Brookdale Redwood City

Since the allegations are alleged to have occurred in areas our agency has no jurisdiction or inspection authority over, these allegations are determined to be unfounded due to being unable to investigate because of no inspection authority. The Department has investigated the complaint allegations of possible physical plant violations. It was determined the allegations are unfounded, meaning the allegations are false, could not have happened and/or is without a reasonable basis and therefore dismissed. This report is reviewed and discussed with facility representative and exit interview conducted.

On 1/9/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility to conduct a Plan of Correction visit in regards to the deficiency cited on 1/8/2025. LPA Calandra was greeted by Monica Ceron-Tapia and explained the purpose of the visit. No deficiencies were cited during today's visit. This report was reviewed with Monica Ceron-Tapia, Executive Director and a copy of the report along with the Plan of Correction(POC) clearance letter were left at the facility.

On 1/9/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:00 AM to continue the 1-year required Annual Inspection. LPA was greeted by Monica Ceron-Tapia, Executive Director and explained the purpose of the visit. LPA toured the physical plant. Hot water temperature was measured within the 105-120 degrees Fahrenheit. LPA Calandra reviewed 6 resident records. All were observed to be complete. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA requested copies of the following documents be sent to the Department by 1/16/2025: Current LIC 500 Liability Insurance No deficiencies were cited during today's visit. An exit interview was conducted. A copy of the report was left at the facility.

On 01/31/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management - incident visit. LPA met with administrator and explained the purpose of this visit. Per SOC341 received on this day during an annual inspection, LPA and administrator discussed this incident. SOC341 was being submitted and incident report report to the Department on this day regarding a family member yelling at a resident over the weekend on 01/27/2024 who is their sibling that resides in the facility. Caregiver witnessed this in response to a call light to the resident's room. Caregiver tried to de-escalate the incident as the resident's health and safety was in jeopardy. The family member did not allow staff to assist the resident and the report was made regarding the incident to appropriate staff and the Department. Facility spoke with the resident to understand what happened and a resolution is being worked out between family member and resident. Resident has been monitored for any changes in condition. SOC341 was received in person on this day. Incident report will be sent to the Department on this day. No citations issued. Report discussed with administrator.

On 01/31/2024 Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced 1 year annual inspection visit. LPA met with residential social worker James Murch and later met with large program administrator Crystal Hutchinson via telephone to discuss facility plans. LPA explained the purpose of today's visit to both Crystal and James. LPA toured the facility inside and outside with administrator Monica. While touring the facility LPA tested the water one bathroom in two resident rooms #1353 and #1305. Water is tested at 108F. Resident rooms observed at random are maintained and include the required furniture and lighting per regulations. Residents have an adequate amount of linens and incontinence supplies, incidental supplies, as well as PPE as needed. Two fire extinguishers were checked within the facility. Tagged inspection is dated as 07/03/2023. Extinguishers observed are charged and within operating range including the kitchen's fire extinguisher. Carbon monoxide detectors are present. Facility is hardwired with smoke detectors. 7 day non-perishable food supply and 2 day fresh food supply is observed as in place. Main kitchen is on the ground floor of the building. Food deliveries are made daily for fresh food items. Longer lasting food supplies such as frozen goods, canned goods, dry goods, etc is delivered two times a week. Residents with modified diet plans or prescription diets are posted and reviewed as in place. Medications are stored and inaccessible in a locked medication room on the 3rd floor. Medications are stored in secured medication carts that are used to disperse medications through out the facility. Double locking is in place for controlled medications. 5 of 5 resident medications are reviewed to be in place and accurately marked. Medication administration record is observed as current for clients reviewed including centrally stored medication log. First aid items are observed in medication room. Additional first aid kits are available outside of medication room through out the facility. On site laundry is available and functioning per observations made. Residents can wash their own laundry in the laundry rooms if they wish, but staff do the laundry regularly for residents. Facility does not handle resident monies. Cleaning supplies are stored in janitor closets observed and are locked in the independent living building. Resident menus are posted as well as activity calendar and daily calendar. Facility files, including staff files and resident files, are to be reviewed on a later date. Monica informed LPA that her administrator indicated that her administrator certificate is expired as of January 17, 2024 but did submit the required renewal documents and credits to the appropriate department for renewal in December 2023 and is awaiting a new certificate to be sent. Report is reviewed with Monica. No citations issued.

