Atria Hillcrest.

Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit at 10:00 a.m. Upon arrival LPA was greeted by front door receptionist and explained the reason for the visit. The LPA met with Executive Director (ED) Ramon Pagels and reason for the visit was explained. Entrance interview. Starting at 10:40 a.m. the LPA and ED toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was noted: The facility is a three-story building that consists of a secured memory care unit on the second floor and an assisted living unit. The facility is fire cleared for a capacity of 207 residents age 60 and over of which all may be non- ambulatory. Dementia wing rooms 240 to 258 approved for delayed egress. Hospice waiver for ten (10). LPA observed fire extinguishers throughout the facility, which were fully charged and last serviced on 01/02/2026. LPA observed all the required postings in the Mail Room near the entrance and throughout the facility. The facility maintained a comfortable temperature throughout the visit. Common Areas: This includes the mail room, living room. library, bistro, dining room, private dining room, activity room, theater, fitness center, salon, technology center, wellness center and laundry rooms. Each floor has its own laundry room. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Fireplaces were properly screened. Facility elevators were operating properly. There are five (5) stairwells that all have emergency evacuation chairs on the third floor. Report Continued on LIC 809-C PAGE 2 ... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (PAGE 2) Report Continued from LIC 809-C... Surrounding Grounds (Outdoors) : The LPA observed appropriate outdoor furniture, with a covered shaded area for residents in both, the memory care unit courtyard and the assisted living courtyard. Parking is available for residents and visitors. LPA observed the facility generator adjacent to the entrance of the facility. LPA observed the facility main water and gas shut offs. LPA observed the designated smoking area, along with a putting green. Delayed egress doors checked and were operable at the time of visit. Activities: Planned activities are offered, and the activity schedule was posted, and is provided to the residents on a weekly basis. Activity rooms and common spaces appeared clean and in good repair. LPA observed residents engaged in both the Assisted living and in Memory care. Kitchen : The kitchen appeared clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. The menu was posted and copies are available for residents. The menu is reviewed regularly by a dietician with the last review on 10/09/2025. The facility offers daily specials and a standard selection at every meal. Appliances appeared to be in operable condition. Snacks and beverages are available for residents in the Bistro. Knives are stored and inaccessible to residents. Refrigerator and food pantry were checked for proper labels and expiration dates. Bedrooms: There are one hundred thirty six (136) total apartments in the facility, one hundred seventeen (117) assisted living and nineteen (19) in memory care. There are resident rooms on all three (3) floors, units are designated for assisted living residents on all three (3) floors and a separate unit on the second floor is designated for residents in the memory care unit. There were no obstructions and/or tripping hazards observed. LPA observed sixteen (16) randomly selected resident bedrooms, of which twelve (12) in assisted living and four (4) in memory care. All resident bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. All passageways were observed to be clear of obstructions. Report 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 (PAGE 3) Report Continued from LIC 809-C PAGE 2... Restrooms: LPA observed resident restrooms along with common / community restrooms. Resident restrooms appeared clean, sanitary and in operating condition with grab bars and to be equipped with a slip resistant surface / mat. The restrooms were sufficiently stocked with supplies and paper towels. Towels and washcloths are not shared among the rooms. The hot water temperature was measured and ranged between 110.2 - 115.2 degrees Fahrenheit all within the required range. Medication Audit: There are two (2) medication rooms / wellness centers in the facility. One on the first floor for assisted living and one on the second floor for memory care unit. Med Techs distribute medication at the appropriate times to residents in care. Medication audit for ten (10) residents was conducted. Eight (8) in the Assisted Living Unit and two (2) in the Memory Care Unit. The following was observed. The medications were stored in the medication rooms in carts, both were locked and inaccessible to the residents. Medications are labeled and checked for expiration dates. All medications including PRNs were labeled, stored, and locked inaccessible to residents in care. Medications reviewed were found to be self-administered as prescribed. During the medication review LPA observed four (4) out of ten (10) along with other residents with start dates missing on the centrally stored medication and destruction record. LPA advised Med Techs the importance of proper documentation to ensure medication audit and count it correct. Med Tech and supervisor agreed to conduct an internal audit to ensure all records have the start date document on the centrally stored medication and destruction record. DOCUMENTS: Documents obtained during the visit include: Staff roster and a Resident roster. Due to time constraints the LPA will return to complete the annual at a later date. Exit interview conducted. Copy of report reviewed and provided.

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced Case Management – Incident visit at 9:45 a.m., LPA met with Executive Director (ED), Remon Pagels and explained the reason for the visit. Entrance interview conducted. The Department received two (2) self reported incident reports and a subsequent incident death report regarding Resident #1 (R1) on 12/12/2025, 12/14/2025 and 01/06/2026. On 02/03/2026 a referral was made to Community Care Licensing Division's (CCLD) Investigation Branch (IB) and Investigator Veronica Padilla has been assigned to the incident investigation. During today’s visit, LPA and ED conducted a physical plant tour to ensure there are no immediate health and safety concerns, conducted a brief in-person interview with the ED, a file / record review for R1 along with obtained copies of pertinent documents relevant to the incidents. No immediate health and safety concerns were observed during today's visit. Further investigation is required. Exit interview conducted. Report was reviewed and a copy was provided.

Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent Case Management – Incident visit at 9:55 a.m., The LPA met with Executive Director (ED), Remon Pagels and explained the reason for the visit. Entrance interview conducted. The Department received a self-reported incident report and a subsequent incident death report regarding Resident #1 (R1) on 05/12/2025 and 05/13/2025. Incident report indicated that on 05/11/2025 at approx. 9 a.m. Staff #1 (S1) called the front desk for assistance as they saw R1 on the floor in the parking lot on their way into work that morning. S1 and Staff #2 (S2) went to assist R1 and R1 was bleeding from the head and 911 was called. Paramedics informed staff to lay R1 on their back. At this time S1 and S2 noticed a firearm in between R1 legs / crotch area. Paramedics arrived on scene and transported R1 to the hospital. Police arrived on scene and conducted their investigation. Family and primary care physician notified. On 05/13/2025 LPA's Mosley and Kelly Dulek conducted the initial unannounced visit. During the visit LPAs conducted a physical plant tour to ensure there were no immediate health and safety concerns, conducted an in-person interview with the ED, a file review for R1 along with obtained copies of pertinent documents relevant to the incident. On 05/27/2025 LPA Mosley requested the related police report from Ventura County Sheriff’s Office (VCSO) and received the report on 06/05/2025. On 06/04/2025 LPAs Mosley and Dulek conducted a subsequent visit. During the visit LPAs conducted a physical plant tour to ensure there were no immediate health and safety concerns, conducted in-person interviews with the ED, six (6) staff, attempted three (3) resident interviews, conducted two (2) resident interviews along with obtained copies of pertinent documents relevant to the incident. Report continued on LIC 809-C PAGE 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (PAGE 2) Report continued from LIC 809 Record review revealed that R1 had lived at the facility since 10/31/2024. R1 was on level 0 of level of care, indicating that at the time of move in R1’s comprehensive assessment indicated that R1 did not require personal care services offered by the facility. R1 was able to leave the facility unassisted. R1 did not have a history of suicide attempts/suicidal ideation. Interviews with the ED revealed that R1 was fully independent, still drove their personal vehicle, and had no changes in condition or care other than some recent falls. R1 would often sign themselves out and leave the community in their personal vehicle. The facility strictly prohibits firearms and there was no indication that R1 possessed a firearm. The resident had not exhibited signs of unhappiness or distress. When the ED spoke to R1 on 05/09/25 and 05/10/25 they appeared to be their usual self. R1 maintained a wide network of outside friends and was known to be friendly and communicative with staff. Interviews with staff revealed that R1 was highly independent and rarely needed help from staff. Staff were familiar with R1 but had limited direct interaction with R1 due to their high level of independence. Police report indicated that there was no evidence of foul play or suspicious activity, and the cause of death was suicide. No deficiencies are being cited at this time pertaining to this self-reported incident and death report. Exit interview conducted and a copy of report was provided.

Licensing Program Analysts (LPA’s) Erica Mosley and Kelly Dulek conducted an unannounced Case Management – Incident visit at 11:00 a.m., The LPA’s met with Executive Director (ED), Remon Pagels and explained the reason for the visit. Entrance interview conducted. The Department received a self reported incident report and a subsequent incident death report regarding Resident #1 (R1) on 05/12/2025 and 05/13/2025. During today’s visit, LPA's conducted a physical plant tour to ensure there are no immediate health and safety concerns, conducted in-person interviews with the Executive Director (ED), six (6) staff members, attempted three (3) resident interviews, conducted two (2) resident interviews along with obtained copies of pertinent documents relevant to the incident. If further investigation is needed the LPA will return at a later date. Exit interview conducted. Report was reviewed and a copy was provided.

Licensing Program Analysts (LPA’s) Erica Mosley and Kelly Dulek conducted an unannounced Case Management – Incident visit at 11:45 a.m., The LPA’s met with Executive Director (ED), Remon Pagels and explained the reason for the visit. Entrance interview conducted. The Department received a self reported incident report and a subsequent incident death report regarding Resident #1 (R1) on 05/12/2025 and 05/13/2025 a referral was made to Community Care Licensing Division's (CCLD) Investigation Branch (IB). During today’s visit, LPA's conducted a physical plant tour to ensure there are no immediate health and safety concerns, conducted an in-person interview with the Executive Director (ED), a file review for R1 along with obtained copies of pertinent documents relevant to the incident. If further investigation is needed the LPA will return at a later date. Exit interview conducted. Report was reviewed and a copy was provided.

