Pleasant Hill Oasis

LIC9099-C (Page 2) Allegation: Staff did not accord resident dignity in personal relationships with staff. Finding: Unsubstantiated On 10/17/2024, LPA interviewed witness (W) W1. W1 stated that they didn't know what was going on. LPA interviewed staff (S). S1 stated that resident (R) R1 gets confused. R1 was not available for interview. Allegation: Staff did not return resident’s laundry in a timely manner. Finding: Unsubstantiated On 10/17/2024, LPA interviewed W1. W1 stated that S2 doesn’t return laundry back. LPA interviewed S1. S1 stated that they directed S2 and all male caregivers to not enter resident’s room. S1 stated that laundry was being done during the NOC shift. S1 stated that the laundry will be delivered the following day in the mornings by female caregivers. Allegation: Staff spoke to resident in an inappropriate manner. Finding: Unsubstantiated On 03/12/2025, LPA interviewed S1. S1 stated that they will never speak or talk to any of the residents out of anger. However, S1 stated that their voice is firm to keep control of all the situations and S1 stated that the residents respect them. 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 allegations is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.

LIC9099-C (Page 2) Allegation: Staff did not follow the directives of resident's doctor. Finding: Unsubstantiated On 03/11/2025, LPA interviewed witness (W). W1 stated that resident (R) R1 told them that they were given a medication before their scheduled surgical procedure and was not supposed to take that medication. On 03/12/2025, LPA interviewed staff (S). S1 stated that there were no doctor's orders instructing the Med Techs to not administer the medication. S1 stated that they were not informed by R1 that they were having a procedure until the day before. S1 stated that R1 will not give them any copies of doctor's orders or After Visit Summary when they are seen at the doctor or Emergency Room (ER). S1 stated that R1 is their own responsible party. LPA reviewed the latest Physician's Report (LIC602-A) that indicates R1 is able to administer own prescription medication with an explanation, "but may need reminders." S1 stated that they called and spoke with the nurse care coordinator to get clarification and advised that the LIC602-A was not appropriate. S1 stated that R1 has an scheduled appointment with their primary care physician in April and will get the physician's report updated regarding medications and if they are able to leave the facility unassisted. LIC9099-C 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 LIC9099- C (Page 3) Allegation: Staff are not able to effectively communicate with residents. Finding: Unsubstantiated On 03/11/2025, LPA interviewed W1 that stated R1 told them that the caregivers do not speak English. On 03/12/2025, LPA interviewed S1 that stated all staff caregivers speaks English except for maybe one person. S1 stated that the caregiver speaks Spanish and that they use a translator on their phone to communicate. S1 stated that every shift including the NOC shift has at least one (1) caregiver that speaks English. S1 stated that the caregiver that speaks Spanish does know how to communicate in terms of giving care to the residents. Although the allegations 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 allegations is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.

LIC9099-C (Page 2) Allegation: Resident sustained unexplained injury while in care. Finding: Unsubstantiated On 06/11/2024, LPA interviewed Witness (W) W1. W1 stated that resident (R) R1’s neck appeared to be swollen and that R1 had tears in their eyes. W1 stated that it took R1 a long time to look up, there was dried up blood on R1’s face and they were also wearing a mask. LPA interviewed R1. R1 stated that they haven’t had any injuries, falls, been hurt or felt any pain and that no one has hurt them while at the facility. Allegation: Resident's hygiene needs are not being met. Finding: Unsubstantiated On 06/11/2024, LPA interviewed W1. W1 stated that when they visited R1 they didn’t look clean. LPA interviewed R1 and R1 stated that they take showers and brush their teeth. LPA interviewed R1 that stated that they do take showers every week. LPA reviewed the Shower Schedule (as of 04/18/2024) and it shows that R1 is scheduled a shower 2 times a week on Sundays and Thursdays. Allegation: Staff did not ensure that the resident had clean clothes. Finding: Unsubstantiated On 06/11/2024, LPA interviewed W1. W1 stated that R1’s clothes didn’t look clean and that their jacket looked like it was on the ground. LPA reviewed the “Laundry Day of Residents,” that showed R1’s laundry day is scheduled on Saturdays in the LIC9099-C 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 LIC9099-C (Page 3) A.M. LPA interviewed R1 and R1 stated that their clothes get laundered weekly. LPA observed that R1 had clean clothes hanging in their closet and appeared clean during visit. Allegation: Staff does not provide resident with appropriate bed linens. Finding: Unsubstantiated On 06/11/2024, LPA interviewed W1. W1 stated that 3 weeks back R1 had a white blanket, a tarp and a flat sheet on their bed. LPA interviewed staff and S1 and S2 stated that all residents have bed linen sheets, blanket and bed spread/comforter on their beds. LPA observed flat and fitted sheets along with a blanket on R1’s bed. Although the allegations 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 allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.

