Vi at Palo Alto

In response to Incident Reports dated 10/27/25 and 10/30/25, LPA Jeung met with director of resident services and wellness center manager/LVN for independent residents and reviewed file for client #1. After resident's reported unsupervised absences, she was evaluated by staff to require care and supervision; evaluations and assessments were documented. LPA toured facility with Ms. Rajagopal and Ms. Pascual and observed location of client #1 independent living apartment on second floor, elevators, outdoor courtyards, and path leading to care center building. On 10/27/25, client #1 told her husband that she would take a walk. About 25 minutes later, she presented at the care center building, which is on the community grounds, but in another building. On 10/30/25, client #1 was with a substitute private caregiver, who allowed client to independently walk to the dining room for lunch. She was not in the dining room nor her apartment, and was reported missing. Client did not leave the community, and was found by staff two hours later. Staff responded appropriately and client will be relocated to a higher level of care within this Continuing Care Retirement Community. No deficiency cited.

On June 19, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. LPA met with the Director of Assisted Living (DAL), Neda Armanfar, and Administrator, Valerie Alves, and disclosed the purpose of the inspection. The facility consisted of a combination of Independent Living (IL), Assisted Living (IL) and Memory Care (Canvas) units. Memory Care units were located on the first floor and Assisted Living units were located on the second floor in the same building. The Independent Living building had multiple wings with 4 floors each. The Administrator informed the LPA that the facility had 594 residents in care at the time, including 33 in Assisted Living, 18 in Memory care, and 543 in Independent Living. At 12:40 PM, LPA initiated a walk-through of the facility, accompanied by ALD. LPA inspected the main kitchen in the Independent Living building 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 rooms in Assisted Living and Memory Care were inspected and were found to be clean, with all furniture in good repair. A five-week food menu and menu with alternate food options were available to the residents. LPA inspected the fire extinguishers mounted on the hallway walls in Assisted Living and Memory Care and found them fully charged, with the last service tag dated 08/14/2024. The fire alarm, smoke detector, and fire sprinkler systems are tested annually by a third-party vendor, Everon Solutions, with the last inspection completed on March 27, 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 LPA inspected randomly selected eight (8) resident rooms in Assisted Living and Memory Care units. The rooms were found to be clean, well-lit, and equipped with the required furniture. LPA inspected the private bathrooms in random 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 118.1°F to 119.8°F. “Oxygen in Use” signs were observed posted outside the residents’ room where oxygen was administered. Two locked storage rooms were inspected. One storage room contained hand sanitizers, water bottles, wipes, gloves, and incontinence supplies. The second storage room contained clean linens. LPA inspected grand salon activities room, library, fitness center, card games room, and common living room areas. LPA observed residents watching movie and engaged in recreational programs and activities. A monthly activity calendar was available for the residents. All common areas were free from obstructions, and hallways were well-lit. Evacuation chairs were observed in the stairwells. LPA inspected locked laundry stations in Memory support and Assisted Living and observed washer and dryer units. Sharp objects, detergents, and chemicals were observed to be locked and inaccessible to persons in care. LPA toured the outside courtyard and patio areas and found passageways in good condition, free of obstructions, and without any blocking or tripping hazards. These areas had patio tables, chairs, and umbrellas for residents’ use. Delayed egress was observed on exit doors. No accessible bodies of water or hazards were observed. LPA observed locked centrally stored medication carts in the Assisted Living and Memory Support units. Medications were organized separately for each resident. Narcotics were locked. All medication bottles and bubble packs were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. 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, Personal Rights, and Consent forms. 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. 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 inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster (Fire and Earthquake) Drills were conducted quarterly, with the most recent drill completed on 04/10/2025. The following updated forms are requested to be submitted to CCLD by 06/26/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Administrator Certificate(s) No deficiencies were cited during today's visit. An exit interview was conducted with the Administrator. A copy of this report was provided to the Administrator, Valerie Alves, whose signature on this form confirms receipt of the report.

