residents resting in their respective bedrooms and engaging in leisure activities, such as watching a movie, coloring, and listening to music. LPA did not observe any immediate threats to the health or safety of residents in care. Based on observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was provided to the facility.

Per record review, in the month of February 2023 and March 2023, LPA Rodriguez observed the clock in times for staff in February 2023 and March 2023 and observed that there were multiple staff members present, and verified that there was never just one staff member present. It was alleged that bathrooms are being made inaccessible to residents. LPA Rodriguez conducted a total of 6 resident interviews, all of which did not corroborate with the allegation. LPA Rodriguez conducted a total of 2 staff interviews, of which both did not corroborate with the allegation. LPA Rodriguez observed that on the assisted living side, there are two bathrooms designated for staff, which remained unlocked, and one bathroom designated for the public, which also was unlocked. LPA Rodriguez observed that each resident room had their own bathroom and was made accessible to the resident(s) living in that room. LPA Rodriguez observed that on the memory care unit, there are bathrooms in each resident’s room, and one extra shared bathroom located in the hallway, that is designated only for residents. LPA Rodriguez observed that the memory care bathroom in the hallway was locked, however it is due to safety concerns, to prevent the residents from entering the bathroom on their own since per physician reports, the memory care residents are unable to use the bathroom independently and require assistance. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. For this visit, there were no citations were issued. An exit interview was conducted with Wellness Director Ruby Racca-Magao and Business Office Manager- Briana Garcia. A copy of this report was provided and explained.

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA met with Executive Director (ED) Rhon Hipolito and discussed the purpose of the inspection. During the inspection, LPA and ED conducted a tour of the inside and outside of the facility, common areas, resident rooms, and observed the following: The facility consists of a single-story building used for memory care and assisted living and an additional attached two-story building used solely for assisted living. Select resident rooms were inspected and all were observed to have the required furnishings. LPA observed all resident beds had linens and blankets. Signal system was tested and observed to be operable. There are three courtyards with multiple shaded sitting areas. LPA observed residents socializing in common areas and resting in their respective bedrooms. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 105.9-116.4 degrees Fahrenheit. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. There are two fire extinguishers located in every hallway of the facility. Fire extinguishers were observed to be fully charged with service tags dated October 14, 2024. Facility appliances were inspected and observed to be operable. Toxic chemicals, cleaning solutions, and disinfectants were observed to be inaccessible to residents. Medication was observed to be centrally stored and locked in medication carts. LPA reviewed centrally stored medication for select residents and did not observe any discrepancies. LPA reviewed ten resident files and five staff files. LPA interviewed ten residents and five staff. (Cont. 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 Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.

Interviews were conducted with four facility staff, and seven residents regarding allegation, facility staff are not preventing physical altercations between residents. Four of four staff interviewed denied witnessing or having any knowledge of any physical altercations between residents. Six of seven residents denied witnessing or having any knowledge of physical altercations between residents taking place. One of seven residents denied personally having a physical altercation with another resident, however, indicated they were involved in a verbal altercation with another resident at an unknown time in the past. During the complaint investigation, LPAs and WD conducted a tour of the facility and observed the air conditioning to be operating as designed and room temperature tested between 76- and 82- degrees Fahrenheit. LPAs observed residents in common areas and resting in their respective bedrooms without disturbance, and no physical altercations between residents were observed. Based on observations and due to conflicting information received during interviews conducted, LPA is unable to determine if facility staff are not ensuring air conditioning is maintained in good repair or if facility staff are not preventing physical altercations between residents. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.

CONTINUED FROM FORM LIC9099 Regarding the allegation that Resident did not receive medication correspondence sent to the facility in a timely manner, the following has been concluded: Based on records reviewed, residents R1, R2, R3 and R4 have been confirmed to have been assessed to be capable of managing their own medication by their respective primary care physicians. During interviews conducted, one out of four residents indicated that their medication was delivered directly to their unit by the pharmacy upon request from their physician. Another one of four residents stated that she had medication delivered by postal service on or around July 10, 2024 but never received it. The same resident stated that facility management had reported that no postal deliveries had been documented by front desk staff on that day. Another package was noted to have been brought by USPS on July 7, 2024 and stated by staff to have been brought to the resident's unit as the resident does not come down to the lobby. No active grievances regarding interference with personal correspondence appear to have been formally filed with facility management in the period from January 23, 2024 to the present visit. Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was provided to a facility representative.