Licensing Program Analyst (LPA) Kelly Dulek arrived unannounced to conduct a required annual visit. The LPA met with Executive Director (ED) Remon Pagels and reason for the visit was explained. Beginning at 10:45AM, the LPA and Maintenance Director Hector Arjon toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. The following was observed: Common Areas: The facility is a three-story building. Facility elevators were operating properly. There are three stairwells that all have emergency evacuation chairs on the third floor. There are resident rooms on all three floors, units are designated for assisted living residents on all three floors and a separate unit on the second floor is designated for residents in the memory care unit. There were no obstructions and/or tripping hazards observed. The facility maintained a comfortable temperature throughout the visit. The fire extinguishers were charged and last serviced 01/06/2025. Various rooms' smoke detectors and common area carbon monoxide detectors were tested during today's visit; all tested were functional. The facility uses Johnson Controls to inspect their fire suppression system with the last annual inspection completed 06/06/2024; 5-year inspection was completed on 10/11/2021. A fire and life safety inspection was conducted by Ventura County Fire Department on 07/23/2024 and no violations were noted. Required postings were observed on the first floor. Activities: Planned activities are offered, and the activity schedule was posted, and is provided to the residents on a weekly basis. Activity rooms and common spaces appeared clean and in good repair. There is a movie theater, hair salon and exercise/therapy room for residents use. Report 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 Kitchen: At the time of the visit, there was a sufficient supply of perishable and nonperishable food. The facility also has an emergency supply of food and water. The menu was posted and copies are available for residents. The menu is reviewed regularly by a dietician with the last review 10/03/2024. The facility offers daily specials and a standard selection at every meal. Appliances appeared to be in operable condition. Resident Rooms: The LPA toured 12 (twelve) randomly selected resident rooms (both the memory care and assisted living unit). Rooms appeared well kept, with sufficient lighting and appropriately furnished. Restrooms: Resident restrooms observed to be fully stocked with supplies; grab bars and slip resistant surfaces. The water temperature was tested on all floors in various resident rooms and water temperature ranged from 107.7 to 115.2 degrees Fahrenheit. Outside Areas: The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There was an enclosed patio for residents whom reside in the memory care unit on the second floor. Delayed egress doors checked and were operable at the time of visit. Interviews: LPA interviewed 6 (six) residents and 3 (three) staff during the visit. No concerns were noted. Record Review: Record review began at 01:13PM. The LPA reviewed 5 (five) resident files for, but not limited to: admissions agreements, medical assessment, updated appraisals. Resident records reviewed were in order at this time. The LPA reviewed 5 (five) staff files for items including but not limited to: health assessments, TB results, criminal record statements and clearances, first aid/CPR certification. Staff files reviewed were in compliance with regulation at this time. Medication: Medications review began at 02:50PM in Assisted Living and 03:45PM in Memory Care. The LPA reviewed medications for 2 (two) residents. Medications are maintained locked inaccessible to residents in medication carts in the Medication Room. Resident medications reviewed were documented and stored in compliance with regulation at this time. Infection Control/Emergency Disaster Plan: LPA reviewed the facility's infection control plan and Emergency Disaster plan. Both documents were observed to be completed and updated annually as required. Facility conducts emergency disaster drills as required with the last documented drill 03/01/2025. No deficiencies cited at this time. Exit interview conducted. Copy of today's report was provided.

Staff denied ever confining R1 or any resident of the facility. According to staff and other potential witnesses interviewed, R1 was provided with appropriate care ser vices. Based on the above information gathered, although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “ Resident was confined by staff ” is deemed unsubstantiated at this time. Regarding allegation - Staff did not safeguard resident's funds – It was reported that staff are stealing money from R1. On 03/27/2025, LPA reviewed records from 11:30 a.m. – 12:30 p.m . LPA also conducted interview with three (3) staff and eight random residents from approximately 1:30 p.m. – to 4 p.m. Staff reported that resident funds are not handled by facility staff. Staff denied stealing monies for resident. Random resident interviews did not reveal any financial abuse. Potential witnesses interviewed revealed that R1’s finances were handled by R1's responsible person. Interviews revealed no evidence of any financial abuse. Based on the above information gathered, although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, allegation “Staff did not safeguard resident's funds” is deemed unsubstantiated at this time. Regarding allegations - Staff are attempting to poison resident and Staff mismanaged resident’s medication – It was reported that R1’s was refusing to take medications due to fear of facility "trying to poison R1”. No specifics or identifying information was provided for the allegations. On 05/31/2024 and 03/27/2025, staff were interviewed and denied the allegation. Staff reported that R1 was not consistent with taking medications (amlodipine and Seroquel). Review of R1’s medication records revealed/confirmed that R1 was consistently refusing to take medications; physician and family were aware. Staff and potential witnesses interviewed reported that due to R1 being non-compliant with medications, R1 showed increasing signs of paranoia, delusions and had high blood pressure; resulting in hospitalization (9/2024); later discharged to a Skilled Nursing Facility where R1 passed away in 11/2024. Based on the above information gathered, although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, allegations “Staff are attempting to poison resident and Staff mismanaged resident's medication” are deemed unsubstantiated at this time. Exit interview conducted. Copy of report provided.