On June 03, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Case Management – Other Inspection visit. Upon arrival, the LPA met with the Administrator (ADM), Valerie Alves. The LPA disclosed the purpose of the visit. The purpose of this visit was to hand deliver an immediate exclusion letter for a staff member (S1), who the Department determined engaged in conduct inimical. The immediate exclusion letter for S1 was handed to the Administrator. The administrator confirmed S1 never worked for the facility. The Administrator was informed to remove S1 from any contact with clients and not allow S1 to be physically present in the facility. LPA advised the Administrator to separate S1 from the facility roster. No deficiencies were cited during today's visit. An exit interview was conducted with the Administrator. A copy of this report was discussed and provided to the Administrator, Valerie Alves, whose signature on this form confirms receipt of this report.

LPA Marrufo obtained copies of invoices for items ordered by the facility and delivered to the facility Lifestyle Department. The invoices are dated from July 11, 2023 to December 6, 2023. The invoices include items such as Christmas ornament craft kits, Dementia Activities for Seniors with Memory Loss, large print coloring books, painting canvases, watercolor sets, and playing cards. LPA Marrufo obtained a copy of the Memory Support 1:1 Room Visits Log dated 02/23-25/2024. The log records that on 02/23/2024, staff entered the rooms of three residents and offered them exercise sessions, but two out of the three residents declined. Staff provided newspapers and books to one of the residents who declined. On 02/24/2024, staff entered the rooms of three residents. Two of the residents participated in an exercise program and one of the residents discussed engineering and science with staff. On 02/25/2024, staff entered two resident rooms. One resident participated in an exercise session and the other resident declined the invitation to the exercise session and walked with his/her private duty aid instead. During visit on 02/28/2024, LPA Marrufo toured the facility, including the office where supplies for activities were stored. LPA observed a rolling bookshelf, a shelf with DVD movies, dumbbells, and art supplies. During interview on 02/28/2024, staff S1, facility Lifestyle Director, stated that staff have been bringing memory care residents to activities. S1 stated that staff provided activities such as coloring books, watercolors, and craft projects to the memory care residents. During interview on 02/28/2024, S2, facility Assisted Living Lifestyle Coordinator, stated that memory care residents have been attending activities with assisted living residents while the facility searches for a new Memory Care Activities Coordinator. S2 stated that staff will conduct room visits with memory care residents who are unable to leave their rooms and conduct one-on-one activities with them. During visit on 02/28/2024, LPA Marrufo interviewed 5 other staff. 4 out of the 5 interviewed staff stated that there have been activities at the facility since the prior Memory Care Activities Director left. The same 4 out of 5 interviewed staff stated that staff bring books and craft materials to residents in their rooms if the residents are not able to attend exercise activities. 1 out of 5 interviewed staff stated that there have not been activities at the facility. Page 2 of 4. 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 03/24/2025, LPA Marrufo attempted to contact 5 resident family members by telephone. 2 out of the 5 resident family members answered LPA Marrufo’s telephone call. Family Member FM1 stated that there are activities offered to residents at the facility. FM2 stated to have observed television programs offered to residents in the memory care unit. During visit on 02/28/2024, LPA Marrufo toured the facility, including the office where ADM’s dog stayed. LPA Marrufo observed the office to have a cage for the dog and that the dog was leashed. LPA toured did not observe any dog urine odor or foul odors. During interview on 02/28/2024, ADM stated that ADM bathes the dog at home as often as dogs are supposed to be bathed. ADM stated the dog is taken outside to relieve itself on the planter boxes outside the facility. ADM stated the dog has never had an accident inside the facility. During interviews on 02/28/2025, 7 out of 7 interviewed staff stated to have not observed any dog odors at the facility. During interviews on 12/18/2024, LPA Marrufo interviewed two housekeeping staff. Both staff stated to have never observed any dog odors at the facility. LPA Marrufo obtained copies of facility cleaning logs from 12/12/2023 to 02/22/2024. The cleaning logs indicate the administration offices and corridors are cleaned daily. During interviews on 03/24/2025, FM1 and FM2 stated to have never observed any dog odors at the facility. During interview on 03/24/2025, LPA Marrufo interviewed a concierge staff who has worked at the front desk in the Assisted Living portion of the facility. The concierge staff stated to have never observed any dog odors at the facility. Page 3 of 4. 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 information from interviews conducted with staff and resident family members, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22 This report was reviewed with ADM Valerie Alves and a copy of this report was provided. Page 4 of 4. END REPORT

