Regency Place.

On 4/14/2026 at 3:00 PM, LPA Shakaricka Hughes conducted an unannounced case management visit to the facility. LPA met with the executive director Heidi Charette. The current census is 53 with 9 facility staff present. The purpose of this visit was to conduct a resident records file review related to a complaint control: 27-AS-20260225112031. LPA reviewed and collected documents for residents R1, R2, R3, and R4. No citations were issued during this visit. An exit interview was conducted and a copy of this report was provided to the facility.

On 1/28/26 at 9:15am, Licensing Program analyst (LPA) Kevin Gould conducted an unannounced case management inspection to deliver an immediate exclusion order for the staff member identified as S1 (see confidential names list, LIC 811 dated 1/28/26. LPA met with R1 and Food services director Rommel Aquino. LPA met with S1 and informed them of their immediate exclusion from the facility. LPA observed S1 depart from the facility. LPA met with Food Services Director and backup administrator and informed them of S1's immediate exclusion. As R1 is identified as the active administrator LPA confirmed there is a designee as a backup to the administrator, Rommel Aquino who possesses a valid, current administrator certificate. Certificate #7010123740 and expires on 9/3/27. LPA made contact with the Licensee representative Julie Myers and informed the licensee of S1's immediate exclusion. Licensee agrees to submit documents to approve a new administrator by Friday, 1/30/26. Documents to approve a new administrator will include: LIC 200 form - application (signed by the Licensee), LIC 500 form - personnel Report with all staff and dates and times worked, LIC 501 form - personnel record (a resume or CV can be substituted if includes information required),LIC 503 form - Health screening and TB clearance, copy of administrator certificate, evidence that the appointed administrator meets the education/experience requirements for facilities licensed for 50 or more. No deficiencies observed or cited during today's inspection. Exit interview conducted and a copy of this report was left at the facility.