LIC9099-C Continued... Allegation: Questionable Death Investigation Finding: Unsubstantiated During investigation, the Department conducted interviews of facility staff & responsible parties and reviewed resident (R1) documents. Review of R1’s medical documents showed that on 01/07/2022, R1’s primary diagnosis was unspecified depressive disorder. On 01/27/2022 R1 had an ER visit at Contra Costa Regional Medical Center for nicotine patch and redness in right ear. On 04/27/2022 Staff (S1) received a radio call approximately 1145-1300 that there was an emergency in R1’s room. S1 stated that they found R1 unresponsive while S2 was performing the Heimlich Maneuver. S1 stated that they began giving Cardiopulmonary Resuscitation (CPR) and dialed 911. S1 stated that Paramedics arrived and continued emergency resuscitation. S1 stated that R1 was admitted at John Muir Medical Center in Walnut Creek, CA. Per review of subject resident’s Needs & Services and interview resident was independent in eating and not a choking risk. Review of documents reports that R1 passed away on 05/04/2022 at 1312. Documents obtained do not suggest R1’s death was a result of neglect or lack of care for suspicious circumstances from facility staff. Based on records review, interviews conducted, and observations made, the department has investigated the above allegation of questionable death and found it to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation of questionable death is unsubstantiated. Exit interview conducted and a copy of this report provided.

On 11/01/2024 at 9:30 AM, Licensing Program Analysts (LPAs) L. Alexander and D. Doidge arrived unannounced to conduct a Plan of Correction (POC) visit. LPAs met with Business Office Manager, Reynaldo "Jun" Gutierrez and explained the purpose of the visit. Jun called the Executive Director, Liza Elegado to inform. Liza arrived shortly after. On 10/08/2024, LPA conducted an Annual visit in which deficiencies were cited. The POC due dates was 10/24/24, 10/25/24, 10/31/24, 11/08/24 and 11/15/24. Administrator failed to submit the POC by the due dates and this is why LPAs came to make a POC visit. Deficiencies cleared: 87555(b)(16) 87463(a) 87506(a)(b) 87458(b)(1) 87211(a)(1) Deficiencies not cleared: 87211(a)(1) = $100 X 6 = $600.00 87458(C) = $100 X 1 = $100.00 Civil Penalties in the total amount of $700.00 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing daily civil penalties until deficiencies is corrected. Exit interview conducted. A copy of this report, appeal rights provided and LIC421FC provided.

On 09/12/2023 at 11:05 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Executive Director, Liza "Gigi" Elegado and explained the purpose of the visit. The facility’s fire clearance was approved for 49 Resident capacity in which all may be non-ambulatory. Approved hospice waiver for 10 Residents. LPA toured the facility with Gigi 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 76 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 140.3 and 141.3 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 12:45 PM, LPA reviewed 10 Residents records. At 3:00 PM, LPA reviewed 7 Staff records and 7 of 7 have current first aid training but all 7 staff were associated to the facility. LIC809 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 09/19/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Updated Facility Sketch Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 05/11/2023 at 2:08 PM, Licensing Program Analyst (LPA) L. Alexander and Licensing Program Manager J. Fong arrived unannounced to conduct a POC (proof of correction) inspection. LPA and LPM met with Business Office Manager, Reynaldo "Jun" Gutierrez. The following deficiencies was cited on 04/28/2023 as a result of a case management visit and cleared by visit: - 87202(a); LPAs observed that R1 was occupying a room that did not have a fire clearance. LPA and LPM observed that R1 has been moved and the room has been cleared. LPA cleared POC and provided a copy of the POC letter. - 87307(d)(2); LPAs observed that facility was not being maintained, with unlocked sheds, weathered doors and other miscellaneous items in disrepair at the building's exterior. LPA and LPM observed that the locks were placed on all sheds outside, all doors had locks attached, weathered doors were replaced and accumulated items outside was removed, cleared and cleaned up. Exit interview conducted. A copy of this report provided.

On 05/11/2023 at 2:45 PM, Licensing Program Analyst (LPA) L. Alexander and Licensing Program Manager, J Fong arrived unannounced to conduct a Case Management regarding ongoing discussion pertaining to a capacity increase. LPA and LPM met with Business Office Manager, Reynaldo "Jun" Gutierrez and explained the reason for visit. LPA and LPM reviewed physical plant changes being proposed and observed that there is a bathroom that is next to the entrance hallway, and currently a staff room on the opposite side of the bathroom from the hallway. As explained to LPA and LPM, a door will need to be cut out from the hallway to lead into a small alcove/hallway and the staff room to be converted into a new, shared resident room. The bathroom will be modified to accommodate the alcove, and a wall removed so that it flows into an adjoining shower area. There is a second room currently serving as a conference room further down the entrance hallway and to the side of the previously referenced bathroom and staff room. This room will also be converted into a shared room. A door will need to be cut out between this room and the aforementioned bathroom - which will become a shared "Jack and Jill" bathroom for the two rooms to be converted. Lastly, there is a room that has already been constructed near the kitchen. LPM advised facility designee that the proposed work would constitute an alteration/modification to the physical plant and per Title 22 regulations requires Continued on 809C... 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 a permit. LPM advised facility designee that contact should be made with the County to discuss the changes to the physical plant, obtain the permit (or a statement in writing from the County that they will not need to issue one), then submit to CCLD a written statement describing the work to be performed, how the residents will be kept safe from hazards during the construction, a copy of the permit, and a copy of what will be the final facility sketch. No Deficiencies cited. A copy of this report and the Title 22 Regulation pertaining to RCFE modifications/alterations were provided.

