Channing House

On 10/20/2025, Licensing Program Analyst (LPA) Murial Han conducted a change in capacity inspection. LPA met with Chief Executive Officer, Rhoda Bekkedabhl and Chief Operating Officer, Elvyra Abare. LPA explained the purpose of today's visit. The additional capacity of 26 residents is located on 430 Forest Avenue Palo Alto that is about 2 blocks away from the main facility. During today's inspection, LPA observed the facility has a total of 3 floors and 2 townhouses that is next the facility. There are 5 apartments one the 1st and 2nd floor and the penthouse is on the 3rd floor. LPA toured 2 apartments on the 1st floor as the other apartments are occupied with tenants and according to the CEO and the COO, the tenants were provided with the notice to vacant last Thursday by 12/31/2025. During the tour of the apartments and the townhouse, LPA observed, kitchen, dining room, living room, laundry area, common areas, patio and bathroom. LPA did not observed any furniture and furnishings in any the apartments and the townhouse. LPA observed the water temperature in the bathroom and kitchen was measured at 128- 133 degrees F, no grab bars and no non-skid mats in the showers, broken patio furniture, dust in varies areas, unpleasant smell in one of the apartments, and dead flies in of the townhouse. The CEO and the COO were aware of the above observations and stated that the complete renovation will start after 12/31/2025. Increase in capacity for this location is not approved at this time. This report is reviewed and discussed with the COO. A copy is provided.

On 07/21/2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management – Incident visit regarding an incident that occurred on 07/03/2025 when the resident (R1) eloped from the facility. Upon arrival, LPA met with the Chief Operating Officer (COO), Elvyra Abare and Assistant Administrator (AAD), Beth Shirley. The LPA disclosed the purpose of the visit. LPA interviewed COO, who stated that R1’s wife (R2), was a resident of the Independent Living (IL) unit and took R1 out around 9:15 AM for AM exercise in the IL. Later around 11:45 AM, R1 called to let the Assisted Living (AL) staff know that R1 will be eating lunch with R2 at R2’s apartment at IL. R2 checked on R1 after lunch and observed R1 taking a nap. R2 took a nap as well and when R2 woke up, R1 was not in the room. A few minutes later, a private caregiver of a resident at Skilled Nursing unit saw R1 walking alone and verbally notified the staff. The Assistant Director of Nursing and one of the CNA went and brought R1 back inside the Assisted Living. A head-to-toe assessment was done and R1 was put on 72 hours monitoring. Law enforcement was not involved. COO stated that the facility held R1’s plan of care meeting with R2 and rest of R1's family members. The facility was offered an option of a private caregiver or family assisting R1 with the walks. The COO further stated that R1 likes to walk, and it would be good if R1 had a scheduled walk every day. The family decided to have R1 walk with their daughter who lives nearby. According to COO, the family stated that they are willing to sign whatever it takes for R1 to go out on walk on their own and offered to write a letter to the facility to indicate that family was liable for R1. LPA reviewed past Incident Reports and observed that R1 had dementia and have eloped from the facility twice on the same day in February 2025. Continued on LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The COO stated that the after R1's latest elopment incident, the facility has enforced the check-out and check-in procedure for R1 if anyone is taking R1 out of Assisted Living. R1 already have a wander guard bracelet on them. Additionally, R1’s family was going to provide and place an AirTag in R1’s shoes. The facility will continue to reassess R1’s well-being and safety by continuing R1’s safety discussions with R1’s family members. No deficiencies were cited during today's visit. An exit interview was conducted with the COO. A copy of this report was provided to the COO, Elvyra Abare, whose signature on this form confirms receipt of the report.

Based on observations, interview conducted with the Assistant Administrator, and records reviewed, the department has determined that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, the allegation is UNFOUNDED. No deficiencies were cited under the California Code of Regulations, Title 22. An exit interview was conducted with the Assistant Administrator. A copy of this report was provided to the Assistant Administrator, Beth Shirley, whose signature on this form confirms receipt of the report.

