Ciela.

At 9:35 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct a required annual inspection. Upon arrival LPA introduced herself to Valerie Trujillo and she was informed of the purpose of the visit. Valerie informed LPA that Rony Shram-Administrator would be arriving soon. At 10:15 AM, the Administrator Rony Shram arrived, and he was informed of the purpose of the visit. The facility is licensed to serve 100 non-ambulatory residents aged 60 and above, of which 20 may be bedridden. The facility is approved for 20 hospice residents and approved for delayed egress. All facility units are approved for bedridden clients. The facility is a four story building with two underground floors located in a residential area. There are currently no hospice residents or bedridden. The Annual Licensing Fees are current. The first floor consists of: The main entrance with lobby/front desk, office areas, kitchen, dining room, residential mail area, public restrooms,bistro, and lounge area. The first floor also has dementia care unit, kitchen area, café, dining room area, and medication room. The second floor consists of: Salon, office rooms, lounge/library area, courtyard, public bathrooms, and residential units. The third floor consists of: outside patio area, public bathrooms, and residential units. The fourth floor consists of: residential units Continued 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 are two underground lower levels that consists of: parking garage, theater room, gym, spa room, pool room, food storage, staff break room, resident storage. The facility has a total of 82 residential units, and several indoor and outdoor common areas with shaded seating. At 10:30 PM, LPA reviewed six (6) residents files for admission agreements, updated physician reports, needs and services plans all of which appeared to be current. LPA reviewed seven (7) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings which all appeared to be current. At 12:45 PM, LPA conducted a tour of the kitchen and there was 5-day supply of perishable and a 7day supply of non-perishable food items available, which were adequately maintained/stored. LPA also observed that there was a menu available for review there were no health and safety concerns. LPA inspected a total of six (6) bedrooms and six (6) bathrooms. The beds and bedding were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were in good condition and operational with required handrails and nonskid flooring. The water temperature ranged from 105°F to 118. °F. LPA observed that the facility appeared to be clean, sanitary, and appropriately furnished throughout the facility. LPA also observed the temperature to range between 72°- 85° degrees. Based on LPA observation no deficiencies were cited per Title 22 Regulations. An exit interview was conducted, and this report was discussed and provided to Rony Shran- Administrator at the conclusion of the visit.

of 6 Staff were interviewed and insisted that they have not had any mismanagement of residents' medication. LPA España conducted a comprehensive review of the medication management practices at the facility. This included an inspection of the Assisted Living (AL) cart on the second floor and the Memory Care cart on the first floor. The review focused on ensuring compliance with medication protocols and identifying any discrepancies in medication administration. Not limited to comparing the medication MAR to the actual medication for each residents. Specific findings related to each resident's medication management were documented during the tour. LPA found that for 6 of 6 residents medication distribution was in compliance and found no errors. A review of the facility's medication training and Med -tech schedule was reviewed. LPA found that all Med- Techs have continuous monthly training on medication protocols. And Med tech staffing is adequate to provide adequate services for the residents in care. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove, “ Staff mismanage residents' medications. ” did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Rony Shram, Executive Director.

