San Leandro Senior Living

On 4/16/2026 at 11:00 am, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced case management visit regarding two self reported incidents that were reported to CCLD on 4/7/2026 and 4/10/2026. LPA met with Executive Director Glenda Bertucci and explained the purpose of the visit. The first incident report stated that on 3/29/2026 around 9:00 am, Staff two (S2) was preparing resident (R1's) medication when S2 observed that the expiration date on the medication bottle indicated that it expired on 3/5/2026. The incident report indicated that R1 was given expired medication of Amlodipine 2.5 mg from 3/5/2026- 3/29/2026. On 3/29/2026, S2 noticed the expired medication and notified S3 to verify the expired medication and S3 re-confirmed that the medication was expired. R1's order is Amlodipine 2.5 mg: take 1 tablet by mouth 2x daily at 9:00 am. Physician and POA were notified of the incident. R1 was not resulted injury or medical problem due to this incident. In-service training was provided to staff on 3/30/2026. The second incident report stated that on 4/3/2026 around 10:00 am, S1 was reviewing R1's Centrally Stored Medication and Destruction Record and observed that there was a discrepancy with medication dosage of R1's medication of Amlodipine 2.5 mg. S1 observed that R1 was given the Amlodipine 2.5mg but staff only gave R1 1 tablet per day due to the previous physicians order dated on 9/10/2025 that indicated to give R1 Amlodipine 2.5mg 1 tablet by mouth daily. When S1 was reviewing R1's documents S1 realized that the medication dosage was changed to Amlodipine 2.5mg: take 1 tab daily by mouth two times a day on the physicians order dated 12/29/2025 that was received from the Skilled Nursing facility when R1 returned back to the facility. Continued on LIC809C. 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 LIC809. S1 stated that R1 was given 1 tablet of Amlodipine 2.5 mg daily as opposed to 1 tablet two times a day from 12/29/2025 to 4/3/2026. S1 stated that R1 was sent out to the hospital on 11/21/2026 and was later admitted to a Skilled Nursing Facility from 11/26/2025 - 12/29/2025. S1 stated that the Skilled Nursing Facility changed the dosage amount on 12/8/2026 while R1 was still attending the Skilled Nursing Facility. Physician and POA were notified of the incident. R1 did not result in injury or obtain ill side effects due to this incident. In-service training was provided to staff on 4/3/2026. S1 acknowledged that both the under dosage and the expired medication was overlooked by staff. LPA interviewed S1 and S2. LPA attempted to interview S3. LPA reviewed and obtained R1's MAR (Medication Administration Record) from September 2025 - April 2026, updated Needs and Services Plan, Alert Charting report, Prescriber notification medication error report regarding Wrong Time and Wrong Dose, Physicians Order dated 9/10/2025, and Order Summary Report (Change of dosage) dated 12/29/2025. LPA also reviewed and obtained the Med Tech to Med Tech Communication Log, LIC500 (personnel Report), Resident Roster, and staff training. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalty. Exit interview conducted with Glenda. Appeal Rights and a copy of this report provided.

On 4/14/22 at 2:05 p.m. Licensing Program Analyst (LPA) G. Clark arrived unannounced to conduct Infection Control Inspection. LPA met with Administrator, Gilbert Castro and explained the purpose of the visit. During the Infection Control Inspection, LPA toured facility including but not limited to: front entrance, screening station, hand washing stations, common areas, kitchen and courtyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Visitors policy is posted on the front entrance. 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 and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPE maintained at 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.

Continue from LIC 9099 It was reported to the Department that staff inappropriately locked resident’s room. The department conducted interviews and reviewed documents which reveal that residents apartments are locked and all responsible staff has master keys to get into the apartments for care and emergency services if needed. Therefore, this allegation is un-substantiated. This agency has investigated the complaint alleging Staff inappropriately locked resident’s room. We have found that the complaint was unsubstantiated. 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, a copy of this report provided .