On January 09, 2025, at 9:00 AM, Licensing Program Analyst (LPA) Kiran Jain arrived at the facility to conduct a Case Management – Other Inspection. Upon arrival, the LPA was greeted by the Director of Assisted Living (DAL), Neda Armanfar and Director of Nursing (DN), Andrea Fadem. The LPA disclosed the purpose of the visit. The purpose of this inspection visit was to deliver a "Decision and Order" for the exclusion of staff S1. The Department of Social Services Community Care Licensing Division has issued a Decision and order for the exclusion of S1, effective 12/30/2024. S1's Home Care Aide registration has been revoked or deemed forfeited. A copy of the Decision and Order was provided and discussed with DAL and DN. DN stated that S1 was never an employee at the facility and is not on the payroll. DN stated that they received a copy of revocation and exclusion notice for S1 but didn’t know what to do with it since S1 was not an employee or Private Duty Assistant (PDA) at the facility. DN stated that S1 will be put on their “Do Not Return” list. A copy of facility’s Visitor’s Log for past (1) year was provided to the LPA and no records were found for S1. DN stated they will reach out to all the private care giving agencies that the residents use. A copy of payroll screenshot was provided to the LPA, showing no records for S1 on the payroll system. A copy of S1’s disassociation/separation in the Guardian system was provided to the LPA. LPA advised the facility that S1 is not allowed to work and volunteer in any licensed facilities. DN stated they will email a copy of LIC500 Personnel Report to the LPA by 01/15/2025. No deficiencies were cited during today's visit. An exit interview was conducted. A copy of this report was discussed and left with the Director of Assisted Living, Neda Armanfa, whose signature on this form confirms receipt of this report.

