Alta Vista Senior Living.

On 04/27/25, the department received the following documents: Face Sheet, Identification and Emergency Information, Physician's Report, Preplacement Appraisal Information, Needs and Services Plans for R1. The investigation revealed the following: Allegation: Staff does not prevent resident from threatening another resident. It is being alleged that a resident has been threatened several times by another resident. It is also alleged that the resident attempted to report the issue to a manager, but nothing has been done about these incidents. On 04/26/25, between 10:25 AM and 12:00 PM, the department interviewed S1-S5. Based on interviews conducted, 3 out of 5 staff interviewed denied the allegation, and 2 out of 5 staff interviewed did not know of the allegation happening. 5 out of 5 staff interviewed stated that the facility ensures that all residents feel and are safe and comfortable in the facility. On 04/26/25, between 01:10 PM and 02:40 PM, the department attempted to interview R1 and interviewed R2-R9. Based on interviews conducted, 4 out of 8 residents interviewed stated that no resident has threatened another resident in the facility, and 4 out of 8 residents interviewed stated that they don’t know of a resident being threatened by another resident in the facility. The department was unable to interview R1 for an answer. 8 out of 8 residents interviewed stated that no resident has ever threatened them, and the department was unable to interview R1 for an answer. 7 out of 8 residents interviewed stated that they feel safe and comfortable in this facility, and 1 out of 8 residents interviewed stated that they did not feel safe and comfortable at this facility. The department was unable to interview R1 to get an answer. Based on interviews, a review of records and observation, the above allegation is found to be 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. No deficiencies were cited during this visit. An exit interview was conducted with Activities Director, Destiny Quijada, and a copy of this report was provided.

