Aldersly.

Continued from LIC9099 Review of R1’s pre-appraisal dated 10/20/2025 stated that R1 did not have any known behaviors of aggression or violence. Review of R1’s medication list stated that they have a PRN or “as needed” medication for agitation or delirium. Review of R1’s medication authorization record showed that R1 received their PRN for agitation on 10/25/2025. There was no record of R1 receiving their PRN medication for agitation on 10/24/2025 as written in the facility communication log. Review of R1’s communication log indicated that R1 moved to the facility on 10/24/2025. Review of documentation for 10/24/2025 – 10/26/2025 showed that R1 was noted to be restless and agitated. Communication log noted that on 10/26/2025, R1 hit staff when they tried to provide incontinence care. R1’s communication log also stated that R1 was provided their PRN or “as needed” medication for agitation on 10/24/2025 and 10/25/2025. Email correspondence provided to the Department corroborated this information and noted that facility staff attempted to give R1 their PRN medication for agitation but spit it out on 10/26/2025, Interview conducted with Health and Wellness Director (HWD) stated that the facility was not capable of caring for R1 because they required a higher level of care. Per interview, a reassessment for R1 was done and R1’s responsible party was informed in-person and via telephone of the new behaviors being observed at the facility. Interview further revealed that it was discussed to have additional private caregivers to help assist with R1’s behaviors. Per HWD, the process of eviction was not discussed because R1’s responsible party decided to move them out of the facility. Interview conducted with Memory Care Coordinator (MCC) stated that they contacted R1’s responsible party multiple times a day to inform them of R1’s observed behaviors such as throwing furniture or running at residents. Interviews conducted with HWD and MCC revealed that these conversations with R1’s responsible party were not documented or written anywhere because the events happened very quickly over the course of a few days. Interview conducted with R1’s responsible party stated that R1 did not have any behaviors while living at home and that facility informed them of R1’s behaviors such as throwing food and being violent towards facility staff a few days after they moved to the facility. Per interview, the facility did not discuss with them about R1 requiring a higher level of care or needing additional caregivers for help. Per interview, no additional documents regarding R1 and their care were reviewed or signed apart from the admissions agreement. Review of R1’s file showed that facility conducted a reassessment on 10/30/2025 for R1 regarding their observed behaviors of aggression and violence. It was observed that this reassessment was not signed by Continued on LIC9099C 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 LIC9099C their responsible party acknowledging the changes in care. Review of facility notes stated that R1 went to the hospital on 10/29/2025. Notes further state that R1 was no longer receiving services on 10/31/2025. There are no additional documentation or notes proving that the facility contacted R1’s responsible party to discuss the changes in care or behaviors. It was also observed that R1, their responsible party, and Community Care Licensing (CCL) did not receive a 30-day eviction notice as required by regulation. Title 22 Regulations under Eviction Procedures, 87224(a)(4) states, “87224 Eviction Procedures: (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required… (4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident." Based on interviews conducted, record review and observations made, these allegations are Substantiated . A finding that the Complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, Plan of Corrections, and Appeal Rights, discussed and provided to Executive Director. Signature on form confirms receipt of documents. 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 LIC9099 Based on documents reviewed, this allegation is Unsubstantiated . A finding that the complaint is Unsubstantiated means that 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. Exit interview conducted. Copy of report discussed and provided to Health and Wellness Director. Signature on form confirms receipt of documents.