On 3/20/2025 at 4:05PM, Licensing Program Analysts (LPAs) G. Luk and Y. Brown arrived unannounced to conduct a case management visit in regards to an incident report. LPAs met with Executive Director (ED), Glenda Bertucci and explained the purpose of the visit. Based on the incident report, facility have been sending emails and tried to call R1 without response. On 3/10/2025, facility observed R1 was not in his apartment. Facility contacted R1's family and they did not know R1's whereabouts. R1's family informed facility that he will contact the police to file a missing person's report. Police made a visit to the facility to conduct investigation. During visit, LPAs interviewed staff and reviewed R1's file including physician's report, decline services document, and incident report. R1's physician's report stated that R1 can leave the facility unassisted. Interview with staff revealed that family have been providing updates on police investigation. No deficiencies are being cited on this date. LPAs may return on a later date. Exit interview conducted with Glenda Bertucci. A copy of this report provided.

Licensing Program Analyst (LPA) L. Ibo conducted a case management visit on the AWOL incident report submitted by S2 , LPA meet with Executive Director Gilbert Castro and informed him the purpose of the visit. Report indicated that around 2:00 AM on July 22, 2021, staffs went on their rounds and found R1 was not in the room, fire exit door was noted open. Staffs called Executive Director Gilbert, S2, and R1’s family, 911 was also called for assistance. At around 5:00 AM police found R1 walking on the street and was brought back to the facility. LPA conducted interview. LPA requested for the following documents from Gilbert C. , admission agreement , LIC601, LIC602A, Pre-placement appraisal and incident reports pertaining for R1. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalty. Exit interview conducted. A copy of this report and appeal rights provided.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED . California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided. 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 Staff left resident in wheelchair for an extended period of time. Interview with staff revealed that R1 can transfer to bed and sometimes need help with transfer. S6 stated that R1 likes being in the wheelchair all the time. Sometimes when S6 put R1 to bed, R1 wants to stay in the wheelchair to watch TV. Staff did not provide resident a clean bed. Interview with witness indicated that R1’s bed is not clean and mattress has urine stain. However, LPA toured a few resident’s rooms and observed the beds are clean. Interview with staff revealed that resident’s beddings would be changed when it’s soiled or wet. Staff did not ensure resident's room was clean and sanitized. Interview with witness indicated that R1’s room was uncleaned and feces were found under the bed. However, LPA toured a few resident’s rooms and observed resident rooms were cleaned. Interview with residents and staff revealed that resident’s rooms are cleaned once a week. Residents stated they did not have any issue of having the room cleaned. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore these allegations are UNSUBSTANTIATED . No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.

On 12/4/2024 at 1:15pm, Licensing Program Analysts (LPAs) Carol Fowler and David Doidge arrived unannounced to conduct a complaint investigation visit LPAs observed deficiencies. LPAs met with Lisa Lostica, Business Office Manager and explained the reason for the visit. LPAs observed, R1 Physician Report has not been updated. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809 D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of the appeal rights, and this report.

Resident developed pressure injury while in care. R1's physician's report dated 7/31/2023 revealed that R1 has a history of skin condition or breakdown. R1 has home health that would assist with R1's wound care. Outside agency documentation indicated that a nurse have provided wound care for R1. Interview with staff revealed that R1 was repositioned every 1-2 hours. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore these allegations are UNSUBSTANTIATED . No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.

Allegation: Staff did not keep the resident's room clean or sanitary. LPA toured the apartments of R1, R2 and R3. LPA observed all three apartments to be clean and odor free. LPA also observed a notice in each apartment of their weekly housekeeping cleaning schedule. R3 stated that she loves her housekeeper and that she does a “wonderful job.” This agency has investigated the complaint alleging staff did not keep the resident's room clean or sanitary. We have found that the complaint was unsubstantiated. 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, a copy of this report provided.