LPA Miller reviewed the Admission Agreement executed on 11/9/23. Section 7, states in part, “We will refund to you 80% of the amount (“the Excess”) of the New Resident Services Fee that exceeds $500.00 and we will retain $500.00 plus 20% of the Excess if (A) we have conducted a preadmission appraisal of your condition and you do not move into the Community, or (B) you move into the Community and stay for less than one month.” R1 had a preadmission appraisal and stayed for less than one month. The facility retained only $500.00 of the New Resident Services Fee and did not hold the additional 20% as stipulated in the agreement. A review of the facility financial statements reflect that an accurate refund was issued to R1 and calculated as follows: 80% of $2,895.00 Community Fees = $2,316.00. less $500.00, as outlined in the admission agreement, being $1,816.00. The facility further deducted 1) $309.47 Pro-rated December rent 2) $120.38 Late Fee 3) $350.14 for December Level 5 Care, and 4) $57.21 December Med Lev 1 Care. ($1,816.00 - $309.60 - $120.38 - 350.14 - 57.21 = $978.80, being the balance refunded to R1. LPA Erika Miller interviewed R1’s representative on 1/7/2025, and R1’s representative indicated they did not have an issue with the refund that was provided. 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, therefore the allegation is Unsubstantiated. Allegation: Staff did not provide care services agreed upon. It was alleged that staff did not provide care services as agreed upon in the admission agreement, as the facility did not provide two-person transfer assistance to R1. LPA reviewed Physician’s Report dated 11/14/23, which states R1 is ambulatory, but needs assistance in self-care. LPA reviewed 11/20/23 Functional Needs Assessment, which states R1 is non-ambulatory and uses a walker and wheelchair. Based on the results of the assessment, it was determined that R1 required Level 5 Care, providing up to 17.5 hours of care per week and Med Level 1 Care, that provided for up to two medication passes per day. Facility classified R1’s fall risk as a Stand-By/Remind level of assistance. R1 required limited assistance in bathing/showering, and dressing. R1 also required minimal level of assistance in transfers and escorting. No documents in R1’s file indicate they required two-person transfer assistance. Interview with R1’s representative revealed after R1 moved in, they were informed the facility is not “licensed” to provide a two-person transfer. R1’s representative stated R1 was very weak when they first moved in from the hospital and needed a two-person assist for several days. R1’s representative stated staff “dropped” R1 on the floor three separate times during a wheelchair to bed transfer, but only reported one fall. 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 reviewed files for Unusual Incident Reports on R1 and found no incidents reported during R1’s stay at the facility. Staff confirmed that they were unaware of any falls R1 sustained while at the facility. There was insufficient evidence to support that facility was unable to or failed to provide care as stipulated in the Admission Agreement. The facility is not required to have a specialized license to perform a 2-person assist. 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, therefore the allegation is Unsubstantiated. An exit interview conducted, and a copy of this report issued.