Based on the staff (S1, S2, S3, S4, and S6) interviews conducted on 10/30/2024 and 12/02/2024 with (5) staff members, Resident (R1) didn’t have a bowel movement for a few days. Doctors ordered to give him a suppository. R1 asked about the suppository and ok’d to be given the suppository. PDA (Private duty aid) was present with the R1. There was no restraint used. R1 was cooperative. The nurse (S3) asked for a CNA (S4) assigned to help. Staff got R1 on his side. R1 didn’t complain. Staff lifted R1’s leg and the suppository was given. R1 was advised that they should stay in bed for an hour or so. S3 and S4 don’t remember the nurse (RP2) alleging the incident was present in the room. RP2 was going under orientation and was a new employee there. Based on the private caregiver (PDA) interview conducted on 12/02/2024, PDA stated that S3 and S4 asked R1 if it was ok to put the suppository since R1 didn’t have bowel movements for almost 3-4 days. R1 asked what this was for and what was being done. S3 explained what they were going to do and explained they wanted to put this on their back. R1 said OK, then S3 put the suppository. S3 asked the resident to turn to the side facing the window. It helped R1 with the bowel movement and relieved the constipation. R1 was cooperative. Only S3 and S4 were present and RP2 was not in the room when the suppository was administered. R1 didn’t complain of any pain or discomfort during the procedure. Nothing unusual happened. If the abuse was there, PDA would have told their agency and R1’s family. Based on the R1’s family member (FM1 and FM2) interview conducted on 11/13/2024, FM2 stated that they have a 24x7 thread with their caregivers. They weren’t aware that this happened. Staff would know if any boundaries were pushed. If this incident happened, FM2 would be 100% certain that they would be pressing charges. PDA staff is very cautious. They all understood if anything became a problem, they would be there within 15 minutes. They will call us, and they know that. Violation cannot happen. Nurses would have informed us. They didn’t even allow sleep medicine that was not allowed by the doctor. Regarding the allegations that Staff are not following reporting requirements, Reporting Party (RP) stated that Jean was told by Jing not to document the restraint. Based on the staff (S1, S2, S3, S4, and S6) interviews conducted on 10/30/2024 and 12/02/2024 with (5) staff members, detailed notes are documented in R1’s progress notes, and suppository and medications administered are documented in Medical Administration Record (MAR). 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 Based on the R1’s family member (FM1 and FM2) interview conducted on 11/13/2024, FM2 stated that the facility documents everything even if any fall happens. Based on the records review conducted on 11/13/2024, the facility documented the suppository administered in the Medical Administration Record (MAR), given at 8:06 PM on 09/22/2024 for constipation. The Progress Notes indicated that R1 was alert and verbally responsive. All due meds were given and tolerated well by R1. PDA was in the room on standby to assist with need. Based on observations, interviews conducted with staff members, a private caregiver, and family members, and records reviewed, the department has determined that although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies were cited under the California Code of Regulations, Title 22. An exit interview was conducted. A copy of this report was discussed and left with the Neda Armanfar , Director of Assisted Living, whose signature on this form confirms receipt of this report.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Valerie Alves, Care Center Administrator. During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo toured the facility kitchen area and observed there to be a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPA Marrufo toured the locked storage areas for cleaning supplies and the laundry areas. LPA Marrufo reviewed the first aid kit and found it to be complete. LPA Marrufo toured the facility hallway bathrooms and 7 resident bathrooms. The water temperatures in the bathrooms ranged from 105 F - 115 F. Each bathroom had available soap and paper towels as well as working lights. LPA Marrufo toured 7 resident bedrooms and observed each bedroom to have functioning lights and available beds and clothing storage areas. LPA toured the outside area and found the exits to be clear of obstructions. LPA Marrufo reviewed the Automatic Fire Alarm System Inspection Log and found the smoke detector system was last tested on May 1st, 2024. LPA Marrufo toured 7 resident Centrally Stored Medication Logs and found them to be complete. LPA Marrufo reviewed 7 resident files and 7 staff files. The last Emergency Disaster Drill was conducted on May 28th, 2024. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Valerie Alves and a copy of this report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Valerie Alves. The purpose of the visit was to amend the LIC809 Case Management report from 12/28/2023. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Valerie Alves and a copy of this report was provided.

***Amended on 01/18/2024 to change "See LIC809-D" to "See LIC809-C"*** Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Valerie Alves Care Center Administrator. The purpose of the visit was to address an Incident Report submitted by the facility on 08/17/2023 reporting an incident on 08/15/2023 in which resident R1 stated that three teenage individuals had entered R1's living unit and sexually assaulted R1. The facility had also submitted an SOC341, R1's Physician's Report, the Internal Abuse Investigation Report, and R1's Resident Appraisal. During visit, LPA Marrufo interviewed resident R1, who stated that the incident of sexual assault may have occurred or may have been imagined. R1 stated the facility staff responded to the alleged incident and R1 underwent an evaluation after the incident. LPA Marrufo conducted a telephone interview with R1's Responsible Person (RP1). RP1 stated that R1 has been diagnosed with dementia since the incident and had been re-evaluated. RP1 stated to have been satisfied with how the facility staff handled the incident and believes the facility security is excellent. LPA Marrufo obtained copies of the following documents during visit: R1's Hospital Discharge Report from R1's hospital visit on 08/16/2023, R1's previous and current Service Plan (updated on 08/17/2023), R1's Resident Progresss Notes from 08/16/2023, and R1's Emergency Contact Information Form. R1's Hospital Discharge Report form states that R1's Family Member (FM1) reported to hospital staff that R1 has a history of memory issues without diagnosis and has reported sexual assault in the past. R1's updated Service Plan states that R1's Behavioral Interventions include "Episodes of confusion and delusions." R1's Resident Progress Notes from 08/16/2023 state that "Staff will provide care to resident with 2-person assist to ensure there is a witness at all times. Nurses to monitor resident for 72 hours for any signs of distress." See LIC809-C for more information. Page 1 of 2. 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 Marrufo conducted an interview with staff S1, who stated the facility requires all visitors to check in with the front desk, staff conduct 2 hour checks with all residents, and 2 staff assist R1 with showering, so they will be able to observe R1 for bruising or signs of abuse. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Valerie Alves and a copy of the report was provided. Page 2 of 2. END REPORT