At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required Visit, and met with Business Office Manager, Eliana Lopez, and Health and Wellness Director, Melanie Fenn. Facility has an approved fire clearance and total capacity of 172 Non-Ambulatory Residents, where 12 can be bedridden. Facility has an approved hospice waiver for 8 individuals. Facility provides care and assistance to Older Adults in Assisted Living and Memory Care. Facility has a plan of operation for dementia care and programming on file. Upon arrival, LPA was informed that there were 14 residents in Assisted Living, 17 residents in Memory Care, 3 residents in Extended Care, and 48 Independent Living residents for a total of 82 residents in care. LPA was also informed that there were 27 staff members on-site. LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA finished review of staff files and resident files. All files were well organized and contained the required documentation. LPA reviewed 6 resident medications. LPA observed that 1 of 6 residents had 3 medications that were not centrally stored as required (deficiency cited, regulation 87465(h)(6)). During medication review in Extended Care, LPA observed that the medication cart keys were accessible and the cart itself was unlocked and accessible to guests and residents in care (deficiency cited, 87465(h)(2)). LPA also observed that noon medications were pre-poured in Memory Care. Per discussion with Medication Technician, the noon medications were poured at around 9AM (technical violation issued, LIC9102, regulation 87465(h)(5)). Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), LIC9102 (Technical Violation/Advisories) Plan of Corrections, and Appeal Rights discussed and provided to Health and Wellness Director. Signature on form confirms receipt of documents.

At approximately 8:30AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a 1 Year Required Visit, and met with Resident Care Manager, Sourabh Singh . Executive Director, Mike Sharkey, arrived during visit at approximately 1:00PM. Facility has an approved fire clearance and total capacity of 172 Non-Ambulatory Residents, where 12 can be bedridden. Facility has an approved hospice waiver for 8 individuals. Facility provides care and assistance to Older Adults in Assisted Living and Memory Care. Facility has a plan of operation for dementia care and programming on file. Upon arrival, LPA was informed that there were 13 residents in Assisted Living, 15 residents in Memory Care, 3 residents in Extended Care, and 45 Independent Living residents for a total of 76 residents in care. LPA was also informed that there were 22 staff members on-site. At approximately 9:00AM, LPA reviewed the Facility's Staff Roster with Resident Care Manager and found that all staff members on site were background cleared and associated to the facility per regulation. LPA followed up on an incident report that was self-submitted to Community Care Licensing (CCL). Incident Report 1/SOC-341: CCL received an incident report and SOC-341 report from the facility on 10/02/2025. Reports stated that on 10/01/2025, Facility's Safely You Video System alerted Staff Member 1 (S1) of Resident 1 (R1) having a fall but they did not check on R1 until 2 hours later. Reports further stated that R1 did not have any injuries due to the fall and S1 was terminated following the incident. Facility made all appropriate notifications per regulation. LPA obtained documents related to the incident. 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 LPA conducted a walk-though of the facility with Resident Care Manager and Executive Director and observed the following: Facility consists of multiple buildings for Assisted Living and Memory Care. Facility has an Extended Care unit which is a separate wing for Assisted Living residents that require a higher level of care. Facility also has independent living units on the property. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has a Infection Control Plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to residents. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Mattress pads were in place or available for Resident use. Hot water temperatures for a sample size of 9 sinks were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility's fire extinguishers were last inspected December 2024. Facility smoke detectors are hard wired and connect directly to the local fire station. Facility's sprinkler system were last inspected August 2025. Facility's last emergency/disaster drill was conducted September 2025. LPA began resident file review. LPA unable to complete Annual Visit. Annual Continuation Visit to be conducted at a later date. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC809D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Executive Director and Resident Care Manager. Signature on form confirms receipt of documents.

