complaint·August 20, 2025

Allegation: Facility does not have enough afternoon and night staff to meet residents’ needs Investigation Finding: Substantiated During investigation, LPA conducted interviews with reporting party (RP), staff (ADM, S1) and reviewed facility’s personnel record (LIC500), work schedules and residents’ roster. Review of residents’ roster (LIC9020) showed a total of 33 residents residing at the facility. Staff (S1) confirmed with LPA that there is not enough staff in the PM and Night (NOC) shifts to meet residents’ care needs. S1 stated that there is 1 medtech and 2 caregivers in the PM shift and 1 medtech and 1 caregiver in the NOC shift. S1 also stated that approximately 11 of the 33 residents require 2+assist. Based on LPA’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that facility does not have enough PM and NOC staff to meet residents’ needs was found to be substantiated. Allegation: Facility is not equipped to serve residents in the dining area Investigation Finding: Substantiated During investigation, LPA conducted interviews with reporting party (RP), staff (ADM, S1) and LPA A Gomez. Prior unannounced visits conducted by LPA A Gomez on 07/01/25, 07/24/25 and 08/13/25 showed that LPAs observed the facility’s dining room area only had 4 tables that could seat 4 residents at any given time and that staff was using the activities/TV room area to feed the other residents. On 08/15/25, LPA confirmed with S1 that ADM has not purchased the additional dining tables for residents’ use and has not implemented a dining plan to properly feed all residents for each meal without using the activities/TV room for residents’ meals.. Based on LPAs’ observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that facility is not equipped to serve residents in the dining area was found to be substantiated. Continued on next page, LIC 9099-C Allegation: Administrator is not at the facility a sufficient number of hours per week Investigation Finding: Substantiated During investigation, LPA conducted interviews with reporting party (RP), staff (S1) and LPA A Gomez. Prior unannounced visits conducted by LPAs on 05/21/25, 07/24/25 and 08/13/25 showed that LPAs observed ADM was not present at the facility during these visits . S1 stated that ADM comes to the facility 1 to 2 times per week for about an hour and then leaves. Based on LPAs’ observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that Administrator is not at the facility a sufficient number of hours per week was found to be substantiated. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POCs) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties . Exit interview conducted. Appeal Rights and a copy of this report provided.