On 05/28/2024, from 11:11 a.m. to 2:30 p.m., LPA Z. Chochian conducted an initial 10-day complaint visit for the above allegations. Upon arrival, LPA Chochian met with the Executive Director (ED), Remon Pagels and explained the reason for the visit. During the visit, the LPA reviewed resident files and gathered information pertinent to the case. On 06/19/2024, from approximately 12:15 p.m. to 2:45 p.m., Investigator Ferris conducted interviews with the Executive Director (ED), staff and residents; on 07/15/2024, from approximately 12:45 p.m. to 3:30 p.m., with R1’s resident representative, attempted an interview with R1, and staff; and on 07/30/2024, at approximately 2:30 p.m., with R1’s Primary Care Physician (PCP) nurse. In addition, the investigator reviewed Los Robles Regional Medical Center hospital records, Affinity Home Health Resources records, and facility file documents related to R1 and the investigation. According to R1’s Physician’s Report, dated 09/19/2023, diagnoses included dementia with confusion and disorientation, aortic stenosis, and urinary incontinence with the ability to follow instructions, communicate needs, and was ambulatory, but unable to bathe self, dress or groom self, or care for own toileting needs. R1 was not prescribed any medications. A review of the Unusual Incident/Injury Report (SIR) dated 02/05/2024, noted R1 tested positive for COVID-19 and placed on 5-day quarantine in apartment. The SIR dated 02/10/2024, noted R1 was sent to the hospital for weakness and that R1 had not eaten in two days or drank any fluids. (During interviews, Staff #1 (S1) denied R1 stopped eating and drinking completely but clarified R1’s intake of food and liquids lessened after R1’s COVID-19 diagnosis and that was what was meant by their statement on the SIR dated 02/10/2024). The SIR dated 02/16/2024, noted R1 was transported to the hospital for confusion. A review of the facility meal attendance reports showed R1 ate on 02/05/2024, (02/06/2024 meal attendance report could not be located), 02/07/2024, 02/08/2024, 02/09/2024, (R1 was hospitalized on 02/10/2024 and returned on 02/15/2024) and was hospitalized again on 02/16/2024 without returning to the facility. The shower/bath log for February 2024, showed R1 was showered on 02/02/2024, 02/06/2024, 02/09/2024, and 02/16/2024. Report Continued on 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 Los Robles Regional Medical Center (LRRMC) records documented, on 02/10/2024, R1 was brought in by ambulance from Atria Hillcrest for evaluation of generalized weakness and increased darkness of urine, onset two days ago. The notes documented R1 had advanced dementia who presented to the emergency department with a recent COVID-19 diagnosis. R1 was admitted for severe sepsis and complicated urinary tract infection (UTI). A malnutrition screen was conducted on 02/12/2024, noting in summary, the nutrition problem was inadequate oral intake and etiology was acute illness and chronic disease with no notations or concerns of neglect and/or lack of care. On 02/15/2024, R1’s Primary Care Physician (PCP) discharged R1 back to the facility. On 02/16/2024, R1 was re-admitted to the LRRMC hospital due to the chief complaint of mental status changes. The hospital notes document “Patient with dementia recent admission post COVID-19 with hypernatremia, AKI, and UTI who presents to the emergency room after discharge. Likely toxic metabolic encephalopathy from UTI and recent hospitalization in setting of advance dementia. Urinalysis is still positive, started Cefepime. Oral intake is adequate, and labs are stable.” On 02/20/2024, R1 was discharged to a skilled nursing facility with a discharge diagnosis of dementia, acute encephalopathy, altered mental status, and history of COVID-19. On the allegation Neglect/Lack of Care: Staff neglected or failed to provide an adequate level of care to Resident #1 (R1) which resulted in R1 developing sepsis from a urinary tract infection while in quarantine for COVID-19. The Department’s investigation did not provide sufficient evidence to substantiate neglect/lack of care. Staff interviewed stated R1’s adult diaper was changed on a regular basis and R1 was checked every two hours. Staff also stated R1’s urine had a strong odor, and R1 was tested for a urinary tract infection with negative results, but they were unable to provide documentation to confirm this information. Affinity Home Health Resources medical records had no notations for concerns of neglect and/or lack of care. Los Robles Regional Medical Center (LRRMC) Hospital medical records had no notations concerning neglect and/or lack of care. Per R1’s resident representative there were no concerns with R1’s care prior to R1’s COVID-19 diagnosis and all issues resulted after R1’s diagnosis and while R1 had COVID-19. Per R1’s Primary Care Physician (PCP), it is possible COVID-19 was a causative factor of the sepsis diagnosis and no concerns of neglect and/or lack of care were reported. There is no evidence to conclusively determine the cause of sepsis, R1 was diagnosed with comorbidities including COVID-19, and there was insufficient evidence to support the allegation, therefore it is deemed Unsubstantiated at this time. Continued on 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 On the allegation Neglect/Lack of Care: Staff neglected or failed to provide an adequate level of care to Resident #1 (R1) resulting in R1 becoming malnourished while in quarantine for COVID-19. The Department’s investigation did not provide sufficient evidence to substantiate neglect/lack of care. Daily meal records showed R1 was provided three meals on a daily basis and per the Executive Director (ED), R1 consumed the food due to no notations made on the meal records that stated otherwise. Staff interviewed stated R1 consumed the food R1 was provided and at no time was R1 denied access to food. Staff stated R1 was less hungry and thirsty during the quarantine but did eat and drink. No notations or concerns of neglect and/or lack of care were noted on the Affinity Home Health Resources medical records. According to LRRMC medical records, a malnutrition screen was conducted on 02/12/2024, noting in summary, the nutrition problem was inadequate oral intake and etiology was acute illness and chronic disease with no notations or concerns of neglect and/or lack of care. Per R1’s resident representative, there were no concerns with R1’s care prior to R1’s COVID-19 diagnosis and all issues resulted after R1’s diagnosis and during R1’s term with COVID-19. Per R1’s PCP, it is possible COVID-19 was a causative factor of the malnutrition diagnosis and no concerns of neglect and/or lack of care were reported. There is no evidence to conclusively determine the cause of malnutrition, R1 was diagnosed with comorbidities including COVID-19, and there was insufficient evidence to support the allegation, therefore it is deemed Unsubstantiated at this time. On the allegation Neglect/Lack of Care: Staff neglected or failed to provide an adequate level of care to Resident #1 (R1) resulting in R1 becoming dehydrated while in quarantine for COVID-19. The Department’s investigation did not provide sufficient evidence to substantiate neglect/lack of care. Staff interviewed stated R1 consumed the fluids R1 was provided and at no time was R1 denied access to fluids. Staff stated R1 was less hungry and thirsty during the quarantine but did eat and drink. Affinity Home Health Resources medical records had no notations of concerns for neglect and/or lack of care. No notations were made concerning neglect and/or lack of care on R1’s LRRMC medical records. Per R1’s resident representative, there were no concerns with R1’s care prior to R1’s COVID-19 diagnosis and all issues resulted after R1’s diagnosis and while R1 had COVID-19. Per R1’s PCP, it is possible COVID-19 was a causative factor of the dehydration diagnosis and no concerns of neglect and/or lack of care were reported. There is no evidence to conclusively determine the cause of dehydration, R1 was diagnosed with comorbidities including COVID-19, and there was insufficient evidence to support the allegation, therefore it is deemed Unsubstantiated at this time. Continued on 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 This report has been amended to remove allegation "Staff did not provide resident's records to authorized representative." Please refer to report dated 11/18/2024 for supplemental report. No citations issued. Exit interview conducted. A copy of today's report was provided.