On April 23, 2025, at 9:00 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management – Incident visit regarding an incident that occurred on 04/17/2025 when the resident (R1) was administered the incorrect medicine by a staff member. Upon arrival, LPA met with the Chief Operating Officer (COO) Elvyra Abare and Assistant Administrator (AAD), Beth Shirley. The LPA disclosed the purpose of the visit. LPA interviewed three (3) staff members: S1, S2, and COO. LPA interviewed S1 over the phone. S1 stated that on 04/17/2025, they had received a call from staff (S2) reporting a medication error. S2 had administered one of the Assisted Living (AL) resident’s morning medications to Independent Living (IL) resident R1. According to S1, S2 was conducting a medication pass when the phone rang. S2 grabbed a medication cup from the top of the med cart and administered the medications to R1. IL residents who are on medication management typically go down to AL to receive their medications. After completing the phone call, S2 realized that R1’s actual medications were still on the cart, but R1 had already left. R1, R1’s family member, and R1’s primary care physician (PCP) were informed about the medication error. R1 was offered the option to return to AL for monitoring. The PCP recommended that staff monitor R1 and continue with their regular medications. The COO stated that the nurse responsible for the medication error would receive education and training. The plan was to assign the nurse a Relias training module, including a reminder on medication administration protocols and a quiz. Continue on LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The COO emphasized that, fortunately, R1 did not experience any adverse effects or changes in condition. Staff continued to monitor R1 every hour for the first 24 hours and extended the monitoring to 72 hours. S2 stated that around 8:20 AM on 04/17/2025, R1 came to AL to receive their medication. At the same time, another AL resident was approaching quickly on a scooter requesting their medication, and the telephone rang. S2 answered the phone and, while distracted, handed the wrong medication cup to R1, who took the medication and left. A few minutes later, S2 realized that R1’s medications were still on the cart and that the wrong medications had been given. S2 checked whether R1 had any known allergies to the administered medication and then went to R1’s room to inform them of the error and the need for monitoring. S2 then returned to the nursing station and notified S1 of the incident. S2 also contacted R1’s PCP office, and at approximately 1:50 PM, the medical assistant advised to continue regular medications and to withhold one specific medication only if R1’s blood pressure was below 130/80. S2 confirmed that R1 did not experience any adverse effects and was doing well. S2 endorsed the situation to the incoming evening shift and instructed them to continue monitoring R1 and to check blood pressure before administering medications. S2 stated they learned from the incident and acknowledged the importance of not answering phone calls during medication passes unless it is an emergency. Although S2 had not yet received new training following the incident, they mentioned having worked at the facility for 17 years and had always maintained focus on their responsibilities. S2 also shared that R1 had expressed understanding, stating, "Everyone makes mistakes. We are all human and not perfect." AAD called to check if the resident (R1) is willing to talk to the LPA about the medication incident that happened last week, but the resident stated that it’s not necessary for them to talk to the LPA LPA reviewed R1’s progress notes for 04/17/2025, which documented the medication error in detail. The notes indicated that R1 had been offered the option to stay in an AL room for monitoring, but R1 declined. Staff began taking R1’s blood pressure readings hourly starting at 9:30 AM. At 1:30 PM, R1 left the facility with a family member for a pre-scheduled appointment with their cardiologist. After 3:30 PM on 04/17/2025, R1 resumed their regular medications. Continue on LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA also reviewed R1’s Centrally Stored Medication and Destruction Records, the Medication Administration Record (MAR), and obtained a list of the incorrect medications that had been administered. LPA requested AAD to submit proof of S2’s training and continuing education. No deficiencies were cited during today's visit. An exit interview was conducted with the Assistant Administrator. A copy of this report was provided to the Assistant Administrator, Beth Shirley, whose signature on this form confirms receipt of the report.

The second occasion involved S1 raising his/her voice at R1 when S1 found R1 on another floor of the building. R1 stated S1 used a raise voice towards R1 to ask R1 what R1 was doing and to tell R1 that R1 is not supposed to be in that part of the building alone. LPA Marrufo obtained a copy of resident R2’s Appraisal/Needs and Services Plan (ANS). R2’s ANS states, “The resident has episodes of being verbally aggressive towards other residents,” and “Resident had an incident of physical aggression with another resident, the resident moved [his/her] walker and hit another resident on [his/her] right leg.” LPA Marrufo obtained a copy of written statements made by staff as part of an internal investigation by the facility. The internal investigation had interviews of six staff. One of the six interviewed staff, S2, stated to have observed the incident in which R2 was having aggressive behaviors and S1 was attempting to supervise and redirect R2. S2 stated that while R2 was having aggressive behaviors, R1 was sitting in the common area. R2 stated that S1 was attempting to tell R1 to go to his/her room and that the area was not safe. S2 stated that S1 did not raise his/her voice at R1 but used a firm, but not disrespectful tone. S2 stated that S1 was encouraging R1 to go to his/her room. S2 stated that R1 continued to walk towards R2 and walked around R2. On 11/09/2023, LPA Marrufo interviewed R1. R1 stated that R1 had an incident with a staff, but did not want to name the staff. R1 stated that a resident used his/her walker to block R1 and a staff. R1 stated the resident uses the walker “almost as a weapon.” R1 stated to have asked the resident to let him/her out and R1 was able to walk past the resident, but the resident continued to block the staff. R1 stated the staff did not say anything to R1, but R1 did not like that the staff told R1’s child that he/she was protecting R1 from the resident with the walker. On 11/09/2023, LPA visited R2, who had a private care giver at the facility. LPA Marrufo attempted to interview R2. However, R2 appeared confused, and LPA Marrufo did not continue with the interview. LPA Marrufo interviewed R2’s private care giver, who stated that R2 does block people with R2’s walker. Page 2 of 3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 On 03/21/2025, LPA Marrufo conducted a telephone interview with S1. S1 stated to recall R1 and recall the incident involving R2 having aggressive behaviors while R1 was in the common area. S1 stated that R2 has been both verbally and physically aggressive towards others. S1 stated that R2 was being verbally aggressive and S1 feared that R2 may become physically aggressive. S1 stated that S1 told R1 that R2 was not in a good mood and the situation was not good. S1 stated that S1 may have suggested to R1 to go back to his/her room, but did not use an angry or disrespectful tone and did not yell at R1. S1 stated to have not acted in a way that did not give R1 dignity. S1 stated to have never yelled at R1 or spoken to R1 in a disrespectful or angry tone while R1 was in an elevator on another floor of the building. LPA Marrufo obtained copies of R1’s training logs, which include “Dementia Bill of Rights” completed on 03/29/2023, “Mandated Reporting,” completed on 04/24, 2023, “Interpersonal Communication” completed on 7/11/2023, and “Res. Behaviors, Narcotic Count, Breaks, Trays, Res. Appts, TEFs, Meal Waivers, Announcements” on 10/26/2023. Based on information from interviews conducted with staff and residents, and records reviewed, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with Beth Shirley, Assistant Administrator and a copy of this report was provided. Page 3 of 3. END REPORT