Regarding the allegation staff do not ensure that resident's dietary needs are met, it was reported that staff put food in front of the residents and leave them slumped over alone to eat. It was stated that R1 required assistance with eating. It was further reported that R1 has lost a significant amount of weight (approximately 30 to 50 lbs.) since being placed at the facility. Information obtained from interviews with facility staff advised that R1 does eat well balanced meals and can feed themselves. It was advised that R1 may need assistance with certain foods, but there are no documented plans regarding eating assistance in R1’s service plan. Interviews with additional residents indicated that there were no noted concerns with ensuring their dietary needs were met, they do not have any concerns regarding dietary needs being met to at this time. A review of the records confirmed R1 is able to eat with her hands but may require assistance if utensils are needed. Additional information obtained from observations revealed that R1 was able to eat without assistance. A review of the records did not corroborate that any significant amount of weight was lost the information obtained from a review of R1’s weight records confirmed a loss of six pounds from the time of admissions to discharge date on 05/21/2023. Regarding the allegation the facility has insufficient staffing to meet the needs of residents in care, it was reported that staffing has been a consistent issue and the reason that most of R1’s needs do not get met. Information obtained from interviews with Administrator, Jennifer Gephart advised that the facility guidelines for staff meeting the needs of residents in care is to follow the resident’s plan of care upon admissions and to conduct an assessment. Interviews with additional staff indicated that R1 was receiving Hospice services and nurses were at the facility two to three times a week to attend to the needs of R1. A review of the records confirmed that R1 was receiving services through Cabrillo Hospice agency; narrative charting, nurses sign in sheets, and other documents were obtained. Interviews with additional staff indicated that the care staff are continuously training on personal rights care and supervision, and that staff are scheduled per each shirt to provide adequate care and supervision. Additionally, residents are encouraged to visit their primary physicians annually. Documents provided and reviewed on site to confirm this. Addition interview with administrator, Jennifer indicted that staff are continuously receiving training on personal rights, and the care and supervision of residents in care. Interviews with additional residents indicated that there are sufficient staff to meet their needs, and that there are all ways enough staff from the Med-tech to the nurses. The nurses are usually moving about there were no reported concerns. Information obtained from records reviewed included staff schedules and confirm adequate staff are scheduled per shift. No noted concerns document currently. 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 Regarding the allegation staff did not keep the resident's room clean and free from odor it was reported that R1’s room had an unpleasant smell, the baseboards were covered with a sticky brown substance, and that R1’s room had piles of dirty laundry. Information obtained from interview with Administrator advised that the facilities policy on housekeeping and how the residents’ rooms are maintained is that the house keeping is scheduled daily from 6:00am to 6:00pm. There are three house keepers, and each work daily or as needed. A review of the house keeping scheduled corroborated the information. Interviews with additional staff indicated that housekeeping and how the residents’ rooms are maintained is through the housekeeping team. Information obtained from interviews with additional staff indicated that caregivers inform the housekeeper staff if there is an additional need and they will clean it. Additional information stated that caregivers do not usually clean the residents’ rooms that is what the housekeepers are for. Interview with R1 was not possible currently. Interviews with additional residents indicated they are happy with the housekeeping and how their rooms are maintained. Additional information obtained from resident interviews stated that there are no noted concerns with how their rooms are kept clean. Regarding the allegation staff did not safeguard resident's personal items, it was reported that another resident was observed coming in and out of R1’s room without permission. Information obtained from interviews with facility staff advised that facility’s policy on safeguarding personal property that the residents are responsible for the safeguarding of their own personal items and property. Interviews with additional staff indicated that the facility encourages residents not to have anything of value, if so, there are lock boxes in the respective living units. Observations confirmed facility had security cameras in place, safety lock boxes if requested in living units, and doors can be locked. Interviews with additional staff stated that each resident living unit has a lock on the door and each room is equipped with a lockbox if requested. Interviews with additional residents indicated that there were no noted concerns with the safeguarding of their personal items. Based on LPA's inability to interview pertinent parties, interviews, record reviews, and observations there is not enough information to support the listed allegations. Therefore, these allegations have been determined unsubstantiated. An allegation finding of unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of this report was provided to Executive Director, Jennifer Gephart. 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 Regarding the allegation staff did not keep the resident's room clean and free from odor it was reported that R1’s room had an unpleasant smell, the baseboards were covered with a sticky brown substance, and that R1’s room had piles of dirty laundry. Information obtained from interview with Administrator advised that the facilities policy on housekeeping and how the residents’ rooms are maintained is that the house keeping is scheduled daily from 6:00am to 6:00pm. There are three house keepers, and each work daily or as needed. A review of the house keeping scheduled corroborated the information. Interviews with additional staff stated that housekeeping and how the residents’ rooms are maintained is through the housekeeping team. Additional information obtained stated that caregivers advise the housekeeping staff if there is an additional need and they will clean it. Additional information stated that caregivers do not usually clean the residents’ rooms that is what the housekeepers are for. Interviews with additional residents indicated that they are happy with the housekeeping and how the residents’ rooms are maintained. Additional information obtained from resident interviews stated that there are no noted concerns with how their rooms are kept clean. Regarding the allegation staff did not safeguard resident's personal items, it was reported that another resident was observed coming in and out of R1’s room without permission. Information obtained from interviews with facility staff advised that facility’s policy on safeguarding personal property that the residents are responsible for the safeguarding of their own personal items and property. The facility encourages residents not to have anything of value, if so, they have a lock box in the respective living units. Observations confirmed facility had security cameras in place, safety lock boxes if requested in living units, and doors can be locked. Interviews with additional staff stated that each resident living unit has a lock on the door and each room is equipped with a lockbox if requested. Interviews with additional residents indicated that there were no noted concerns with the safeguarding of their personal items. 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 Additional information obtained from interviews with Executive Director Diane Domingo advised that a conference call with R1’s family, and the family agreed to the service plan. Information obtained from interviews with the Hospice Nurse advised that R1 had behavioral problems and is easily agitated and that the Hospice Nurses maintain a record of R1’s progress and treatment of overall health. Further information obtained from observations revealed that R1 appeared to look well and was well cared for. Information obtained does not support the allegation. Regarding the allegation Resident's wound has not recovered due to staff neglect, it was reported that R1 has a wound located on their hip. It was reported that the wound has not healed in over one year. Information obtained from interviews with Administrator, advised that Hospice nurses were treating R1’s wounds and monitoring R1’s general health. The wound was initially observed by Hospice who completes the full body assessment during showers, a review of the records corroborated this Information obtained from an interview with a Hospice Nurse advised that the facility staff maintain a record of R1’s progress and treatment of their overall health. There was not sufficient evidence to support that R1’s wounds did not recover due to staff neglect. A review of the records revealed that the Hospice Nurses were at the facility two to three times a week to attend to R1's wound. Regarding the allegation staff do not en

Report Continued from LIC 9099... It was alleged that facility issued an unlawful eviction notice to Resident #1 (R1) in December 2023 and again in January 2024, citing nonpayment as the reason for eviction. Records reviewed and interviews conducted revealed that R1 had a Power of Attorney (POA) who was responsible for paying R1’s living expenses at the facility. However, due to the POA’s inability to make payments, the facility issued eviction notices to both R1 and the POA. Interviews with staff confirmed that the eviction notices were issued due to nonpayment. Staff stated that they attempted to contact R1’s POA multiple times without receiving a response resulting in eviction notice. Additionally, the facility proceeded to search for an alternative placement for R1 after issuing eviction notice. Furthermore, law enforcement had an approved Eviction Restoration Notice authorizing the removal of R1 from the facility on July 3, 2024. Based on the information obtained and reviewed during the investigation, the Department found insufficient evidence to support the allegation of “unlawful eviction.” Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. Report was reviewed and copy provided.