Page 2 - 9099C Response times again vary determinate on the needs of other residents as well as R1. Residents confirm on response times being adequate or satisfactory based on their needs. Review of the current staffing show night staff are available. Based on staff interviews R1 calls for assistance and based on history and the facility knowing his behaviors, they do not check unless R1 calls for assistance. Staff do respond but the times vary. These allegations are unsubstantiated. Based on these observations, the above allegations are UNSUBSTANTIATED. 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 above allegations are unsubstantiated at this time. Report is reviewed with the administrator.

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management visit in conjunction with a complaint visit made on this day. LPA met with the administrator and explained purpose of today's visit. LPA met with and discussed the assessments and appraisals for R1 upon return to the facility after being out of the facility and with family for approximately two weeks. According to the administrator the care plan and needs of the resident was communicated to the responsible party accordingly. Medications for R1 are handled by the facility not the wife of the resident. R1 has a private care giver from an outside agency that is now stationed in the room of R1 due to the decline in his health and the falls that have occurred. The private caregiver also ensures that the medications of R1's wife is locked and inaccessible to R1. According to the administrator the wife refuses to be assessed. Physician's report for the wife of R1 is dated in 2022 and confirms she is able to self manage her medication. LPA collected pertinent documents in person on this day from the facility. Report is reviewed with the administrator Monica.

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management visit in conjunction with a complaint visit made on this day. LPA met with the administrator and explained purpose of today's visit. LPA discussed with Monica the medications administration policy at the facility and the basis for adding medication handling to the care plan of R1 which did incur an increase in fees. It was determined that upon entry to the facility R1 was able to self manage medications but due to R1 suffering a medical issue R1 is no longer able to self manage medications. Due to this change the facility assumed the responsibility as it is facility policy that if a resident cannot self manage medications the facility will store and manage the medications. LPA received past and current physician's reports for R1 to show the change in ability to mange medications as well as the policy the facility follows regarding such handling of medications. Report is reviewed with the administrator Monica.

On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management visit regarding a break in that happened over the weekend. LPA met with administrator Monica Tapia regarding this incident. According to her the break in happened on 03/12/2023 at around 1:30 am the suspect jumped a fence and entered the independent living building and burglarized a resident's room. Resident discovered the missing items and reported to facility staff in the early morning hours. According to Monica Redwood City Police Department was alerted and a formal report was taken. Video evidence was reviewed by RWCPD and staff of the burglary. No residents were injured. No other reports of missing items by residents in independent living were reported. Burglary suspect never entered the assisted living main building as video footage was able to confirm that the suspect exited the same route he entered. Incident report is to be received on this day per the administrator. A police report number will also be provided. No citations issued. Report is reviewed with Monica.

Page 2 - LIC9099C The hired agency staff person sits outside in a chair positioned adjacent to the room door of the resident. The chair does not block the door of the resident's room. LPA observed this chair on two occasions, one time the private caregiver was sitting in the chair, and another time the chair was there but the private caregiver was not present. According to staff interviewed, this private caregiver only assists and supervises the resident when he leaves the room to go on walks outside of his room. The private caregiver does not assist the resident in his room despite that option being made available. The resident has declined this service of assistance. The caregiver does not interfere with the resident when he is in his room and does not sit or supervise the resident while he is in his room. The facility insists that this extra measure of supervision is in place to provide additional care and supervision to the resident. Based on these observations, the above allegations are UNSUBSTANTIATED. 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 above allegations are unsubstantiated at this time. No citations are issued. This report is reviewed with executive director Monica Tapia.