On March 20, 2025, at 8:50 AM, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Chief Operating Officer (COO) Elvyra Abare, Assistant Administrator (AAD), Beth Shirley, and disclosed the purpose of the inspection. The facility was a single building, multi-floor facility with a combination of assisted living and independent living sections. The AAD informed the LPA that the facility had 229 residents in care at the time, including 27 in Assisted Living and 202 in Independent Living. LPA initiated a walk-through of the facility, accompanied by AAD. LPA inspected randomly selected resident rooms in Assisted Living and Independent Living. The rooms were found to be clean, well-lit, and equipped with the required furniture. Emergency pull cords were observed to be functioning in the resident rooms. LPA inspected the private bathrooms in these rooms. The bathrooms contained soap, grab bars, towels, a trash can, and non-slip flooring. The hot water temperature at the sink faucets measured between 116.4°F and 118.9°F. LPA inspected the fire extinguishers mounted on the hallway walls in Assisted Living and Independent Living and found them fully charged, with the last service tag dated 09/04/2024. All common areas were free from obstructions, and hallways were well-lit. The smoke and carbon monoxide detector are tested daily by facilities technicians and yearly by a third party vendor, PAFA, with the last testing completed on 10/18/2024. LPA inspected the main kitchen and found it clean. The refrigerator, freezer, and pantry cabinets were checked, and there was a sufficient supply of fresh perishable food for two (2) days and nonperishable staples for seven (7) days. No expired food items were found. Open food items were wrapped and dated. The dining room was inspected and found to be clean, with all furniture in good repair. LPA observed recreational rooms such as activity rooms, fitness centers, library, swimming pool, and auditorium for events, movies, and other activities. The residents were seen actively engaged in recreational programs and activities. Continued on LIC809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA toured the garden terraces and patio area and found ramps and passageways in good condition, free of obstructions, and without any blocking or tripping hazards. These areas had patio tables, chairs, and shaded area for residents’ use. LPA reviewed six (6) staff personnel records and five (5) resident records. The LPA observed that 5 of 5 residents had the Admission Agreement, Physician's Report, Appraisal Needs and Services Plan, and CSDMR. LPA observed that 6 of 6 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 6 of 6 staff members were associated with the facility. LPA observed a locked centrally stored medication cart located near the nursing station in the Assisted Living floor. Medications were organized in separate bins for each resident. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records (CSMR) were reviewed and found to be complete. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted monthly, with the most recent drill completed on 03/12/2025. The following updated forms are requested to be submitted to CCLD by 03/27/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility LIC 400: Resident Cash Resources Affidavit LIC 402: Surety Bond Certificate of Liability Insurance Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Assistant Administrator. A copy of this report was provided to the Assistant Administrator, Beth Shirley, whose signature on this form confirms receipt of the report.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Yadira Gonzalez-Mendoz. During visit, LPA Marrufo toured the food storage areas, including the emergency food supply areas. The facility had a perishable food supply of at least 2 days and a non-perishable food supply of at least seven days. LPA Marrufo observed storage areas for emergency PPE supplies and cleaning supplies. LPA Marrufo toured the outdoor exits and found them to be clear of obstructions. LPA Marrufo toured resident bedrooms in the Assisted Living Area. LPA Marrufo reviewed the Centrally Stored Medication Logs of 5 residents and found them to be complete. LPA Marrufo conducted a resident record review for 5 residents and found them to be complete. Due to time constraints, the annual inspection will need to be continued at a later time. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Yadira Gonzalez-Mendoz and a copy of this report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Yadira Aldana. The facility entrance had a visitor screening area. The facility bathroom had available soap and paper towels. Hand washing posters were posted in the bathroom. The outdoor visitor screening area had a hand washing station with available soap, paper towels, and hand washing instructions. A perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days were observed. A 30-Day supply of PPEs were observed. Cleaning supplies were also observed. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Yadira Aldana and a copy of the report was provided.