Report Continued from LIC 9099... It was alleged that facility is understaffed and unqualified staff are attending residents. It is the complainant’s concern that the memory care unit has been understaffed during the evening shifts leaving one (1) staff member to attend all residents. Additionally, the staff that is being placed in memory care, do not have the training or experience to assist the residents. Record review and interviews conducted revealed that the memory care unit typically has two (2) or three (3) staff which includes caregivers and a medication technician. Per staff schedule, dated January 2024, it confirms that there are at least two (2) staff in the memory care unit for the AM and PM shifts. Additional staff interviews revealed that although staff calls out at times, there is other staff that is able to assist. Staff stated that caregivers from the assisted living side and even outside agency staff are used at times when necessary. Staff added that the front desk clerk and kitchen staff were also used to assist in memory care; however, during interviews it was revealed that staff used from different departments only assisted by escorting residents to and from their rooms before and after meals times. Furthermore, record review of three (3) randomly selected staff hired in February 2024 revealed that staff complete all necessary training through Atria University which is an online based training. Correspondingly, randomly selected staff has completed online training as well as shadowing peers for all the required hours per regulations. And although each department requires different training, all facility staff are first aid trained upon hiring. Based on the information obtained through record review and interviews conducted, the Department does not have sufficient evidence to support the allegations of “facility is understaffed” and “underqualified staff are attending to residents”. Therefore, these allegations are deemed Unsubstantiated at this time. It was also alleged that due to facility staff neglect, incontinent residents are being left in soiled diapers for extended periods of time. It is the complainant’s concern that staff is double briefing residents to limit the times residents are being changed. Interviews conducted with staff revealed that incontinent residents are changed every two (2) to three (3) hours. Staff stated that some residents require changing more often than others and are checked more often to ensure they are not left in soiled diapers. Staff added that they are aware of which residents require more changing as it is placed in the resident’s care plan. Interviews conducted with residents revealed that staff often check on them throughout the day and assist with their toileting needs when requested. Report Continued on LIC 9099C... 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 Report Continued from LIC 9099C... Residents stated that they use their pendants to request for staff assistance and staff usually arrives at a decent time after the request. Furthermore, residents did not report any concerns while living at the facility. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “due to facility staff neglect, incontinent residents are being left in soiled diapers for extended periods of time”. Therefore, this allegation is deemed Unsubstantiated at this time. Exit interview conducted. Report was reviewed and copy issued.

Allegation: " Facility staff not meeting the incontinence needs of the resident(s) in care:" LPAs interviewed both residents and staff in regards to this allegation. Staff interviewed indicated that the facility uses ipods to track the care needs of residents. All residents' care needs are entered into the computer system, then each care staff does carry an ipod that indicates what tasks are assigned for the day. Staff then check off the tasks for each resident as they are completed. Staff interview revealed that they check residents approximately every 2 (two) hours and change residents as needed. If a resident is observed to be wet or soiled, they are changed additional times as needed. During the facility tour in both initial complaint visit and the subsequent visit, no incontinence odors were noted. Care staff interviewed indicated that sometimes residents refuse incontinence care, which is also documented on the ipod as well as reported to management. Residents interviewed felt their incontinence needs are being met and did not note any concerns with the care they receive at the facility. Based on interview and observation, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation "facility staff not meeting the incontinence needs of the resident(s) in care is deemed UNSUBSTANTIATED at this time. Allegation "Facility staff have inadequate training:" LPA Dulek reviewed facility staff records and conducted interviews related to this allegation. Record review revealed that prior to 2023, all training records were documented and recorded on paper copy. Beginning in 2023, staff began completing some initial and ongoing training on the facility's computer system. LPA reviewed both paper documents and printouts from the electronic training system. All staff files reviewed did contain adequate initial and ongoing documented training. Interviews revealed that upon staff hire, staff complete 2 days of computer training, including orientation and training in line with Title 22 regulation. After the 2-days, the staff are then directed to the Department head to schedule additional training, shadowing, and hands on training with seasoned staff prior to beginning work with residents. Based on interview and record review, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation "facility staff have inadequate training" is deemed UNSUBSTANTIATED at this time. No citations issued. Exit interview conducted. A copy of today's report was provided.