At approximately 10:20AM, Licensing Program Analysts (LPA) Felias arrived unannounced to conduct a 1 Year Required Visit, and met with Executive Director/Administrator, Shannon Brown, and Health and Wellness Nurse, Melanie Fenn. Facility provides care and assistance to Older Adults in Assisted Living and Memory Care. Facility has a plan of operation for dementia care and programming on file. Upon arrival, LPA was informed that there were 35 residents in Assisted Living and Memory Care with 28 Independent Living residents for a total of 63 residents in care. LPA was also informed that there were 26 staff members on-site. At approximately 10:45AM, LPA reviewed the Facility's Staff Roster with Health and Wellness Nurse and found that all staff members on site were background cleared and associated to the facility per regulation. At approximately 11:30AM, LPA conducted a walk-though of the facility with Health and Wellness Nurse and observed the following: Facility consists of multiple buildings for Assisted Living and Memory Care. Facility has an Extended Care unit which is a separate wing for Assisted Living residents that require a higher level of care. Facility also has independent living units on the property. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has a Infection Control Plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to residents. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Mattress pads were in place or available for Resident use. Hot water temperatures for a sample size of 8 sinks were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility's fire extinguishers were last inspected January 2024. Facility smoke detectors are hard wired and connect directly to the local fire station. Facility's smoke and carbon monoxide detectors and sprinkler system were last inspected January and August 2024. Facility's last emergency/disaster drill was conducted September 2024. LPA followed up on incident reports that were self-submitted to Community Care Licensing (CCL). 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 Incident Report 1: CCL received an incident report from the facility on 05/03/2024. Report states that on 05/02/2024, Resident 1 (R1) was found outside on facility grounds by the Assisted Living building. Facility made all appropriate notifications per regulation. Review of R1's physician's report and care plan indicates that they are unable to leave unassisted but they do not have a dementia diagnosis. Incident Report 2: CCL received an incident report from facility on 06/19/2024. Report states that on 06/19/2024, Resident 2 (R2) was found on the floor. R2 was not observed to have any visible injury. Facility staff observed that R2 seemed to have had alcohol and found wine in R2's room. Facility identified that the wine was brought in by R2's family. Facility made all appropriate notifications per regulation. Review of R2's physician report indicates that they have a diagnosis of mild cognitive impairment. Incident Report 3: CCL received an incident report from the facility on 08/26/2024. Report states that on 08/26/2024, Resident 3 (R3) was found outside across the street. Per report, facility alarm system and R3's wander bracelet was operational and functional during incident. Facility identified that the garden exit was inoperable and needed a new lock. Facility had maintenance examine and secure the identified exit. Facility made all appropriate notifications per regulation. Review of R3's physician's report and care plan indicates they are unable to leave unassisted and has a dementia diagnosis (deficiency cited, see LIC809D and LIC421IM, Regulation 87705(b)(2)). At approximately 1:10PM, LPA reviewed resident files. Resident Files were all found to be well organized, thorough and contained the required documentation. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. **A Civil Penalty in the amount of $1,000.00 is being issued today due to a repeat violation of Regulation 87705(b)(2) within a 12-month period. (See LIC421IM).** LPA unable to complete Annual visit. Annual Continuation visit to be conducted at a later date. Exit interview conducted. Copy of report, LIC809D, LIC421IM (civil penalty), LIC811 (Confidential Names), Plan of Corrections Letter, and Appeal Rights discussed and provided to Health and Wellness Nurse. Signature on form confirms receipt of documents.

An Informal meeting was conducted today in the Santa Rosa Regional Office. Present in the meeting were Licensing Program Manager (LPM) Kimberley Mota, Licensing Program Analyst (LPA), Caitlynn Felias, and Administrator/Executive Director, Shannon Brown, and Health and Wellness Director, Melanie Fenn. The purpose of the Informal meeting was to address an incident that occurred on 09/13/2023 where Resident 1 (R1) went missing during a community outing at approximately 12:45PM. R1 was found safe in a nearby neighborhood at approximately 7:45PM. Items addressed during today’s meeting: · Facility’s procedures regarding community outings, resident elopements and absence without leaves (AWOLs) · Staff Training for residents with dementia and elopements · Incident Report received by Community Care Licensing (CCL) on 10/16/2023. Incident Report received stated that Resident 2 (R2) eloped from the facility on 10/15/2023. R2 was found by local police approximately two blocks away from the facility. Facility made all notifications per regulation. Review of R2’s Physician Report and Care Plan indicated that they are unable to leave the facility unassisted (This deficiency has been cited, see LIC809D and LIC421IM, Regulation 87705(b)(2)). Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. **A Civil Penalty in the amount of $1,000.00 is being issued today due to a repeat violation of Regulation 87705(b)(2) within a 12-month period. (See LIC421IM).** Exit interview conducted. Copy of report, LIC809D, LIC421IM, LIC811 (Confidential Names), Plan of Corrections, and Appeal Rights discussed and provided to Administrator/Executive Director. Signature on form confirms receipt of documents.