On 01/07/24 around 10:45 AM, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced annual inspection. LPA met with Glenda Bertucci, Executive Director (ED) and explained the purpose of the visit. ED currently holds a standard certificate (#7016878740 ) exp. 08/13/2026. The facility’s fire clearance was approved for forty (40) non-ambulatory residents. Upon arrival, LPA observed several residents in the main lobby conversing and lounging together. Additional staff and residents were also in the dining area for breakfast. Staff and residents were moving about throughout the facility's common areas as well. LPA toured the facility including, but not limited to the common areas, bathroom, dining area, nurses station, front courtyard, 1st, 2nd and 3rd floors. The facility consists of individual apartments; each floor has an activities area, tabletop games, books, music, and a television on the 1st floor. All outdoor and indoor passageways were free of obstruction. There were no bodies of water present. A comfortable temperature was maintained at the facility. The facility has an emergency food supply on site and contracts with US Foods twice weekly for deliveries. LPA observed lighting in all areas to be adequate for the comfort and safety of the residents. Hot water temperature in the shared bathroom was measured at 109.8 degrees Fahrenheit (F) with hand washing signs, soap, paper towels, and garbage cans; the areas were safe, and sanitary. On site laundry facilities are available. PPE, sanitizer, and paper goods remain sufficient. Safety drill completed 12/18/24, fire extinguisher observed full and last inspected 04/15/24. Continued on LIC809C... 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 LIC809. Smoke detectors and carbon monoxide were in operating condition during visit. Emergency Disaster Plan was current. Five (5) staff and seven (7) residents records were reviewed and were complete. The following forms are to be updated and submitted to CCLD: -Resident Roster (Reviewed) -LIC500 Personnel Report (Reviewed) -LIC308 Update Designation of Administrative Responsibility (Reviewed) -LIC610D Emergency Disaster Plan (Reviewed) Exit interview conducted and a copy of this report provided to ED.

On 10/24/24 at approximately 09:35 am, Licensing Program Analyst (LPA) J. Clancy-Czuleger conducted a case management visit pertaining to a letter received by the Oakland CCLD ASC Regional Office from the facility. LPA met with Executive Director (ED), Glenda Bertucci and explained the purpose of the visit. On July 11, 2024, the Oakland CCLD ASC Regional Office received from the facility a letter of intent to de-license the third floor of the physical plant and convert those units for Independent Individuals who are 55 years of age and older. The letter did not specifically request approval from CCLD and had insufficient detail pertaining to how the co-mingling of Independent aged 55+ renters, and licensed RCFE Assisted Living residents, would be managed to ensure the Health & Safety of the Assisted Living residents. On 10/16/24 LPM Jeremy Fong and on 10/24/24 LPA J. Clancy-Czuleger and ED confirmed that the facility’s website is advertising for independent renters aged 55 and older, which constitutes a change to the Plan of Operation without having obtained approval from Community Care Licensing. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.

On 5/29/2024 at 2:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit. LPA met with Interim Executive Director, Jeralyn May and explained the purpose for the visit. While LPA G. Luk was at the facility for a complaint investigation (#15-AS-20240523150242), the following deficiency was observed. After reviewing Guardian system, LPA G. Luk observed staff (S1) was fingerprint cleared, but not associated to the facility. Facility contacted RO (Regional Office) and associated S1 to the facility during visit. LPA re-checked Guardian system and observed S1 has been associated to the facility as of today, 5/29/2024. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.

On this day at around 2:20 PM, Licensing Program Analyst (LPA) Luisa Fontanilla arrived at the facility to conduct a case management visit related to an incident reported by the facility. LPA met with Gendelle Camarillo, Resident Services Director. Executive Director (ED) Glenda Bertucci arrived at around 3pm. . On July 14, 2024, a stranger came to the facility and dropped off R1. R1 was found at the Safeway Supermarket on Washington Ave. which is 0.3 miles from the facility. R1's Physician's Report indicates R1 has Mild Cognitive Impairment (MCI) and is not able to leave the facility unattended. Based on interview with RSD, R1 was not harmed from the incident. RSD added that staff training was conducted and R1 has been reassessed by R1's doctor. Pending the release of R1's updated Physician's Report, the facility has plans in place to ensure R1's safety while at the facility. If R1 is diagnosed with Dementia, R1 will need to be moved out of the facility because the facility does not have a dementia program. A technical violation advisory was issued during the visit. A copy of this report was provided to the Executive Director.

While at the facility investigating a complaint (Control # 15-AS-20240311152642), Licensing Program Analyst (LPA) Delmundo observed the laundry room where laundry supplies are kept was unlocked. LPA informed staff, Gendelle Nebril Camarillo who was on the floor at the time. LPA also informed Lisa Lostica. Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with the Jeralyn May. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.

...Continued from 9099 The facility informed R1 and family that they are not a medical facility and are unable to care for the wounds of this seriousness. The facility said that they could wait for the wound to heal for R1 return or to obtain hospice services to care for the wound. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED . Exit interview conducted and a copy of this report provided.