On the allegation Staff did not distribute resident's medication as prescribed it is the reporting parties (RP) concern that in or about August 2022 staff only distributed half of Resident#1 (R1) Covid medication, while R1 was quarantined. RP also reported that R1’s Covid medicine was in R1’s kitchen counter. To investigate the allegation, file review and interviews were conducted. File review revealed that R1 could manage their own medication. Furthermore, file review reflected that R1 had been assessed on 11/25/21 to determine their ability to self-manage medications. R1 was able to tell time/day/month, could explain signs/symptoms which would require PRN medication use, demonstrated ability to correctly verbalize time and routes of all medications, demonstrated ability to document, order medication and could call refills in a timely manner as well as demonstrated the ability to self-administer all medications prescribed by physician. Staff interviewed revealed that R1 was independent and was not receiving care or part of the medication program. Staff also revealed that staff cannot administer medications to residents who are not on the medication program and residents’ family would have to notify the facility if the resident could no longer manage their medication and needed to be placed on the medication program. While residing at the facility, R1 tested positive for Covid in or about August 2022, however staff revealed that they were unaware if the resident was taking their medication since they were independent and not on the medication program. Based on interview and record review, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that " Staff did not distribute resident's medication as prescribed"and "is deemed UNSUBSTANTIATED at this time. On the allegations that Staff did not ensure that resident was hydrated, and that Staff did not monitor resident for change in condition it is the reporting parties concern that on 9/1/2022, R1 was observed to be curled up in bed and not feeling well, and afterwards R1’s physician diagnosed R1 with dehydration. To investigate the allegation, interviews and file review was conducted. Staff interviews revealed that R1 tested positive for Covid in or about August of 2022. Staff noted that residents are not being reassessed, when they get COVID, staff checks on them but no actual paper assessment is done. That if there is a significant change in condition then the resident will get sent to the hospital. Staff interviews also revealed that residents are assessed yearly or when there is a change of condition. On 11/10/22 Senior Executive Director (ED) Brian Larios stated that the nurses were responsible for doing the assessments on the residents. ED Larios also noted that before his time, the previous Executive Director spoke with the family regarding concerns with R1 regarding having dementia and they wanted to move up the date for the resident's medical assessment due to their concerns. REPORT WILL CONTINUE ON LIC9099-C (3RD 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 Furthermore, file review reflected that on 08/31/22, the facility’s Divisional Nurse spoke with R1’s son regarding R1’s increased confusion and disorganization and discussed possible transition to memory care, however R1’s son did not feel R1 was ready for memory care. File review further revealed that a request was sent to R1’s physician for an updated LIC602 due to change in condition, and additional tasks for status checks and escorts to meals were entered for two weeks. In addition, file review reflected that facility staff was in communication with R1’s physician. On 7/19/22 a “Notification of Incident or Change of Condition” was sent to R1’s physician informing them that R1 had experienced confusion and difficulty with their speech and R1 was taken to the hospital. R1’s physician did not issue any new orders. On 08/29//22 and additional “Notification of Incident or Change of Condition” was sent to facility staff by the Physician regarding concern for dehydration for R1. R1’s physician provided new orders. Lastly, staff interviews revealed that residents are provided water with every meal, however they can only encourage residents to drink water but cannot force residents. It was also revealed that water is provided throughout the facility, as they have water dispensers throughout the community and residents can go to the bistro, and the dining room and get water bottles at any time. Based on interview and record review, at this time there is insufficient evidence to support the allegations or that a violation occurred, therefore, the allegations that "Staff did not ensure that resident was hydrated, and Staff did not monitor resident for change in condition" are deemed UNSUBSTANTIATED at this time. On the allegation that Staff did not meet resident's dietary needs, it is the reporting parties concern that on 8/29/2022, staff delivered R1 a meal that contained sausage and a bottle cap in the food. To investigate the allegation, interviews, file review and observations were conducted. Staff and resident interviews revealed that in 2022 R1 tested positive for Covid on 08/16/22 and when residents test positive for Covid staff would deliver meals to the residents in their rooms. It was also revealed that by 08/26/22 R1’s Covid had resolved. Staff interviews revealed that staff are unaware of any staff delivering a meal with sausage and a bottle cap to any resident. Staff revealed that R1’s family made them aware of the meal tray, however it is unknown who placed the meal in front of the resident’s bedroom. Interviews also revealed that if a resident was mistakenly delivered the wrong meal they could call the front desk and request something different. REPORT WILL CONTINUE ON LIC9099-C (4TH 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 Furthermore, file review of the meal attendance report reflected that R1 was accounted for at the dining room during breakfast, lunch, and dinner on 8/29/22, however it is unclear if R1 went down to the dining room or received their food in their room since the facility was still experiencing a Covid outbreak. Facility’s menu obtained by LPA Lopez in 2022 reflected that the facility provided a variety of food options including Vegan and Vegetarian options in 2022. Menu options included vegetarian minestrone, veggie quesadilla served with guacamole and salsa, salads, eggplant parmesan served with garlic bread stick, among other options. Lastly, during today’s visit the LPA observed resident’s eating a variety of foods in the dining room and was able to interview a resident who is Vegan. Interview conducted with the resident revealed that there have always been food options for them during the 10 years that they have lived at the facility. Based on interview and record review, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that " Staff did not meet resident's dietary needs." is deemed UNSUBSTANTIATED at this time. Exit interview was conducted, and a copy of the report was issued.

On the allegation that Staff did not prevent resident's room from having plumbing issues, the reporting parties concern is that Resident#1’s (R1’s) room had plumbing issues three (3) times in six (6) months during 2023. To investigate the allegation, the LPA reviewed interviews conducted and documents collected during the initial 10-day visit and conducted interviews. Interviews and documents revealed that the facility did have plumbing issues in 2023, however they had services done to fix the issues and moved R1 to a new unit. Based on the documents review, the above allegation is deemed Unsubstantiated at this time. Exit interview was conducted, and a copy of the report was issued.

Licensing Program Analyst (LPA) Zabel Chochian arrived unannounced to conduct a required annual visit. The LPA met with Executive Director Remon Pagels and reason for the visit was explained. At approximately 1:45pm, the LPA, Executive Director Remon Pagels and Maintenance Director Hector Arjon toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations. Common Areas: The facility is a three-story building. Facility elevators were operating properly. There are three stairwells that all have emergency evacuation chairs on the third floor. There are resident rooms on all three floors, units are designated for assisted living residents on all three floors and a separate unit on the second floor is designated for residents in the memory care unit. There is a central entry point for universal screening. There was hands-free hand sanitizer interspersed throughout the common areas. There were no obstructions and/or tripping hazards observed. The facility maintains a comfortable temperature at 71 degrees Fahrenheit. The fire extinguishers were charged and last serviced 1/3/2024. Smoke detectors and carbon monoxide detectors are tested yearly - The facility uses Johnson Controls to inspect their fire suppression system with the last inspections being conducted on July 11, 2023 through July 12, 2023. According to Maintenance Director the facility maintenance staff conducts monthly inspections of all smoke and carbon monoxide detectors with the last inspection being conducted in March 2024. Required postings observed on the first floor. Activities: Planned activities are offered, and the activity schedule was posted, and is provided to the residents on a weekly basis. Activity rooms and common spaces appeared clean and in good repair. There is a movie theater, hair salon and exercise/therapy room for residents use. Kitchen: At the time of the visit, there was a sufficient supply of perishable and nonperishable food. The facility also has an emergency supply of food and water. The menu was posted and copies are available near the elevators for residents to take. The facility offers daily specials and a standard selection at every meal. Appliances appeared to be in operable condition. (Continue to 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 Resident Rooms: The LPA toured eight (8) randomly selected resident rooms (both the memory care and assisted living unit). Rooms appeared well kept, with sufficient lighting and appropriately furnished. Restrooms: Resident restrooms observed fully stocked with supplies; grab bars and non skid mat/floor surface. The water temperature was tested on all floors and water temperature ranged from 114-115 degrees Fahrenheit. Interviews: LPA interviewed five residents during the tour and no concerns were noted. Outside areas: The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There was an enclosed patio for residents whom reside in the memory care unit on the second floor. Delayed egress doors checked and were operable at the time of visit. Due to time constraints, the annual inspection will be completed on a follow-up visit. No deficiencies cited at this time. Exit interview conducted. Cope of report provided.