During interview, staff S1-S3 denied stealing any belongings from R1's apartment, including any credit cards. Staff S4 and S5 stated to have conducted investigations to determine if anything had been stolen from R1's apartment. S4 and S5 stated that after R1 reported a bag of quarters were stolen, S4 and S5 found a bag of quarters in R1's apartment. However, R1 told S4 and S5 that it was a different bag of quarters that went missing. S4 and S5 also stated to have investigated another claim that R1 made about bottles of shampoo that were missing and when S4 and S5 found bottles of shampoo that matched R1's description of the missing shampoo bottles, R1 stated that it was another set of shampoo bottles that had gone missing. Staff S6 stated during interview that R1 reported a manilla envelope was stolen from R1's apartment and when S6 came to R1's apartment to investigate, S6 observed the manilla envelope in R1's apartment. S6 let R1 know that the manilla envelope was in R1's apartment. Based on information from interviews conducted with staff, resident, witnesses, and observations, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22. This report was reviewed with Robinetta Wheeler and a copy of this report was provided.

Licensing Program Analysts (LPAs) David Marrufo and Ravi Patel conducted an unannounced Case Management Visit and met with Valerie Alves, Care Center Administrator. The visit was conducted in response to an Unusual Incident Report that was self-reported by the facility on 03/28/2023 regarding resident R1 alleging that staff S1 physically abused R1 on 03/26/2023. During visit, LPAs obtained copies of the Internal Investigation Report that the facility made in response to the incident. The Internal Investigation Report stated that staff S1 was assisting R1 on the toilet on 03/26/2023 at around 3:30 AM. The report states S1 was assisting R1 and then S1 stood in front R1's doorway and redirected R1 back to R1's bed. The report states R1 was agitated, so S1 called staff S2 for assistance, and R1 reported to S2 that S1 hit R1. The report states a wellness check was conducted on R1 and no injuries or signs of abuse were observed. The report states the next day, R1's family member (FM1) arrived at the facility and gave R1 a walk after lunch. The report states FM1 stated R1 seemed fine. During visit, LPAs conducted a telephone interview with FM1, who stated that R1 seemed fine and FM1 did not observe any signs of abuse on R1. LPAs attempted to conduct a telephone interview with S1, but were only able to leave voice mail on S1's telephone. LPAs conducted a telephone interview with S2, who stated that S2 came into R1's room to assist R1 in getting back into bed and S2 told S1 to leave the room. S2 stated to have told S1 to return to the dinning area where S2 had been observing in order to have a staff at that area. S2 stated to have not observed any signs of abuse on R1 and did not recall R1 stating to have been physically abused. LPAs interviewed Valerie Alves and staff S3 during visit. LPA Marrufo interviewed resident R1 during visit and R1 stated to have not experienced any incidents of physical abuse with staff. See LIC809-C for more information. Page 1 of 2. 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 LPAs discussed with Valerie Alves the facility's plan to prevent abuse, which includes regular training of staff in regards to explaining kinds of abuse, preventing abuse, reporting abuse, and ensuring the safety of residents. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Valerie Alves, Care Center Administrator, and a copy of the report was provided. Page 2 of 2. END REPORT.