A review of hospice care notes from August to December 2024 shows R1 receives hygiene care, including showers, from a home health aide at least 2 times per week. No concerns were noted regarding R1 being left in soiled briefs or wearing the same clothing for extended periods. Additionally, hospice provided staff training on 7/21/24, covering incontinence care, hydration, nutrition, and skin care. Care notes from December 2023 to December 2024 document instances where R1 refused hygiene or care. R1 has been known to engage in behaviors such as smearing feces, which required housekeeping to change bed linens. These incidents were recorded as being addressed by staff. Interviews with staff consistently confirmed that residents are checked frequently, usually every two hours, and that incontinence care is part of the routine. Staff stated they have not witnessed any residents, including R1, being left in soiled briefs for extended periods. One staff stated that clothing and hygiene are addressed during regular care or sooner if needed. Resident interviews did not support the allegation. One resident stated they receives assistance when requested and did not confirm being left in soiled briefs. Another resident shared that staff assist them with changing adult brief at least twice per shift and that help is given in a timely manner. Another resident did not have any personal experience to share regarding the allegation. During observation, LPA tested a resident’s call system and noted a staff response time of approximately five minutes, suggesting staff are available and responsive to residents’ needs. Based on all gathered information, including documentation, observations, and statements from staff and residents, there is insufficient evidence to support the claim that staff left residents in soiled briefs for extended periods. Therefore, the allegation is UNSUBSTANTIATED. {2 of 5} 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 Allegation - staff left resident in the same clothing for extended periods: The investigation into this allegation consisted of interviews, record reviews and observation. R1’s care records show that R1’s needs changed over time due to diagnosis of Alzheimer’s disease and dementia. According to the 11/30/2023 Needs and Services Plan, R1 required standby assistance with bathing twice a week and help preparing clothing. R1 was also noted to wander but could dress and move independently. However, review of 8/1/2024 Resident Assessment showed increased care needs: R1 required one-person total assistance for bathing and dressing, along with frequent toileting assistance and checks throughout the day. Hospice care was also involved, with home health aides providing hygiene care at least three times a week. R1’s Physician Report dated 11/14/2024 confirmed that R1 could no longer independently bathe, dress, toilet, or feed. Hospice records from August to December 2024 showed no noted concerns about R1 being left in soiled clothing or wearing the same clothes for long periods. Additionally, on 7/21/2024, hospice provided training to staff on topics including skin care, hygiene, and incontinence care. A review of R1’s care notes from December 2023 to December 2024 showed that R1 occasionally refused meals, medications, and hygiene care. There were also reports of behaviors such as smearing feces, requiring bed linen changes. Interviews with residents did not reveal any concerns about hygiene or clothing. None of them reported witnessing any resident being left in the same clothing for too long. They confirmed that staff provide assistance, although they wished there were more staff available. Staff interviews were consistent in stating that residents are checked frequently—every two hours or more depending on the shift. They also stated that clothing is changed during hygiene routines or when clothes are dirty. Specifically regarding R1, one staff shared that R1 required two-person assistance for care and was often provided fresh clothing. Staff denied seeing any residents left in soiled or unchanged clothing for extended periods. During an observation on 10/9/25, visiting LPAs tested a resident’s call button and staff responded within about five minutes, indicating timely care response. Based on the gathered information, this allegation is determined to be UNSUBSTANTIATED. {3 of 5} 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 Allegation - staff did not meet resident’s dietary needs resulting in weight loss: The investigation into this allegation consisted of record reviews and interviews. According to weight records, R1’s weight changed over the year. On 1/8/2024, R1 weighed 128.8 pounds. Between February 5 and July 7, 2024, R1 experienced a significant weight loss of 15.6 pounds, dropping from 131.2 to 115.6 pounds. However, by 12/6/2024, R1’s weight increased to 133.2 pounds. R1 was admitted to hospice on 7/20/2024, with a terminal diagnosis of Alzheimer’s disease and secondary diagnosis of weight loss. Hospice records indicate that R1 had decreased functional ability, minimal food intake, and refused further hospital care. Hospice care notes from August to December 2024 show that R1 received regular visits from a home health aide at least three times a week, with no issues noted related to food intake. Hospice also trained facility staff on key topics such as nutrition, hydration, and incontinent care. A review of R1’s dietary orders confirmed that R1 was on a regular diet with no pork. The facility’s menus from April to October 2025 showed a rotating schedule of different meals for breakfast, lunch, and dinner, along with snacks between meals. The food options varied daily and included alternative meal choices. Staff interviews revealed that R1 was given Ensure supplements with lunch and dinner, and when R1 refused a meal or disliked a dish, alternate options were offered. R1’s assessment records show a progressive decline in abilities. In November 2023, R1 required minimal assistance with daily activities. By August 2024, R1 required full assistance with most activities, including bathing, dressing, toileting, and feeding. Staff documented that R1 often refused meals, medications, and hygiene care. Resident interviews did not support the allegation. Residents stated that they liked the food served, received help from staff, and did not observe any issues related to staff neglecting dietary needs. While some residents expressed they wished for more staff, they confirmed their care needs were met. Staff interviews consistently stated that dietary needs are addressed, and that staff are trained on residents’ food preferences. S4 confirmed that the kitchen maintains a list of special diets. Staff reported that residents, including R1, are checked regularly and receive assistance with meals as needed. S1 and S2 stated that R1 was assisted during meals and that R1’s food refusals and weight changes were likely due to medical condition, not from a lack of care. Based on gathered information, the allegation is determined to be UNSUBSTANTIATED. {4 of 5} 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 Allegation - Staff consumed resident’s personal food items: The investigation into this allegation consisted of record reviews and interviews. LPA spoke with other residents in care. Residents stated that they liked the food served and did not witnessed staff take their food. One resident stated they heard rumors about staff taking items, but denied seeing it happen. None of them reported that their own food or belongings were taken. Residents interviewed also stated staff helped them when needed, though they wished there were more staff at times. Interviews with staff showed they all denied taking any resident’s food. They said that residents are checked regularly and helped with eating, hygiene, and changing clothes. Staff interviewed stated they did not see or hear of anyone eating food that belonged to residents. Review of the following records, hospice care notes and facility staff care notes, do not indicate that R1’s food items were missing. During facility visits on 10/9/25, 9/17/25, and 7/21/25, visiting LPAs did not note any staff consuming residents’ food items. Based on all the information collected, including interviews, documents, and observations, there is not enough evidence to prove that staff took or ate R1’s personal food items. Therefore, the allegation is UNSUBSTANTIATED . Note: A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was conducted with AD and a copy of this report and appeal rights were provided. {5 of 5}

