Follow-up on corrections·August 29, 2025

On 8/29/2025, Licensing Program Analyst (LPA) Triel Ellen Lindstrom visited the facility unannounced to conduct a case management visit regarding the fire that occurred at the facility the morning of 8/26/2025. LPA Lindstrom met with Administrator Jacob Harryman (S1), introduced herself, and explained the purpose of the visit. LPA Lindstrom interviewed S1, S2, and S3. S1 stated that on 8/26/2025, a fire broke out in the living room of a resident’s apartment (R1). R1 was in the apartment at the time of the fire. Staff (S2) rescued R1 within moments of the smoke alarm sounding in their apartment and staff evacuated all residents and staff from the facility within ten minutes. S2 stated that they determined that the alarm was sounding in R1’s apartment, entered R1’s room, and saw R1 sitting in a chair on their balcony. S2 observed smoke and flames about a foot high in the corner of the living room near an outlet located on the back of a kitchen counter. S2 stated that they observed R1’s oxygen concentrator in this corner near the outlet and that the oxygen concentrator tubing that stretched from the machine, across the living room, and beneath the balcony door was on fire. S2 went onto the balcony, removed the oxygen tubing canula from R1’s nose, lifted R1 up, and carried them out of the apartment to safety. S2 stated that they called 911 at 7:07 AM and that the fire department arrived approximately ten minutes later. S2 stated that R1 uses an oxygen concentrator at all times. S2 stated that staff did not supply oxygen to R1 from the time she was evacuated from her apartment until the fire department arrived on scene. S1 stated that R1 was transported to the local hospital for smoke inhalation. (Continued on 809-C) The LPA inspected R1’s apartment. LPA Lindstrom observed the outlet in the living room where the fire started. The counter wall with the outlet had black scorch marks on it, as did the adjacent carpeting and wall. LPA Lindstrom observed a thin, blackened line that ran from the outlet area, across the living room carpet, under the balcony door, and across the balcony floor, to within approximately ten inches of the chair R1 had been sitting in. LPA Lindstrom observed charred remains of oxygen concentrator tubing on the balcony floor. The LPA also observed the uncharred remains of tubing, including the cannula, and approximately two and half feet of line coming from it. LPA Lindstrom observed a photograph of damaged items removed from R1’s room. The damaged items included a rectangular device approximately 3 feet wide by 2 feet deep. S1 stated that they had never noticed the electric fireplace in R1's apartment. S2 stated that the electric fireplace had been in the resident’s room since Fall 2023 when the resident moved in. S3 stated that she had observed the electric fireplace in R1’s room since early 2024. On the day of the fire, the electric fireplace and the oxygen concentrator had been plugged into a non-surge protected outlet extender located at the outlet where the fire started. LPA Lindstrom reviewed the facility’s Admission Agreement, titled “Foothill Village California Residency Agreement.” R1 signed this agreement on 9/20/2023. This admission agreement was written by Integral Senior Living, which was the previous management company for the facility. In May 2025, Red Bench Living assumed management of Foothill Village. The LPA observed that on page 6 of the admission agreement that R1 signed, there is a section titled “Explosives, Firearms, and Flammables.” This section says: “No explosives, flammable materials, or firearms may be brought into any area of the community. This includes weapons, barbecue equipment, gasoline, motor oil, space heaters, and candles.” LPA Lindstrom reviewed the facility’s LIC610E Emergency and Disaster Plan for Residential Care Facilities for the Elderly. The LPA reviewed Section C of page 6, which lists procedures that address, “Operating assistive medical devices that need electric power for operation, including but, not limited to oxygen equipment…” The facility made no mention of plans for assistive oxygen equipment on the form. S2 stated that facility staff did not administer oxygen to R1 between the time of evacuation from their apartment and arrival of the fire department. (Continued on 809-C) California Code of Regulations (CCR), Title 22, Section 87468.1(a)(2) states that residents shall have the personal right “to be accorded safe, healthful and comfortable accommodations, furnishings and equipment.” California Code of Regulations (CCR), Title 22, Section 87405(b) states that the facility administrator “shall have the responsibility and authority to carry out the policies of the licensee.” California Code of Regulations (CCR) Title 22, Section 87212(b)(2)(A) states that “each facility shall have a disaster and mass casualty plan of action…” that includes a fire safety plan. This facility is hereby cited per 22 CCR Section 87468.1(a)(2), Section 87405(b), and Section 87212(b)(2)(A). Due to a violation involving administrator qualifications and duties, an immediate civil penalty of five hundred dollars ($500) was hereby assessed. The immediate civil penalty was assessed using the LIC412IM paper form. The Administrator and Licensee were informed that a civil penalty assessment based on Health and Safety Code Section 1569.49(f) is currently under review and may be assessed at a later date. Once this has been determined, CCLD personnel will return to assess the civil penalty, if necessary. An exit interview was held with the Administrator. Appeal rights and a copy of this report were left with the Administrator.