Licensing Program Analysts (LPAs) David Marrufo and Ravi Patel conducted an unannounced Case Management visit and met with Valerie Alves, Care Center Administrator. The purpose of the visit was to respond to a Death Report and Incident Report regarding resident R1 falling on a treadmill in the facility on 03/25/2023 and passing away on 03/29/2023. During visit, LPAs obtained copies of R1's Admission Agreement and Emergency Contact Face Sheet. LPA's reviewed R1's resident records and did not observe any documents indicating assisted living services were provided to R1 or that R1 needed supervision. LPA's obtained a copy of R1's Fitness Center Release and Waiver form which R1 signed on 08/25/2015. LPAs discussed with Mark Nelson, Associate Executive Director of Independent Living, about the facility's plan to remind resident about proper use of exercise equipment. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Valerie Alves, Care Center Administrator, and a copy of the report was provided.

LPA Marrufo interviewed 7 Memory Care staff. All 7 out of 7 interviewed staff stated that staff usually clean bodily waste in a resident’s room in around 5 minutes. They all stated during interview that although housekeepers are not on duty from 5PM to 7 AM, CNAs and nurses at the facility during those hours will clean any bodily waste in a resident’s room. The staff stated that there is an emergency cleaning kit available to staff when the housekeepers are not available. LPA Marrufo observed the emergency cleaning kit near the kitchenette in the Memory Care Unit. The emergency cleaning kit contained cleaning sprays, a cleaning brush, and a cleaning bucket. LPA Marrufo interviewed R1’s Durable Power of Attorney (DPOA) #1, #2, and #3. DPOA #2 stated that R1 has a behavior of leaving bodily waste in R1’s living unit. DPOA #1 stated that there R1 has a private duty care aid who would be available to clean up any bodily waste in R1’s living unit. DPOA #2 stated there was an incident in which R1 had left bodily waste in R1’s living unit, and DPOA #3 wanted staff to clean the bodily waste immediately. However, the facility staff were serving lunch at the time and told DPOA #3 that they would clean the bodily waste after lunch because the staff did not want to handle bodily waste while serving lunch. LPA Marrufo interview staff S1, who also stated that there was an incident when staff did not immediately clean R1’s bodily waste in R1’s living unit because lunch was being served at that time and staff did not want to handle bodily waste while serving lunch to residents. During interview, DPOA #3 stated that there was bodily waste in R1’s living unit and no staff came to clean up the bodily waste. LPA Marrufo reviewed R1’s medications, Medication Administration Record (MAR) and Physicians Order Report, which lists R1’s prescribed medications. After reviewing the medications and MAR, LPA did not find any medications that were not administered according to prescription orders. Based on information from interviews conducted with staff, and records reviewed, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are unsubstantiated. No Deficiencies cited under California Code of Regulations Title 22. This report was reviewed with Valerie Alves and a copy of the report was provided. Page 2 of 2. END REPORT.