Regarding the allegation: Facility is trying to persuade resident and or their responsible parties to change physicians or home agency to one’s preferred by administration. It was alleged that the facility is trying to persuade residents and or their responsible parties to change physicians or home agency to one’s preferred by administration for financial gain. It was communicated that some residents have lived at the facility for an extended period of time and due to individual health conditions and care plans, were recommended to receive home health services by their primary care physician. Staff confirmed that they are unable to refer a resident to receive home health services from a specific agency or refer a resident to use an in-house physician, as they are not medical professionals and that decision is to be made in collaboration with the resident’s responsible party, the resident and/or the prescribing medical professional providing care for the resident. Staff and in -house physician further indicated that they offer recommendations for various home health agencies based on experience and services available for the resident however, it is not inferred to use any home health agency over another as that choice is ultimately left to the resident and their responsible parties. In addition the choice to use an in-house doctor is by personal choice of the resident and responsible parties, if they choose to use an in-house doctor it is based on preference,ease of access to care and resident on resident recommendations and that is a personal choice. Interviews with residents who receive home health services confirmed that the resident was referred to home health by either the resident’s primary care physician or admitting physician in the hospital, and that it was not the decision of the facility administration on who they chose. Interviews with residents who use in-house physician confirmed that it was not the decision of the facility administration on using them as it was a matter of convenience and accessibility. This facility uses various home health agencies. However, further review confirmed that facility provides family members and residents with a choice of agencies if requested, which is a list of available local home health agencies to aid in the family’s choice in choosing the best fit for the resident in question. Family interviews confirmed that they were never persuaded or forced to choose the facility’s internal home health agency or in-house physician. A review of the resident roster confirmed that there are currently at least six (6) different home health agencies providing home health services to residents in this facility. Based on the information obtained, there is insufficient evidence to support the claim that the facility is inappropriately referring residents to change physicians or use a preferred home health agency. This allegation is Unsubstantiated at this time. No deficiencies observed. Exit interview conducted. A copy of the report was issued.

Allegation: Facility is charging for services not provided. Complainant alleges that the facility charges the residents and/or responsible parties for weekly maintenance including housekeeping, laundry, changing linens, and cleaning the facility further alleging that these services are not being completed by the facility while still accepting money from residents regularly. Upon arrival to the facility LPA observed that the facility was conducting a regular carpet cleaning of the facility. LPA further observed housekeeping conducting cleaning services throughout the facility. Interview with Administrator confirmed that services rendered at the facility are part of the general cost of living and all services such as housekeeping, laundry, changing linens and cleaning the facility are provided to all residents either daily or weekly depending on their personal plan of action. In addition,the facility does maintain regular and daily cleaning protocols and maintenance. Interviews with staff and residents did not express concerns with charges administered for services not rendered or with services not being completed. Interviews with residents expressed that the services are great and no issues with housekeeping. Based on interviews and LPA observation, there is insufficient evidence to support the allegation that the “facility is charging for services no provided”. Therefore, the allegation is deemed Unsubstantiated at this time. Allegation: Facility does not provide special diets to resident(s) as prescribed. Complainant alleges that the facility does not provide special diets to residents in care who have documented dietary requirements, which has led residents to become ill while in care. Interview with administrator revealed that special diets are comprised of low sodium, low sugar, or no sugar. Residents in care are not on diets that require special textures such as blended or chopped. All residents who require a special diet are in charge of managing what they consume. The facility will provide specialized options for residents to choose from within the parameters of the resident’s diet however, ultimately the choice of what the resident decides to eat is left up to them. Interviews with residents confirmed that they are provided options based on their special dietary needs and will opt in for them however,they do have the option to choose something else. Based on interviews, there is insufficient evidence to support the allegation that the “facility does not provide special diets to resident’s as prescribed”. Therefore, the allegation is deemed Unsubstantiated at this time. Allegation: Facility staff do not have criminal record clearance. Complainant alleges that Staff members employed in the facility are not associated to the facility, do not have a criminal record background check, and have not gone through the fingerprinting process prior to beginning employment at the facility. Record review conducted by LPA confirmed that all staff scheduled and on the staff roster are associated to the facility. Based on record review, there is insufficient evidence to support the allegation that the “facility staff do not have criminal record clearance”. Therefore, the allegation is deemed Unsubstantiated at this time.