On 04/19/2023 at 10:30 AM, Licensing Program Analysts (LPAs) L. Alexander and L. Hall arrived unannounced to conduct a Case Management regarding a capacity increase. LPAs met with Executive Director (ED), Liza "Gigi" Elegado and explained the purpose of the visit. LPAs toured the facility with ED to view the floor plan for the requested capacity increase for 5 Residents. LPA observed rooms 17 and 19 were shared rooms. Room #17 was previously used for a single room, but fire clearance indicates room #17 could be used for a shared room also. LPA L. Alexander received an updated Administrative Organization (LIC 309) on 1/23/2023 indicating that the interest in the corporation has changed to one (1) person having 100% interest in the LLC. LPA spoke with the owner, via speaker phone to get an understanding of his ownership and the change of ownership took place. LPA also inquired about the construction of the new rooms 24 & 25. The owner stated that rooms 24 and 25 will be constructed and all documents will be submitted to CCL before the capacity increase request. ED will submit a copy of the previous Administrative Organization to CCLD. Exit interview conducted. Copy of this report provided.

On 09/07/2022 at 9:40 am Licensing Program Analyst (LPA) C. Fowler arrived unannounced to conduct infection control inspection LPA met with Business Office Manager, Reynaldo Gutierrez and explained the purpose of the visit During the Infection Control Inspection, LPA toured facility including but not limited to common areas, kitchen, bedrooms, and shared bathrooms. to front entrance, screening station, hand washing stations, common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing signs were posted in common areas. Hand washing posters, soap, and paper towel were observed at hand washing stations. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Visitors policy is posted on the front door. Facility staff were observed wearing masks. Facility has a 30-day supply of PPE maintained at a central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for residents and staff. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore these allegation is UNSUBSTANTIATED. No deficiencies are being cited on this date. Administrator authorized Business Office Manager Reynaldo Gutierrez to sign on the report. Exit interview conducted. A copy of this report provided.

On 09/21/21 at 3PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with administrator. Facility is a single story building with 24 bedrooms with in room toilets, 2 private rooms with shower & toilet and 5 common toilets and showers. LPA observed 11 staff wearing face masks during visit with 5 residents watching TV in the activities room while the other 37 residents were observed relaxing inside their bedrooms. Facility has a completed mitigation plan in place dated 12/31/2020 to mitigate the spread of COVID-19. LPA discussed the completed mitigation plan (LIC 808) with administrator as well as COVID-19 infection control practices. LPA inspected the facility inside and outside. LPA observed screening station located near the front entrance with visitor's log, COVD-19 questionnaire, hand sanitizer, gloves, face masks and no touch temperature probe. Routine symptom screening (+/-) temperature and symptom checks are done at entry for all staff, residents and visitors. LPA observed COVID-19 signages posted in common areas to promote hand washing, cough/sneeze etiquette and physical distancing. Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Pathways were observed to be free of obstruction and fire hazards. Facility has a visitation area with furniture spaced six feet apart for social distancing among residents. Continued on next page 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 A written Emergency/Disaster plan dated 08/08/2021 was posted in a common hallway leading to the activities room. Centrally stored medications were locked in the medication room. Sharp objects were also locked in the medication room. Toxic chemicals were locked in the laundry/chemical rooms. Adequate supply of PPE was observed stored in the hallway closet. Facility has conducted staff training on infection prevention, symptoms, transmission and proper donning & doffing of PPE. Trash bins with lid operated foot pedal were located inside bedrooms, bathrooms and kitchen. Infection control designated leader is the administrator. All staff and residents have been fully vaccinated since March 2021. There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the kitchen and outside storage shed. Facility room temperature was maintained at 74 degrees Fahrenheit. A certified administrator is on site a minimum of 20 hours a week to oversee proper business operation and compliance with COVID-19 infection control practices. Fire extinguisher was observed fully charged. Smoke and Carbon monoxide detectors were operational. Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 09/22/2021: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan · Evidence of Liability Insurance No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided to administrator.