Casa de las Campanas.

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to conduct a Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Residential Care Coordinator Silvia Cruz. According to the facility’s license, the facility has a maximum capacity for five-hundred eighty-two (582) residents, of which two-hundred twenty-seven (227) may be non-ambulatory but none may be bedridden, and of which twenty (20) may be under hospice care. During this annual inspection, there were a total of five hundred and three (503) residents in care, of whom one-hundred fifty four (114) were non-ambulatory, and none were bedridden. Ten (10) of the residents were under hospice care. The facility’s license included endorsement for use of delayed-egress doors in the facility’s dementia-care unit. LPA reviewed records for multiple residents and multiple staff. LPA interviewed multiple residents and multiple staff. LPA, accompanied by Silvia Cruz, also toured the interior and exterior of the facility, and inspected common areas and multiple resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Multiple resident pendant, push-button, and pull-cord call devices were tested. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was compliant at 74 F. (CONTINUED ON NEXT PAGE) 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 [CONTINUED FROM LIC 809] Where tested, hot water temperature at taps accessible to residents were all compliant: Bedroom #476A Sink was 117.1 F, Bedroom #478 Sink was 117.2 F, Bedroom #18 Sink was 113 F, Bedroom #16 Sink was 106 F. Appliances to preserve perishable food were also all compliant in temperature. There was at least two (2) days of perishable food, and at least seven (7) days of non-perishable food present, all safely stored. Plenty of cooking and dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, active fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. The facility’s swimming pools were secured behind locked fences and gates, consistent with regulation. Per Executive Director Stefanie Thune-Barnes no firearms or ammunition are kept at the facility. Fire detection system, carbon monoxide detectors, nighttime lighting, emergency lighting, and facility telephone were all working. The facility’s fire extinguishers were serviced within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. Fire/disaster drills were performed at required intervals. There were reserve supplies of Personal Protective Equipment (PPE). Licensee presented proof of current business liability insurance. No deficiencies were cited during this annual inspection. An exit interview was conducted with Silvia Cruz, Executive Director Stefanie Thune-Barnes and Director of Residential Health Shila Jurado (via telephone), to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.

[Continued from LIC 9099] R1 resides in the independent living portion of the facility and has no diagnosis of cognitive impairment. Per review of R1's physician's report dated July 2004, it is noted that R1 can manage their own cash resources. The department had requested from the facility if there was a more recent physician's report on file and it was revealed that R1 had not had any changes in condition that required an updated report. However, the facility conducts annual assessments to monitor resident status. Per review of facility assessments on R1 conducted September 2022, September 2023, and October 2024, R1 is noted to be independent and does not require care and supervision. Per interview with R1, it was revealed that they have a private caregiver from an outside agency that assists with household tasks, errands, and appointments. R1 explained that they were aware their private caregiver could not accept money or tips from R1. When asked about the incident described in the complaint allegation, it was revealed R1 was preparing for a trip and preferred to travel with cash. R1 revealed they were uncomfortable and offended with being questioned about their reasons for withdrawing money and so they provided the first statement that came to mind. An outside source interview revealed they had no concerns regarding R1's cognitive status or concerns about R1 being financially abused. This interview corroborated that R1 preferred to travel with cash on hand. The Department has investigated the complaint alleging financial abuse. 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. We have dismissed the complaint. An exit interview was conducted with Residential Administrator Richards to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to follow up on an incident reported to Community Care Licensing. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Executive Director (ED) Stefanie Thune-Barnes and Health Services Administrator Brooke Patterson. Director of Residential Health Shila Jurado and Residential Administrator Tyre Richards joined later during the visit. Community Care Licensing received an Incident Report on 11/3/25 in which it was reported that on 10/31/25, a memory care Resident (identified as R1), was noted to have small sores behind their knee due to a below the knee splint from a prior injury. Resident was transported to the hospital where they were treated for the injury and the skin assessed. Per the report, R1 returned to the facility same day and that their prior leg injury was stable. R1's responsible party and primary care physician were notified. During today's visit, LPA conducted interviews and file review. Additionally, LPA conducted a visit with R1. Due to time constraints, LPA was unable to complete a determination regarding this case management visit, and additional visits may be necessary to complete review of this incident. At this time, LPA observed no health and/or safety concerns and no deficiencies were cited during today's visit. An exit interview was conducted with Residential Administrator Richards to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to continue a Required Annual Inspection which began on 01/21/2025. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Director of Residential Health Shila Jurado. According to the facility’s license, the facility has a maximum capacity for five-hundred eighty-two (582) residents, of which two-hundred twenty-seven (227) may be non-ambulatory but none may be bedridden, and of which twenty (20) may be under hospice care. Per LPA observation, review of sampled LIC602 Physician’s Reports, facility records, and staff interviews: During this annual inspection, there were a total of four-hundred eighty-two (482) residents in care, of whom one-hundred nineteen (119) were non-ambulatory, and none were bedridden. Six (6) of the residents were under hospice care. The facility’s license included endorsement for use of delayed-egress doors in the facility’s dementia-care unit. During this inspection, LPA observed and tested the function of the two (2) delayed-egress doors, finding they were operational and consistent with regulatory requirements. LPA reviewed records for multiple residents and multiple staff. LPA interviewed multiple residents and multiple staff. LPA, accompanied by Licensee’s staff, also toured the interior and exterior of the facility, and inspected common areas and multiple resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Multiple resident pendant, push-button, and pull-cord call devices were tested; all successfully transmitted signals to staff pagers/devices and were able to be reset. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 74 F. [CONTINUED ON LIC 809] 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 [CONTINUED FROM LIC 809] Where tested, hot water temperature at taps accessible to residents were all compliant: Bedroom #1 Sink was 112.5 F, Bedroom #15 Sink was 113.4 F, Bedroom #17 Sink was 112.1 F, Bedroom #475 Sink was 111.2 F, Bedroom #482 Sink was 109.6 F, Bedroom #485 Sink was 111.6 F, and Bedroom #488 Sink was 112.1 F. Appliances to preserve perishable food were also all compliant in temperature: Main Kitchen Walk-In Refrigerators were 40 F or colder, and Main Kitchen Walk-In Freezers were 0 F or colder. Assisted Living, Memory Care, and Medication Room Refrigerators and Freezers were also complaint in temperature. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Plenty of cooking and dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, active fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. The facility’s swimming pools were secured behind locked fences and gates, consistent with regulation. Per the Licensee, no firearms or ammunition are kept at the facility. Fire detection system, carbon monoxide detectors, nighttime lighting, emergency lighting, and facility telephone were all working. The facility’s fire extinguishers were serviced within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. Fire/disaster drills were performed at required intervals. There were reserve supplies of Personal Protective Equipment (PPE) and staff had been trained on PPE within the last twelve (12) months. Licensee presented proof of current business liability insurance. No deficiencies were cited during this annual inspection. However, LPA issued one (1) Technical Violation (TV) regarding adding three (3) more stairwell evacuation chairs (refer to the LIC9102-TA page); the facility presently has sixteen (16) of these chairs. An exit interview was conducted with Shila Jurado, to whom a copy of this report, the LIC9102-TV page, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Director of Residential Health Shila Jurado. During today’s visit, LPA briefly toured the facility, reviewed staff records, and interviewed staff. No deficiencies were cited during today’s visit. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection. An exit interview was conducted with the Jurado, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

