Chateau Pleasant Hill

LIC9099-C (Page 2) Allegation: Staff are not following resident’s incontinent plan Finding: Unsubstantiated LPA reviewed R1’s Service Plan dated 05/08/25, which indicates that R1 requires Continence Care six (6) times per day, with care partners completing brief checks every two (2) hours to ensure R1 remains clean and dry. Review of chart notes dated 07/13/25 – 07/17/25 indicates that care partners were performing checks every two hours to reposition R1 and ensure they were clean and dry, as documented. In addition, the staffing schedule confirmed caregiver coverage for the required six-times-per-day continence care schedule. Allegation: Staff are not following resident’s special diet Finding: Unsubstantiated LPA reviewed R1’s Physician’s Order dated 07/02/25, which prescribes a pureed diet with thin liquids. Review of chart notes dated 07/13/25 – 07/17/25 reflects that staff offered R1 foods and liquids consistent with the ordered diet, including soup, yogurt, pudding, mashed potatoes, Cream of Wheat, cranberry juice, and water. Documentation indicates that R1 would eat or drink at times and would occasionally refuse food, which is within resident rights. 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 LIC9099-C (Page 3) Allegation: Staff did not ensure resident’s hospital bed was set up for resident Finding: Unsubstantiated S1 stated that once they knew that the mattress was delivered they put the mattress in place. LPA reviewed records that showed delivery of DME including mattress was completed on 04/25/25. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations is UNSUBSTANTIATED . Exit interview conducted and a copy of this report provided.

LIC9099-C (Page 2) On 07/31/2025, LPA G. Luk interviewed S1, who provided the following information: S1 stated that the facility is in the process of replacing the mulch with the landscaping crew. The facility has a contract with a pest control company (Eco Lab), and Eco Lab sprayed all first-floor apartments approximately 2–3 months prior. S1 reported that the facility takes cleanliness seriously. When reports regarding roaches are submitted, a work order is created in the facility’s internal system; however, these work orders are retained only for a limited period. S1 stated that the pest issue began around May 2025. On 11/03/2025, LPA L. Alexander interviewed W1 and W2 regarding the pest concerns. W1 stated that the facility is taking appropriate action regarding the cockroaches and reported not having seen a roach in approximately one week. W2 stated that they observed cockroaches in one of the apartments around May/June, but have not seen any recently. W2 confirmed that the facility conducted pest treatment in the apartment where cockroaches had been seen. LPA Alexander reviewed Eco Lab invoices for service dates 05/16/25, 05/22/25, 06/23/25, 07/10/25, and 07/28/25, which documented treatment services for interior insects throughout the building, including resident apartments. Although the 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 the allegation is UNSUBSTANTIATED . Exit interview conducted and a copy of this report provided.

On 07/17/2025 at 12:00pm Licensing Program Analysts (LPAs) L. Alexander and K. Nguyen arrived unannounced to conduct a case management visit to follow-up on a death report received by Community Care Licensing that was faxed on 07/14/2025. LPAs met with Executive Director, Jon McCraw and explained the purpose of the visit. Resident (R), R1, passed away on 07/14//2025 with an unknown cause of death. LPAs interviewed Staff (S), S1, that stated S1 saw R1 earlier in the morning approximately 7:45 am on 07/14/2025 to deliver R1 breakfast. S1 stated that R1 was up and when asked R1 stated R1 felt ok. S1 stated S1 returned back to R1's room just to check in and observed R1 sitting at R1 dining room table and slouched over R1 walker. S1 called the Med Tech to R1's room and Medtech started cardiopulmonary resuscitation (CPR) on R1. LPA's reviewed LIC 624, and Death Report indicated that the cause of death was unknown declared by the paramedics when they arrived. During today's visit LPAs obtained additional information pertaining to R1's death: Physician's Report S2 will obtain death certificate and will send to LPA No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.

LIC9099-C (Page 2) Allegation: Staff unlawfully evicted a resident Finding: Unfounded It was alleged staff unlawfully evicted R1. Based on information obtained, R1 was issued a second eviction on 12/14/24. However, LPA reviewed a copy of the eviction notice and confirmed that the letter meets the requirements of the eviction procedure (CCR 87224). Based on interview with staff (S1), Although R1 refuses help with Activities of Daily Living (ADLs), the facility continues to provide care to R1. This agency has investigated the complaint alleging Staff unlawfully evicted a resident. We have found that the complaint was UNFOUNDED , meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

LIC9099-C (Page 2) Allegation: Staff are not accepting resident back for re-entry. Finding: Unfounded On 02/06/2025 LPA interviewed Witness (W1). W1 stated that R1 was treated for an infection that they got while they were in the hospital and was ready to be discharged back to the facility. W1 stated that they received phone calls from R1’s responsible party and that they were told that Staff (S1) was not accepting R1 back to the facility. W1 stated that R1’s responsible party told them that they did not know if R1 was colonized with an prohibited health condition. On 01/31/2025 S1 submitted a formal exception request (CCR 87616) to accept and retain R1 whom has a prohibited health condition (CCR 87615(a)(4)). The Department granted approval of an exception to accept R1 on 02/06/2025. This agency has investigated the complaint alleging “Staff are not accepting resident back for re-entry.” We have found that the complaint was UNFOUNDED , meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 10/27/2023 at 12:20 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Jon McCraw and explained the purpose of the visit. The facility’s fire clearance was approved for 2770 Pleasant Hill Rd. 50 Clients May Be All Non-Ambulatory First Floor Only. 2726 Pleasant Hill Rd, 76 Clients May Be All Non-Ambulatory First and Second Floor. Hospice Waiver for Six (6) Residents. LPA toured the facility with Jon including but not limited to 4 residents apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observe lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 72 degrees F. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 105, 106, 108 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. At 2:50 PM, LPA reviewed 7 residents records. At 4:30 PM, LPA reviewed 10 staff records and 10 of 10 have current first aid training and associated to the facility. LIC 809C...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 LIC809 Continued.... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/03/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 11/10/2022 at 10:15 AM, Licensing Program Analysts (LPA) L. Alexander and C. Fowler arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Executive Director, Jon McCraw and explained the purpose of the visit. LPAs toured the facility with Jon including but not limited to 2 residents apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. Hallway temperature was maintained at 73, 72.9, 73.4 degrees F. LPAs observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in a sample of residents’ shared bathroom were measured at 120, degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.