On 11/15/2024, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator – Rony Shram. CCLD staff explained the purpose of the visit and was accompanied by a staff member inside and outside the facility during this inspection. This facility is licensed to serve 100 non-ambulatory adults ages 60 and above, of which 20 may be bedridden. The facility is approved for 20 hospice residents. The facility is approved for delayed egress. All facility units are approved for bedridden clients. The Annual Licensing Fees are current. 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 facility is a four-story building with two underground floors located in a residential street. The first floor consists of: main entrance with lobby and front desk, office rooms, industrial kitchen, dining room, residential mail space, public restrooms, salon, activity room, bistro, and lounge area. The first floor also has the Dementia Care Unit with residential units, the botanical garden, kitchen, café, dining room area, and medication room. The second floor consist of: a beauty bar, office rooms, lounge/library area, courtyard, public bathrooms, and residential units. The third floor consist of: outside patio area, public bathrooms, and residential units. The fourth floor consist of: residential units. The first underground floor consists of: parking garage, theater room, gym, spa room, pool room, food storage, freezer room, fridge room, staff break room, and lactation room. The second underground floor consist of: parking garage, resident storage, and storage rooms. The facility has a total of 82 residential units, 99 bathrooms, and several indoor and outdoor common spaces with shaded seating. The kitchen area has supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. 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 Medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. Last Earthquake drill was conducted on 09/10/2024. There are several fire extinguishers around the premises, and they were last serviced on 09/27/2024. There are landline telephones on the premises. There is a videoconferencing device dedicated for client use in the computer room. 8 out of 82 residential units were checked. There is adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. This facility provides residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb. 5 staff records were reviewed, 5 out of 5 staff records had required documentation. 5 resident records were reviewed and, 5 out of 5 resident records had required documentation. No deficiencies are being cited based on LPA observation and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and a copy of this report was left with the Administrator.

On 11/20/23 Licensing Program Analysts (LPA) Elvira Gonzalez, (LPA) Socorro Leandro, (LPA) Regina Cloyd conducted a pre-licensing evaluation for an RCFE (Residential Care Facility for the Elderly) facility type. Today’s pre-licensing evaluation was conducted with licensee Rony Shram. The licensee has applied for a license to serve (100) age range 60 and over adults. The fire clearance is approved for (80) non-ambulatory and (20) bedridden residents. LPA’s toured facility Kitchen, Dining Room, Living Room areas, (82) Bedrooms, (99) Bathrooms, Garage, and botanical garden, patios with shaded areas. LPA’s toured the lobby, lounge, beauty bar, gym, theater room, indoor pool and several common spaces. LPA’s observed sufficient storage areas for kitchen supplies, linens, medications (secured) and chemicals (secured). LPA observed the following during this visit: MEDICATIONS There is a locked centralized storage area for Resident medications. PHYSICAL PLANT LPA’s observed the facility is clean, sanitary, and in good repair. Indoor and outdoor passageways, stairways, open areas, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68° degrees and 85° degrees. Open patios, and areas of potential hazard are well-lit. Carbon monoxide/Smoke detectors operate properly. BEDROOMS All rooms were inspected and are compliant with California code of regulations title 22. 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 BATHROOMS There are plenty toilets and washbasins for clients, family, and personnel. There are plenty showers for clients, family, and personnel. Hot water temperature is between 105°-120° degrees Fahrenheit. Bathrooms are located inside client bedrooms and common areas. Public restroom calling system is operational. SUPPLIES There is a sufficient supply of clean linens to permit weekly changing or more of client top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE Dining room is near kitchen. Refrigerator and freezer are clean and have the capacity to store at least two (2) days of perishable foods. There is storage for seven (7) day supply of non-perishable food. There are enough tableware, tables, dishes, and utensils. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. RECORDS There is confidential storage for personnel records at the facility. There is storage for Resident confidential information and records at the facility. 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 RECORDS There is confidential storage for personnel records at the facility. There is storage for Resident confidential information and records at the facility. ADMINISTRATION The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES There is an outdoor activity space with a shaded area and furnished for outdoor use. There are at least 3 common areas available to clients for visitors. There are activities scheduled during the current month. MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. Continued 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 MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. LPA’s observed a sign-in/sanitation station at the facility entry. There is hand sanitizer located at the entrance of the facility. Facility has screening process for all visitors, sanitizer/soap, paper towels, and additional PPE supplies are stored inside the facility. LPA Cloyd conducted the Component III Orientation with the Licensee and copy of this report was provided. A copy of the facility evaluation report will be available to the Central Applications Unit (CAU) for review.

COMP II by CAB successfully completed Facility Type: RCFE Capacity: 100 Census (if any clients in care): Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of property