On 10/9/25, Licensing Program Analysts (LPAs) Cynthia Tamayo and Arvin Villanueva arrived at this facility unannounced to conduct an annual inspection visit. LPAs met with Executive Director, Damion Anderson (ED) and explained the purpose of the visit. The facility is a Residential Care Home for the Elderly, approved for age range 60 and over. Approved for 61 non-ambulatory, of which 10 may be bedridden. Approved hospice waiver for 10. ED holds Administrator Certification #7022031740 and expires 3/25/2026. LPAs and ED inspected the physical plant inside and outside to ensure there were no health and safety concerns. LPAs observed the lounge area, lobby, and common areas. In addition, the kitchen areas, dining area, and activity room were toured. Medication room was toured. Kitchen was toured for adequate food supplies and storage. A review of the facility perimeter fence, side gates, and exits was conducted. A review of the resident rooms and bathrooms were conducted. LPAs observed the facility to be free of odor, clean and in good repair at this time. LPAs observed required furniture and lighting throughout the facility. LPAs observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. Refrigerators and freezers were observed to store adequate amount of food. Temperatures for refrigerators and freezers were observed to be within regulatory standard as per observation and review of temperature log. Report continued on 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 The hot water temperature was measured at 117.3 degrees Fahrenheit in 4 sample resident rooms. The room temperature inside the facility measured between 71 and 75 degrees Fahrenheit. Centrally stored medications, toxins, and sharp knives kept locked and inaccessible to residents. LPAs observed the fire extinguisher(s) were up to date and were last serviced on 6/25/25. Smoke and carbon monoxide detector(s) in the facility were in good repair. First aid kit was checked and are complete. Review of 7 resident files include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. Medication review of 3 residents include review of physician orders for over-the-counter medications. No issues were noted at this time. LPAs reviewed 5 staff files include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. No issues were noted at this time. Facility conducts quarterly disaster/evacuation drill and last drill was on 7/1/2024. Facility has a dementia care plan and infection control plan. The following documents were collected during today's visit: LIC 308 Designation of Administrative Responsibility, Proof of Current Liability Insurance, Resident Roster, LIC 500 Personnel Report and Staff Schedule for October 2025 The following documents were requested during today's visit: Updated infection control and disaster plan Per California Code of Regulations, Title 22, no deficiencies were cited during today's inspection. An exit interview was conducted, and a copy of this report were left at the facility.

Regarding the allegation that staff did not provide activities to residents in care, LPA Campbell spoke to R4 and R5. Both confirmed that the community offers many activities though R4 doesn't consider themselves a "joiner" and R5 predominantly plays card games. Both residents interviewed were able to confirm many of the activities on the event calendar have been offered to them. Regarding the allegation that staff did not report an incident to residents authorized representatives, LPA Campbell contacted emergency contacts for R1, R2 and R3.. Of the three emergency contacts and/or family members interviewed, F1, F2 and F3 reported that staff notified them when residents fell or were injured. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore these allegations are UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8,no deficiencies cited.  Exit interview was held and a copy of this report was given to Vandita Chand.

Licensing Program Analyst (LPA) Cynthia Tamayo conducted an unannounced case management deficiency visit at the Regency Place II on June 17, 2025 at 2:10 P.M. LPA met with Administrator Damion E Anderson and informed them of the purpose of todays visit was to follow up on the AWOL for Sally Ebersole (R1) on 6/12/2025. An SIR was received for R1 informing R1 exited the facility unassisted (AWOL). current LIC 602 (dated 11/5/2021) indicated resident cannot leave facility unassisted. Based on record review facility was conducting hourly checks since 5/2025 for R1 due to daughter request for supporting medical verification. Hour check Log from 6/12/25 shows resident was checked on at 6:00PM at the note indicates she was in the lobby. The Med-Tech informed the S1 that R1 stated "I am going to my room". Security Camera's show resident exited the back door at 6:15PM and was found around 6:30 PM. S2 stated R1 told them they where leaving the facility to visit their daughter. S1 stated R1 was moved into Memory Care on 6/13/25. LPA toured the facility an exit door near room 27 to be propped open. S1 stated the house keeper sometimes props the door open during business hours (before 5;00PM when they are doing laundry. S1 stated they will make sure Hours keeping has a key in order to not prop doors open. S1 stated there is a sensor for the back door but there is no sensor for the door that leads to exterior as it is access for Independent Living Residents. The exit door in the dining room does not have an alarm and it locks at 7:00PM each day. There will be a new signal system put in place for exit doors. LPA Tamayo interviewed R1, and they declined leaving the facility and do not recall going out by themselves to visit their daughter. R1 is listed as Mild Cognitive Impairment (MCI). Administrator is requested updated LIC 602 and is pending Kaiser Physician appointment. Continued on 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 LPA Tamayo reviewed Staff Roster, Staff Schedules, Resident File (R1). LPAs reviewed the Physicians Report for R1 which indicates R1 is unable to leave the facility unassisted. R1 does not have a history of elopement. Facility has conducted elopement training and has a prepared elopement bag. Additional alarms are being put in place by 7/27/2025. Based on interviews and records review, it was determined that R1 eloped from the facility without staff knowledge. R1's Physician Report (LIC 602) states that resident was not allowed to leave the facility unassisted. Facility staff shall have supervision of R1 and aware of R1’s general whereabouts at all times. Re-appraisal will be completed for R1. Deficiencies were observed and cited on the LIC 809-D pursuant to the California Code of Regulations, Title 22, and California Health and Safety Code. An immediate civil penalty of $500.00 is assessed for health and safety deficiency. Exit interview conducted, a copy of the report, 809-D and appeal rights given.