Information obtained from interview with Administrator stated they were aware of R2 wondering the halls, but it was not reported R2 entered resident’s rooms and took their belongings. It was advised that due to the concern, the facility began to monitor R2 more closely and redirected R2 back to their room. Information obtained from additional staff interviews corroborated the information and stated there were no concerns advised regarding theft of R1’s belongings. Information obtained from Interview with R1 revealed they reported the concerns to their family, but could not remember if the concerns were relayed to facility staff. Information obtained from R2 did not corroborate the allegation. It was stated that R2 denied entering other residents room and taking their belongings. LPA conducted a record review and could not find any incidents regarding R2 entering rooms of other residents. Pertaining to the allegation that staff do not ensure resident’s room is free of tripping hazards, it was reported that the facility had uneven floors in the living room, bathroom, and entrance of the resident rooms, which caused R1 to fall. Information obtained from interview with Administrator stated there were no issues with the floor being uneven or other hazards which caused falls. It was advised that the floor was updated due to wear and tear, but not because of foundational issues. Information obtained from staff interviews corroborated the information. Information obtained from interview with R1 indicated that they did not observe uneven floors or have issues with the flooring. Additional interviews were conducted and there were no concerns advised regarding the facility. During a visit to the facility, LPA observed eight rooms, including the noted areas of concern and R1’s room. LPA did not observe any abnormalities on the floors that would be considered uneven or hazardous. Pertinent documentation was reviewed and although there were falls reported, they were not due to hazards. Based on observation, record review, client, and staff interviews, the allegations that the facility did not safeguard resident’s personal belongings and staff do not ensure resident’s room is free of tripping hazards, are Unsubstantiated. A finding that the complaint is unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where a copy of this report was provided to Business Office Manager Monica Flores.

LPA conducted (5) staff interviews, which revealed that around the facility did not have hot water for a few hours during the morning. Staff revealed the hot water came back on the same day after restarting the water heater. Staff revealed there is no issue with the hot water presently. During today’s visit, LPA conducted a tour of the facility and checked the hot water temperature in the kitchen, first and second floor. The kitchen has a reading of 120.3F with a hot water sign above the sink that is designated for staff use only. Room 106 on the first floor was checked hot water which read at 113.7F. Room 218 was read for hot water at 115.1F. Therefore, the allegation that the facility does not have hot water is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 9:48am to the facility to complete the unannounced required - 1 year annual inspection. LPA met with Business Office Manager, Monica Flores at the front desk and was granted entry. The purpose of today's visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The facility is approved for 98 non-ambulatory residents of which 10 may be bedridden with 77 residents in care. The facility is approved for delayed egress. The facility has a hospice waiver for 15 residents. Infection Control: The facility has an approved infection control plan and a surplus of infection control supplies including but not limited to gloves, masks, gown and cleaning supplies. Operational Requirements: The facility has a plan of operation, an approved infection control plan, and has an approved fire clearance and liability insurance. Physical Plant & Environmental Safety: The facility temperature read at 72 degrees. The facility has 90 bedrooms and bathrooms, living room, kitchen, dining room, theatre room, salon, game room and patio. The bedrooms have beds with clean linen, dresser, TV and closet space. The bedrooms are clean and clear of obstruction. The kitchen, living room and dining room are all clean and clear of obstruction. The medications are kept in med-tech carts and are locked in med-tech rooms, one on each floor for memory care and assisted living and inaccessible to residents in care. The facility has no bodies of water on the premises. Staffing: The facility has 75 staff members on site to care for the 77 residents in care during the day and night. The facility has adequate supervision of the residents in care. (Continued on LIC809-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (Continued from LIC809) Personnel and Training Records: The staff have complete training records containing; applications, Fingerprint clearance, Health and TB screening, and in-service trainings. Residents Right Information: The facility has posted resident's right information. Planned Activities: The facility has planned activities for residents based on their mobility and level of comfort. Food Service: A 7-day non-perishable and 2-day perishable food supply was observed and all food was properly stored and available to residents in care. Incidental Medical and Dental: The facility has the resident's medication properly stored in the medication carts and in the med-tech room on each floor. The facility documents the distribution of medication in the medication logbook in residents files and the electronic MAR. The facility is in compliance with physician's orders and regulations. Disaster Preparedness : The facility has an Emergency Disaster Plan with evacuation routes posted for both staff and residents in care. The facility has posted the Emergency phone numbers list. The facility has smoke and carbon monoxide detectors and fire extinguishers that are in working order. The last fire drill was completed on 10/26/23. Residents with Special Needs: The facility has an approved Hospice Waiver for 15. The facility continues on-going training for residents with special needs and documents the training. Summary : Based on today's visit, no deficiencies were observed at this time. An exit interview was conducted with Business Office Manager, Monica Flores and a copy of this report was emailed, signature below confirms the receipt of these rights.