S1 states resident did not have shoes on when the staff picked up the resident and states the resident had on grippy socks only. Two out of two staff deny seeing the resident with shoes. Facility progress notes dated 02/23/2024 indicated 911 was called twice for resident with resident being sent out to the hospital in the early morning hours. Facility documentation shows facility left a message for the resident's family on two different occasions that night. Staff 2 states having a conversation with family on the telephone and in-person regarding the alleged missing wheelchair and shoes. Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, all allegations are deemed Unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

Two additional interviews were attempted, but witnesses could not be reached. Regarding the allegation above, 8 of 9 individuals were unable to corroborate the complaint allegation. Three of four residents interviewed denied any problems with anyone entering their room unauthorized and all residents reported they fell safe in the community. Resident 2 (R2) denied any personal items being stolen and said staff only enter the room to pick up dirty laundry. Resident 4 (R4) denied anyone entering the room unauthorized, and denied anything being stolen from the room. When asked if anything has been stolen, R4 said, “Thank God… nothing valuable here.” R3 denied anything has been stolen form as well. All staff interviewed denied items being stolen form residents, but all did mention that some residents claim things have been stolen form them. Staff 1 (S1) mentioned a resident who claimed items were stolen from them and then a couple days later claimed whoever stole the items, brought them back. Staff 3 (S3) mentioned the same resident, and claimed the resident has reported items are missing and really the items are misplaced by the resident. S3 said once after the resident claimed items were missing, S3 located the missing item in the resident’s room. Regarding the complaint allegation: Facility did not report theft During the interviews it was discovered the Resident 1 (R1) reported medications were stolen from the resident’s room. Document review revealed the resident’s son was informed of the reported theft and was informed R1 contacted the Police. The incident number and detective's name in the facility progress notes matched the incident report number and detective’s name provided by R1. During interviews with Staff 2 (S2) and Staff 3 (S3) both were unaware of any reported theft from R1 being reported to the facility. Based on the information gathered during the investigation through interviews, document review, and observations, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, all allegations are deemed Unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

Per documentation review, resident (R1) is diagnosed with Dementia and has a history of falls. On December 25, 2023, R1 sustained an unwitnessed fall in the facility common area, and staff contacted 911, to which then R1 was transported to the hospital. LPA De Perio conducted an interview with R1's responsible party (RP) and confirmed that the facility notified RP immediately of the incident. RP also verified that R1 has had a history of falls, but stated that the fall sustained at the facility is not due to staff neglect, but because R1 likes to walk around and would take off their eyeglasses. R1 is also ambulatory and receives assistance with dressing and bathing. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. An exit interview was conducted with ED Hipolito. A copy of this report was provided and explained.

prescription medications, able to administer own PRN medications and able to store own medications. Based off interviews conducted and documents received Resident 1 was able to self administer medications at time initial complaint received therefore the above allegation Staff did not provide medications to resident as prescribed is deemed UNFOUNDED meaning , that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited during today's visit. An exit interview was conducted with (ED) Hipolito and a copy of today's report and LIC 811- Confidential Names were provided.

Regarding the allegation "Floor in resident room is not cleaned properly," the investigation revealed the following: Nine of ten interviewees denied the allegation indicating Maintenance Director conducts carpet cleaning when requested. Health and Wellness Director Mims indicated "There's a carpet cleaning request list in the front lobby, so residents can call and request carpet cleaning and it'll get done by the Maintenance Director timely." (R2) indicated "My room mate wants to get rid of me, so he keeps saying I'm having accidents and not being cleaned." Five of six residents indicated "Staff disinfect the carpet immediately when needed due to sanitary reasons." Health and Wellness Director Mims indicated "(R1) has requested laminate floor in bedroom area and he's on our list for floor already." Executive Director (ED) Rhon Hipolito indicated laminated floor was installed in (R1) and (R2)s bedroom area on July 19, 2023. Therefore based on the preponderance of evidence gathered through interviews and observations conducted by LPA Quiroz, the allegation that the "Facility does not meet resident’s needs" and "Floor in resident room is not cleaned properly" are deemed UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. This agency has investigated this complaint. No deficiencies cited during today's visit. An exit interview was conducted with (ED) Rhon Hipolito and a copy of report was provided at exit.

On this day Licensing Program Analyst (LPA) Andrea Mendivil conducted a collateral visit. LPA was greeted and granted entry into the facility by Executive Director, Rhon Hipolito and explained the reason for the visit. During the visit LPA Mendivil interviewed Resident 1 (R1). No deficienices noted. An exit interview was conducted and a copy of this report was provided to Executive Director Rhon Hipolito.