While this behavior could be perceived as aggression, it is actually an attempt to facilitate communication with the residents who struggle to hear. Furthermore, S5 recounted an incident involving a former staff member, who reported witnessing another staff member (S2), tapping on a table in an effort to gain the attention of a resident. S5’s investigation confirmed that S5’s action was intended to call the resident to the table for a meal, not to display aggression. S5 emphasized that this behavior was not aggressive in nature but rather a means of communication with a resident who had hearing issues. In addition, S7 acknowledged that staff sometimes raise their voices when interacting with residents who are combative or aggressive towards them. However, S7 clarified that this is done as a response to the resident’s behavior and is not intended to be malicious. The goal is to de-escalate the situation and ensure safety for both the resident and staff. An interview with the Ombudsman, who conducted an observation at the facility on 11/14/24, further supported the absence of aggression in staff interactions with residents. The Ombudsman reported no observed instances of staff being aggressive towards residents during their visit. Finally, observations conducted by this LPA during facility visits on 11/14/24, 12/17/24, and 3/11/25 did not observe aggressive behavior by staff towards residents was noted. Based on the gathered evidence from interviews and observations, there is no substantiated claim of staff aggression towards residents in care. Reports suggest that behaviors that may be perceived as aggressive were, in fact, attempts to communicate with residents or respond to challenging behaviors, with no intent to harm or intimidate. Therefore, this allegation was UNSUBSTANTIATED. An unsubstantiated finding means 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. {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 Allegation: Facility is not adequately staff to meet the needs of residents in care. The investigation into this allegation included interviews with staff members and a review of staffing records for October and November 2024. Interviews with staff members (S5-S9) collectively revealed that the facility is sufficiently staffed and that there are no significant staffing issues. The staff reported that, in the event of staff call-outs, supervisors are typically available to step in and assist with caregiving duties when necessary. Additionally, they confirmed that there are two care staff members assigned to the Memory Care unit during both the AM and PM shifts, as well as two care staff members in the Assisted Living area for each of those shifts. For the NOC shift, there is one care staff member assigned to both the Memory Care and Assisted Living units. Each shift also includes one med tech who covers both the Memory Care and Assisted Living areas. S5 further explained that, in addition to the caregiving staff, other team members such as kitchen and housekeeping staff provide additional support to ensure the well-being of residents. Furthermore, the Memory Care Coordinator is available to cover the mid-shift, offering further assistance and oversight. A review of the staffing schedules for October and November 2024 confirmed the information provided by staff. The schedules show that the staffing levels meet the reported staffing assignments, with two care staff in both Memory Care and Assisted Living for the AM and PM shifts, one care staff for the NOC shift in each area, and one med tech per shift covering both units. Based on the evidence gathered through interviews and record review, this allegation is UNSUBSTANTIATED.Note: an unsubstantiated finding means 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. Exit interview was conducted and a copy of this report and appeal rights were provided. {3 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 A review of the training records for staff members (S1-S5) confirmed that they are consistently receiving monthly training through the Relias platform. Specifically, S1’s training records included a range of relevant and comprehensive topics such as dementia-related education, first aid, medication management, infection control, environmental cleaning, hospice care, cultural awareness, fire safety, abuse prevention, monitoring changes in residents' conditions, and resident rights. For staff members S2 and S3, additional evidence of training was provided. S2's training in 2024 included orientation sessions with various department directors. These included training on activity programs and the memory care program with the Activity/Memory Director, meal services, special diets, kitchen sanitation, and food storage with the Culinary Director, and assessment and care plan procedures, change in condition, incident reporting, fall risk management, medication administration, and infection control with the Resident Care Coordinator. S2 also received orientation from the Maintenance Director on housekeeping services, laundry, maintenance, emergency procedures, fire safety, and life safety, as well as training from the Business Office Manager on abuse/neglect policies, workplace violence policies, job descriptions, and resident safety. Finally, S2 received orientation from the Executive Director on job descriptions, responsibilities, and resident rights. Based on the interviews and record reviews, it is evident that staff members at the facility receive adequate and ongoing training. Therefore, this allegation is UNFOUNDED. *************************************************************************************************************************** Allegation: Facility staff do not follow safety practices of the facility. An investigation was conducted to determine whether facility staff are adhering to the safety practices of the facility, particularly wearing the appropriate attire while on duty. This investigation included interviews, observations, and a review of relevant records. Interviews with the Ombudsman revealed that during their observation on 11/14/24, Ombudsman did not observe any instances of staff failing to follow safety practices, including wearing inappropriate attire while on duty. Additionally, interviews with staff members (S5-S9) confirmed that they are required to wear a uniform provided by the facility, which includes a scrub top, black pants, and slip-resistant, closed-toed shoes. {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 A review of the facility's Appearance and Grooming requirements for Personal Care Assistants further supported these findings. The policy specifies that staff members must wear company-issued uniforms, black pants (excluding jeans, scrubs with ties, or leggings), and appropriate black, closed-toed and heeled shoes. This policy aligns with safety standards to ensure staff are properly attired to perform their duties safely. Additionally, a review of the company policy on slip-resistant footwear confirmed that the footwear required meets or exceeds ASTM safety standards. These shoes are designed with outsoles that provide traction on slippery floors and surfaces, further enhancing staff safety while performing their duties. Finally, during facility visits on 11/14/24, 12/17/24, and 3/11/25, the LPA conducted observations and did not note any staff members wearing inappropriate attire or deviating from the facility’s appearance and grooming policy. Based on the evidence gathered from interviews, observations, and record reviews, staff members were observed adhering to the facility's uniform policy and safety requirements, and there were no violations noted during the investigation. Therefore, the allegation that staff do not follow safety practices, particularly not wearing appropriate attire is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened, or is without a reasonable basis. Exit interview was conducted and a copy of this report was provided. {3 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 Additionally, the Ombudsman interviewed staff member S1, who revealed that staff had not updated some residents' "Life Story Books", particularly for residents who have been at the facility for a longer duration. These books are meant to provide essential personal and life history information to ensure individualized care, but it appears they have not been regularly updated, especially for long-term residents. Based on the evidence gathered, it is substantiated that the facility has not been updating resident records, including both physician reports and life history documentation. Therefore, this allegation is SUBSTANTIATED. Note that the facility has been cited during their annual visit on 11/17/24 and deficiencies has been cleared. Exit interview was conducted and a copy of this report was provided. {2 of 2}