LPA Marrufo obtained a copy of R1’s Continuing Care Residency Contract, which was signed by R1 on 11/11/2011. R1’s Service Plan states that R1 is independent of eating. It states, “Resident eats by herself, but Vi staff will serve plates.” It states R1 has no special dietary needs/diet/supplements. During visit on 11/17/2022, LPA Marrufo observed R1 during meal service. LPA Marrufo observed staff serve R1 a meal. LPA Marrufo did not observe staff assisting R1 with feeding. LPA Marrufo observed R1 eating shrimp, salmon, chopped fruits, and drinking orange juice. LPA Marrufo observed R1 use a spoon to eat fruits and mashed potatoes without assistance. LPA Marrufo interviewed 6 staff. 6 out of 6 interviewed staff stated R1 feeds himself/herself during meals. This agency has investigated the complaint allegations listed. Based on interviews, review of records, and observations, the CCLD has found that the complaint allegations are unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. This report was reviewed with Valerie Alves and a copy of the report was provided. 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 Marrufo interviewed 6 staff. 2 out of 6 staff stated the staff allow R1 to refuse medications. 4 out of 6 staff said they did not know if staff allow R1 to refuse medications. LPA Marrufo interviewed 4 Memory Care residents, including R1, and 3 Assisted Living Residents. All of the interviewed residents stated they have not had a time when they were not allowed to refuse medications. Section 4.6(iv) of R1’s Admission Agreement states that all providers of home health care and private duty aide services must be employed by a licensed agency. DPOA #1 and DPOA #2 stated that the facility has not prevented them from choosing a home care companion for R1. DPOA #1 and DPOA #2 have both stated that DPOA #3 has been hired as R1’s private duty aid. LPA interviewed 6 staff. 6 out of 6 interviewed staff stated R1 has a home care companion. Staff S1 and S2 both stated during interview that the facility only allows residents to hire private duty care givers from agencies, but facility would not intervene in residents hiring their own family members as care givers, so long as the family members still adhered to the visitation policy and visitation hours. During interview, DPOA #3 stated S2 communicated to DPOA #3 that DPOA #3 would not be allowed to be a private care giver for R1 because DPOA #3 is related to R1. During interview, S2 stated to have not communicated to DPOA #3 that DPOA #3 could not be a private care giver for R1 due to being related to R1. S2 stated to have communicated to DPOA #3 that all private care givers must be hired through an agency and any family member being privately hired by a resident to provide care must still abide by the facility visitation policy. Based on information from interviews conducted with staff, and records reviewed, and observations, although the allegations listed above may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. No Deficiencies cited under California Code of Regulations Title 22. This report was reviewed with Valerie Alves and a copy of this report provided. Page 2 of 2. END REPORT.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Associate Executive Director Mark Nelson. During visit, the inside and outside of the facility were toured. The facility entrance had a visitor screening area. The facility bathrooms had available soap and paper towels. Hand washing posters were posted in the bathroom. A perishable food supply of at least 2 days and a non-perishable food supply of at least 7 days was observed. A 30-Day supply of PPEs were observed. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Associate Executive Director Mark Nelson and a copy of the report was provided.

This agency has investigated the complaint allegations listed. Based on interviews and review of records, the CCLD has found that the complaint allegations are UNFOUNDED, meaning that the allegation were false, could not have happened and/or is without a reasonable basis. Resident R1 is not an Assisted Living resident and does not receive any assisted living services. No deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Mark Nelson and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo, Licensing Program Manager Jackie Jin, and Nurse Cristina Wong conducted a tele-visit via Zoom to provide technical assistance to prevent and mitigate the spread of COVID-19 at the facility and met with Mark Nelson. The Mark Nelson reports that there are currently 0 COVID-19 positive residents and 9 COVID-19 positive staff. During today's tele-visit, the following recommendations were made to the facility by Nurse Cristina Wong: 1. Place social distancing signs in activity rooms. 2. Place hand washing sign near the kitchen hand washing station. No deficiencies were cited as per California Code of Regulations, Title 22. This report was reviewed with with Mark Nelson. A copy of the report will be sent to him for it to be signed and returned to CCL.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Yannick Gilbert. The purpose of the visit was to obtain documents for resident R1, whom the facility reported to have been found deceased by staff at the facility on 12/20/2021, and to conduct a health and wellness check with residents. During visit, LPA Marrufo requested copies of R1's resident file and requested a copy of the facility staffing schedule for December 2021. Mr. Gilbert stated that he could provide copies of the staff schedule by Wednesday, 12/29/2021. LPA Marrufo conducted health and wellness checks for residents R2-R6, who stated to have been feeling well, reported to be provided with meals by the facility and with assistance with medications by staff if needed. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Yannick Gilbert and a copy of the report was provided.

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced COVID-19 Infection Control Required - 1 Year visit and met with Mark Nelson. LPA Marrufo toured the facility. During the tour, LPA Marrufo observed the entrance had a visitor screening station at the entrance. Hallway bathrooms had soap, paper towels, and hand washing signs. Elevators have signs posted allowing only two people per ride. The facility PPE storage room had a 30-day supply of PPEs. Staff were observed to be wearing masks. The staff break room and the resident dinning area were observed to have two chairs per table and signs to encourage social distancing. LPA Marrufo observed emergency food and hygienic supply areas. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Mark Nelson and a copy of the report was provided.