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual required 1 year inspection visit focused on COVID infection control. LPA met with executive director Monica Ceron Tapia during today's visit and explained the purpose of today's Upon entry LPA was COVID screened and had temperature taken. LPA did observe COVID some signs posted a the exterior of the facility but LPA suggested to add more. LPA toured facility's building and grounds with Monica and assistant executive director Patty Malera. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident monitoring, containment strategies, environmental preparation and cleaning. Resident and staff daily temperature log is not current but facility has a policy in place to take temperatures of resident's who exhibit cold/flu symptoms. LPA advised on continuing the daily temperature check log of residents. Staff are screened via temperature check and COVID symptoms upon entry to facility. PPE supply is observed as in place in the assistant executive director's office. Medications, toxins and sharps are stored appropriately and inaccessible to clients. Fire extinguishers are observed through out the facility as fully charged. Inspection date noted on one extinguisher on the 3rd floor as inspected on 06/19/2022. Facility has fire sprinklers in place through out the facility. Facility lighting is sufficient for residents and staff safety. Water temperature is tested at 110F in a resident bedroom on the 3rd floor. Non-skid floor or non-skid shower mats are in place in resident rooms. Liquid soap is available and paper towels are available in resident bathrooms. Resident rooms are observed and they are equipped with the required furniture and light fixtures. First-aid kit is complete. A Disaster and Mass Casualty Plan is posted. Staff are observed wearing masks. Criminal record clearances or exemptions for facility staff or other individuals who have client contact is reviewed. Administrator certificate is current. All staff and residents are fully vaccinated and boosted. Continued on attached 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 Page 2 - Required 1 Year Annual The following updated forms are requested to be submitted to CCLD by 02/01/2023 : • LIC 308 Designation of Facility Responsibility • LIC 500 Personnel Report • LIC 610E Emergency Disaster Plan • Copy of updated administrator certificate No citations issued. Report is reviewed with Monica Tapia.

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced case management visit regarding an incident that took place on 8/2/2022. LPA met with administrator Monica Ceron Tapia to discuss this. According to Monica there was an incident that occurred where a person in plain clothes entered the facility through a side entrance where a family member exited from. This side entrance is not an entrance to the facility as it is marked as an exit only. The suspect bypassed the front entrance and did not sign in as per protocol. Video footage was reviewed and it was confirmed that is how the suspect gained entry into the facility. LPA observed this footage as well. A private contractor that was hired to work in the beauty salon reported to Monica that she was missing some of her personal belongings. Monica stated that she advised the contractor to contact the Police Department. While the officers were on site on the 5th floor with the contractor, R1 reported to Moncia that someone was in her room going through her belongings. When the administrator was speaking to R1 the suspect came to the office of the administrator as well and she was questioned by Monica on her identity. The suspect made up a name of someone she was visiting in the facility but the facility did not have a resident by that name. The suspect got upset with Monica and she exited the building. Monica followed the suspect to a car parked in the facility parking lot where there was another suspect sitting in the drivers seat. Monica took pictures of the suspects, of their car, and license plate. Redwood City Police was on site when the suspect was in the facility but had left by the time officers got down to the ground floor after being alerted. Monica provided the information to the officers on site. Monica found out that another resident in the room next to R1 said the same person was in her room and attempted to take the resident's blood pressure but the resident declined and the suspect left her room and went to the room of R1. Officers inspected the rooms of R1 and R2 and per Monica no items were taken according to the the residents. LPA discussed future preventative measures with Monica to prevent this from happening in the future. A police report number of the incident was received by LPA on this day. No citations issued. Report reviewed with the administrator Monica.

On 4/21/2021 Licensed Program Analysis (LPA) Han conducted an unannounced Case Management -COVID-19 inspection. The facility did not report an incident to the Regional Office in a timely manner. Due to the Pandemic this inspection was conducted remotely. LPA Han called and spoke to the Executive Director, Grace Ndomo and explained the purpose of the call. The Executive Director stated that this incident happened while she was on vacation and the facility took actions internally but due to some miscommunication, it was not reported to the Regional Office on time. The Executive Director will educate the managers on the Reporting Requirements. This report was reviewed and discussed with the Executive Director. This report will be emailed to the Executive Director for a signature then returned to the LPA within twenty-four hours.