Allegation: Staff are not assisting residents with transfers as needed Investigation Finding: Unsubstantiated During investigation, LPA observed resident’s (R1) level of care assessment (Level 2) dated 11/24/21 show R1 is able to transfer independently and ambulates independently with or without an assistive device. Other residents stated that staff always assist them when needed. Based on interviews and record reviews which were conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff are not assisting residents with transfers as needed is unsubstantiated. Allegation: Staff are not checking on residents as needed Investigation Finding: Unsubstantiated During investigation, LPA observed residents have a call button to use whenever they need staff assistance. Staff (ADM, S2) stated residents are checked at least 3 times per day when they perform their residents’ status checks. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that staff are not checking on residents as needed is unsubstantiated. Allegation: Impaired staff puts residents at risk Investigation Finding: Unsubstantiated During investigation, staff (ADM, S2) denied any staff being impaired on the job. Random interviews with residents (R2, R3, R5) confirm they did not observe any impaired staff on duty. Based on interviews and record reviews which were conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation that impaired staff puts residents at risk is unsubstantiated. Exit Interview conducted and a copy of this report provided.

On 01/18/2024 at 12:00pm Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a case management visit to follow-up on a death report received by Community Care Licensing that was faxed on 11/10/2023. LPA met with Executive Director, Adiam Welday and explained the purpose of the visit. R1 passed away on 11/02/2023 with an unknown cause of death. Administrator stated that R1 had episodes of collapsing while R1 was with the family. R1 stated that the family is the one that reported the collapsing per the Death Report. Administrator stated that no one at the facility witnessed the collapsing. During today's visit LPA obtained additional information pertaining to R1's death: Physician's Report Resident Assessment Face Sheet Assessment for Medication Self-Management Needs and Services Plan Internal Incident Report 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-C Continued... LPA requested from facility a copy of R1's death certificate. LPA was informed by Administrator that they phoned the family and left a message requesting the death certificate. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided

On 2/15/23 at 3:55 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver amended report for the allegation of facility is in disrepair (see LIC9099C dated 1/17/23). LPA met with Administrator, Gilbert Castro and explained the purpose of the visit. Amended report delivered to administrator. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Continue from LIC9099 Staff did not secure resident's medications as required. Interview and observation revealed that Med Techs (Medical Technicians) pre-pour medication into medication cups with resident’s apartment numbers written on them. S1 stated that when passing morning and bedtime medication that medication is poured into medication cups with room numbers on them, they are placed into a basket and put onto an unlocked pushcart and distributed to residents in their apartments. Allegation is SUBSTANTIATED Based on LPA observations, record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. Appeal rights and a copy of this report provided. 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 Continue from LIC9099 Staff did not administer medications as prescribed. RP stated that R1 was given a wrong dose of medication, b ased on information obtained from the MAR (medication administration record) shows that R1 received the correct dosage, the MAR was signed by staff or documented R1 was out of facility along with the dates. Allegation is UNSUBSTANTIATED. Staff did not properly document resident's medication as required. LPA conducted record reviewed and interviews with staff, the MAR (medication administration record) shows medication was given as prescribed. During interviews staff stated that there was no wrong documentation during R1’s residency at the facility. Allegation is UNSUBSTANTIATED. Staff are not properly trained. LPA conducted interviews and record review which revealed Med Techs (Medical Technicians) attend an online training that covers administering medications such as Introduction to Medication Management, Medication Order and Working with the Pharmacy Reducing Medication Errors: PRN Medications and then complete and pass Medication Management Final Test, and then take and pass a RCFE Medication Orientation Final Exam and then on to on-the-job training. Allegation is UNSUBSTANTIATED 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 conduct and a copy of report provided to Administrator.

All five residents confirmed S2's statement that their rooms do not have air conditioning unit. Four out of five residents indicated they don't have problem with the temperature in their rooms. R3 stated the temperature in R3's room would at times be hot and uncomfortable but R3 has electric fan to cool off the room. LPA tested the temperature in the common area and in one of the resident's room, and measured at 72.9 and 81.9 degrees Fahrenheit respectively. Based on all the information obtained, the allegation is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted and copy of this report provided to Lisa Lostica.

On 1/26/23 at 1:45 p.m. ,Licensing Program Analyst (LPA) Greg Clark arrived unannounced to further investigate the the allegation of facility in disrepair. LPA met with Gilbert Castro, Administrator and explained the purpose of the visit. During the investigation LPA conducted interviews, and randomly selected six apartments for inspection. LPA observed the ceiling and walls in one of the residents' apartments with water damage. Residents in the apartment confirmed that there water was leaking into their apartment during the last storm. Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the case management note dated 1/26/23. Exit interview conducted, a copy of this report and appeal rights provided.