At approximately 10:15AM, Licensing Program Analysts (LPAs) Felias and Rummonds arrived unannounced to conduct a 1 Year Required Visit, and met with Executive Director/Administrator, Shannon Brown. Facility provides care and assistance to Older Adults in Assisted Living and Memory Care. Facility has a plan of operation for dementia care and programming on file. Upon arrival, LPAs were informed that there were 34 residents in Assisted Living and Memory Care with 37 Independent Living residents for a total of 71 residents in care. LPAs were also informed that there were 21 staff members on-site. At approximately 10:30AM, LPAs reviewed the Facility's Staff Roster with Administrator and found that all staff members on site were background cleared and associated to the facility per regulation. At approximately 11:00AM, LPAs conducted a walk-though of the facility with Administrator and observed the following: Facility consists of multiple buildings for Assisted Living and Memory Care. Facility has an Extended Care unit which is a separate wing for Older Adults that require a higher level of care. Facility also has independent living units on the property. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has a infection control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Toxins were observed to be stored inaccessible to residents. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Mattress pads were in place or available for Resident use. Hot water temperatures for a sample size of 8 sinks were found to be within Title 22 regulations of 105 to 120 degrees Fahrenheit. Facility's fire extinguishers were last inspected January 2023. Facility smoke detectors are hard wired and connect directly to the local fire station. Facility's smoke and carbon monoxide detectors and sprinkler system were last inspected November 2022 and January 2023. Facility's last fire drill was conducted on July 2023. At approximately 12:45PM, LPAs reviewed a sample size of 3 resident files. Resident Files were all found to be well organized, thorough and contained the required documentation. 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 LPAs also followed up on a self-reported incident that was submitted to Community Care Licensing (CCL). incident Report 1: On 9/13/2023, CCL was verbally informed that the facility was searching for Resident 1 (R1) who had disappeared during a community outing to the local zoo. CCL received an update that evening stating that R1 had been located and was safe. Facility submitted an incident report on 09/15/2023 regarding the incident and made all appropriate notifications per regulation. LPAs discussed R1 with Executive Director, and reviewed documents. Per conversation with Executive Director, R1 was apart of a community outing to the zoo that consisted of 3 staff members and 5 residents. At approximately 12:30PM, facility staff took R1 and 3 other residents to the bathroom. Facility staff then provided the residents with lunch. At approximately 1:30PM, facility staff observed that R1 was no longer with the group when they were boarding the bus. Facility staff contacted zoo personnel and police to review security footage. Facility staff and police observed that R1 exited the zoo premises at approximately 12:45PM. At approximately 3:00PM, facility staff notified Executive Director and Health and Wellness Director of the situation who headed to the zoo's location to assist in the search. At approximately 7:45PM, R1 was found safe and unharmed in a nearby neighborhood. Since returning to the facility, R1 has been observed to be at their baseline. Facility conducted an inservice training reviewing dementia elopements and AWOLs. Facility has also implemented new procedures regarding community outings. Per review of R1's Physician's Report, they are unable to leave the facility unassisted or without staff supervision (This deficiency has been cited, see LIC809D, Regulation 87705(b)(2). Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Facility provided LPAs with In-service training materials and documentation. Deficiency cited today for Regulation 87705(b)(2) has been cleared during today's visit. **An informal meeting has been scheduled for October 18th, 2023, between the Facility and the Department. LPAs unable to complete Annual visit. Annual Continuation visit to be conducted at a later date. Exit interview conducted. Copy of report, LIC809D, LIC811 (Confidential Names), Plan of Corrections, and Appeal Rights discussed and provided to Executive Director. Signature on form confirms receipt of documents.