Licensing Program Analysts (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Director of Residential Continuing Care Shila Jurado, identifying herself and stating the purpose of the inspection. This facility serves five hundred eighty-two (582) residents 60 and above; of which two hundred twenty seven (227) may be non-ambulatory. Twenty-seven (27) whom may be Dementia Residents in the delayed egress unit. Approved hospice waiver for twenty (20). A tour of the facility was conducted which included a sample of resident units, the dining area, recreation rooms, and food storage areas. This a muti-story, muti-unit complex with memory care on the ground level of the ‘Sur” building. Facility does feature delayed egress doors or a locked perimeter in the memory care unit. There are 3 pools on site, of which two are located outdoors. All pools on site are only accessible by key. Each resident had clean and sufficient bed linens. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Hot water temperature in residents’ bathrooms were compliant. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. LPA reviewed fire clearance inspections documents as well as inspections logs for generators. First aid bag(s) were complete and readily accessible in all the medical rooms. Required licensing postings were observed in visible areas of the facility. PPE supplies are on site. Passageways were free from obstructions. [CONTINUED ON 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 [CONTINUED FROM LIC 809] Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Emergency food supplies were kept in a underground garage locked storage area. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. The food service area was observed to be neat and clean. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closed room not assessable to residents. Centrally stored medications were properly stored and locked in cabinets. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions. Staff records review verified that all staff records were complete and compliant. Resident records were reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. LPA conducted a review of In-service training procedures. Transportation procedures are compliant. There is designated gym area and several large activity rooms as well as gathering areas throughout the facility. At the time of visit, LPA observed one large group activities in which many residents in the memory care unit were participating. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. No deficiencies were issued at the time of visit. An exit interview was conducted with Executive Director Kimberly Dominy to whom copies of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

Based on the evidence gathered, there was not a preponderance of evidence to prove the alleged violation occurred, therefore, the allegation was unsubstantiated. An exit interview was conducted with Harris, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058) were provided via electronic mail. An electronic mail read receipt confirms the documents were received by the administrator.

LPA visited the facility on October 3, 2023 and found R1 in the common area participating in group physical fitness activities. R1 appeared well groomed with no noticeable injuries on R1's body. R1 appeared alert and did not appear in pain or distress. Interview with outside agency revealed that on September 27, 2023 they visited R1 and they did not observe any marks, bruises, or trauma on R1's person. Outside agency stated that from their observation the staff to resident ratio in the memory care was "good." Outside agency further stated that R1's demeanor did not look like R1 had any concern. Outside agency stated that R1 looked content, more then anything. Interview with Director of Continuing Care revealed there is a 24 hour nurse in R1's unit which is always fully staffed. Director further stated that their are camera monitors in the; director's, nurses and supervisors office which provides "extra eyes" on the unit floor. Director stated that due to the location of the skin tear on R1's arm, it was found at the end of the day when R1 was being undressed by staff. Once the injury was found by staff, hospice was immediately notified and hospice responded with Doctor's orders. Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is not valid. An exit interview was conducted with Kim Dominy. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Kim Dominy whose signature below verifies receipt of these rights.