On this day, May 4, 2022. while at the facility for investigation of complaint (15-AS-20220428123317), Licensing Program Analyst (LPA) Delmundo learned that an individual in the facility was tested for COVID-19 with a positive result on April 26, 2022. The case was not reported to Community Care Licensing (CCL) and Local Public Health (LPH) which LPA confirmed with Executive Director Gilbert Castro. LPA also learned from a resident that the shower head fixture holder in the apartment is broken. LPA also learned during interview of staff that the P-trap in one of the apartments' sink is clogged. Deficiencies are cited per Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of corrections by plan of correction due dates and any repeat violations within 12 month period may result in civil penalty. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided to Lisa Lostica at the conclusion of exit interview.

On 1/25/2023 at 1:18 PM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct an annual Infection Control Inspection. LPA met with Administrator, GIbert Castro and explained the purpose of the visit. During the Infection Control Inspection, LPA toured facility with Gilbert including but not limited to front entrance, screening station, hand washing stations, bedrooms, dinning room, kitchen, and courtyard. Facility has a sufficient 2 day perishable and one week non-perishable food supply. Visitors policy is posted on the front entrance. A sign-in policy, Covid questionnaires, thermometer and hand sanitizer were observed at screening station. Hand washing posters were observed. Common touched surfaces are disinfected at least once daily. Bathrooms are equipped with liquid soap, paper towel and trash bins with touchless lids. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff . Facility has a mitigation plan and maintains record of routine screening for residents and staff. Smoke and carbon monoxide detectors were observed and are connected to the sprinkler system. First Aid kit was complete. Fire extinguishers was observed serviced. LPA observed facility passages inside and out free of obstruction. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Residents are equipped with a call button that they wear on their necks, which when pressed the staff are alerted. R1 would not use the call button. Staff were aware that R1 would not use call button, rather would transfer alone. According to staff interviews, they were not sure if R1 was able to comprehend the purpose of the call button. R1 was diagnosed with Dementia on 02/07/2017. However, staff interviewed state they were unaware of R1’s Dementia diagnosis. The above allegation is substantiated. A $500 immediate civil penalty is assessed on this day for violation which resulted to the injury of R1. Civil penalty determination related to serious bodily injury is pending. Allegation: Facility did not provide resident’s representative with proper notification of eviction On 3/2/2022, LPA Luisa Fontanilla interviewed Lisa Lostica, Business Office Manager (BOM). BOM states there was no eviction letter issued to R1. R1’s change in condition prohibits facility from taking R1 back. Based on records reviewed, facility did not take R1 back due to R1 needing two persons to assist, R1 not participating in caregiver ADL assistance and that R1 was diagnosed with Dementia. And that the facility is not a dementia facility. However, facility failed to provide LPA reassessment record. On 3/15/22, LPA L. Fontanilla reviewed R1’s Admission Agreement signed by R1’s responsible person on 3/9/2013. LPA observed Xlll Basic Services Section S states “Dementia Services. The Community features a specialized Memory Care Program that is designed for those Residents with Alzheimer’s disease or related Dementias………” This allegation is substantiated. Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099 D. Exit interview conducted with Senior Business Office Manager. LIC9099D, Appeal Rights and a copy of this report provided.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to provide the alleged violation did occur, therefore the allegation are unsubstantiated. No deficiencies cited. Technical assistance provided. Exit interview conducted and a copy of this report provided to administrator.

On 4/18/2022, Licensing Program Analyst (LPA) C. Lin conducted a case management visit while delivering complaint investigation findings, and met with the Senior Business Office Manager, Lisa Lostica, LPA explained the purpose of the visit. During an investigation conducted by the Department, records obtained indicate that R1 had multiple falls between 09/2019 and 02/2020. On 02/07/2017, the resident was diagnosed with Dementia. There is no documentation to show that the facility conducted reassessment of the resident. The resident’s Appraisal Needs and Services Plan is not updated for changes in condition. Staff interviewed state they were unaware of R1’s Dementia diagnosis. A deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalty. Exit interview conducted with xxxx. A copy of this report and Appeal Rights was provided.