It was alleged that resident sustained pressure injuries due to neglect. The investigation included interviews with facility staff and a review of records. LPA Truong interviewed 6 facility staff members. Two of the staff stated that (R1) may have had skin injuries but could not recall or confirm any such injuries. The records review revealed that R1 was under hospice care with Bristol Hospice. According to Bristol Hospice records, R1 was seen by a hospice nurse, with visit summaries from 09/08/22, to 09/23/22. A hospice notes from 09/14/22, indicated that R1 had a pressure injury in the posterior lumbar area that appeared to be a stage two injury, which had healed or 100% epithelialized. A registered nurse performed wound care for R1. Additionally, a hospice notes from 09/21/22, confirmed that the wound on the R1’s buttocks was fully healed. R1 was discharged from Bristol Hospice on 09/23/22, due to being outside the service area. On 10/25/22, R1 began receiving hospice services from Accent Care. Based on the interviews and statements gathered during the investigation, LPA was unable to corroborate the allegation. It was alleged that staff did not seek timely medical attention for resident in care. This investigation consisted of records reviewed. It was learned that on 09/23/22 (R1) was transported to Methodist Hospital of Sacramento for a chief complaint of right hip pain and impaired mobility. The radiology report stated that R1 sustained an impacted fracture over the right femoral neck due to a possible fall. There are inconsistent statements from staff regarding whether R1 sustained a fall resulting in the hip fracture. There are no direct witnesses, and it is unclear when the possible fall may have occurred. Furthermore, hospice records indicated Regency Place did not report any falls to hospice staff. Hospice staff also assessed R1 multiple times between 09/08/22 and 09/21/22 and no pain or discomfort was noted. Based on the interviews conducted during the investigation process and statements obtained during the investigation process, LPA was unable to corroborate the allegations. It was alleged that the resident sustained unexplained injuries while under care. The investigation involved interviews with facility staff and a review of records. LPA Truong interviewed 6 facility staff members. One staff member stated that they "think" the resident had a fall and was taken to the hospital. However, there were inconsistent statements from staff regarding whether R1 fell and sustained injuries. Additionally, there were no direct witnesses who could confirm that R1 had sustained injuries while in care. A review of the hospice records revealed that Regency Place did not report any falls to the hospice staff. Based on the interviews and statements obtained during the investigation, LPA was unable to corroborate the allegation. Continued LIC 9099-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 investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred. An exit interview was held, and a copy of the report was provided at the end of the visit.

On 8/23/24, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct a case management visit regarding an incident report the Department received on 8/16/24. LPA met with Administrator Damion Anderson and explained the purpose of the visit. The purpose of this case management visit is to follow up on an incident occurred on 8/12/24. Resident (R1) is a 102-year-old resident with dementia who eloped from the facility on 8/12/2024. R1 was last seen at 12:50 PM and was found outside of the community’s grounds at 1:15 PM by facility staff returning from lunch. Based on interviews and records review, it was determined that R1 eloped from the facility without staff knowledge. R1's Physician Report (LIC 602) states that resident was not allowed to leave the facility unassisted. Facility staff shall have supervision of R1 and aware of R1’s general whereabouts at all times. Deficiencies were observed and cited on the LIC 809-D pursuant to the California Code of Regulations, Title 22, and California Health and Safety Code. An immediate civil penalty of $500.00 is assessed for health and safety deficiency. Exit interview conducted, a copy of the report, 809-D and appeal rights given.

On 5/2/24, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct a case management visit regarding an incident report the Department received on 4/12/24. LPA met with Administrator Damion Anderson and explained the purpose of the visit. The purpose of this case management visit is to follow up on an incident that was occurred on 4/11/24. Per incident report, staff (S1) was in the activity room providing supervision over the resident. S1 noticed smokes coming from the kitchen stove top. S1 turned off the electric stove and removed a food serving tray from the stovetop to the sink to attempt to put out the fire. Staff (S2) grabbed a fire extinguisher form the front lobby and began extinguishing fire. During today’s visit, LPA Truong toured the facility and interviewed staff. It was learned that staff (S3) might have accidentally turned on the stove when setting the food tray on the stove. The plastic food tray was melted causing a small fire. It was learned that staff was present during the incident and no residents were harmed. The fire only causing damage to the food tray. Administrator was advised that additional interviews are needed in order to make a determination. No deficiencies were observed during today’s visit pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conducted and a copy of this report was left at the facility.

On 10/24/23, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection. LPA met with Administrator Damion Anderson and explained the purpose of the visit. Administrator holds certification # 6055657740 and expires on 3/25/2024. The facility is licensed to serve 61 non-ambulatory residents, of which 10 may be bedridden. Hospice waiver approved for 10. There are 46 residents in care currently. LPA toured and inspected the physical plant inside and outside to ensure there were no health and safety concerns. LPA observed the lounge area, lobby, and common areas. In addition, the kitchen areas, dining area, and activity room was toured. Medication room was toured. Kitchen was toured for adequate food supplies and storage. A review of the facility perimeter fence, side gates, and exits was conducted. A review of the resident rooms was conducted. LPA observed the facility to be free of odor, clean and in good repair. LPA observed required furniture and lighting throughout the facility. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days maintained on the premises. The hot water temperature was measured at 119.1 degrees Fahrenheit. The temperature inside the facility measured at 74.0 degrees Fahrenheit. LPA observed centrally stored medications, toxins, and sharp knives kept locked and inaccessible to residents. LPA observed the fire extinguisher(s) were up to date. LPA observed smoke and carbon monoxide detector(s) in the facility were in good repair. First aid kit was checked and is complete. Proof of current liability insurance was observed. Report continued on 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 LPA requested resident and staff files for review. LPA reviewed six (6) resident files and five (5) staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. The following documents were obtained during today's visit: LIC 308 Designation of Administrative Responsibility, Administrator Certificate, and Proof of Current Liability Insurance, LIC 500 Personnel Report and LIC 610 Emergency Disaster Plan. Per California Code of Regulations, Title 22, no deficiencies were cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.