complaint·December 4, 2025

Allegation - Staff do not ensure that facility is maintained at a comfortable temperature for residents. It was alleged that Staff interviewed denied the allegation. They stated that they maintain a comfortable temperature at the facility and didn't hear complaints about this matter. LPA observed that the facility temperature was comfortable at the time of the visit (Thermostat in the hallway shows 73 degree F). Interviewed Administrator and staff stated that facility has a centralized AC unit, and the front office manages the temperature and have the ability to adjust temperature at any time using company tablets or phones. Administrator stated that when residents report a concern about the temperature, they are able to adjust quickly and easily. Interviewed staff stated additionally facility provide individual heaters or fans to any residents who request them, ensuring their personal comfort. Residents interviewed were not able to corroborate the allegation. LPA toured the facility. During tour LPA entered 6 resident rooms (Rooms #2, 6, 48, 49, 55). LPA observed the temperature on the thermostats between 72 degree F - 78 degree F which is within Title 22 regulations. Residents interviewed stated that the facility maintains a comfortable temperature for residents and they don't have any complains about this matter. Allegation - Staff prevent resident from leaving the facility. It was alleged that S1 blocks the door with their body to prevent R1 from leaving. Staff interviewed denied the allegation. They stated that they have never prevented R1 or other residents who wanted to leave the facility from doing so. They stated that facility is open door facility and staff is not allowed to black the entrance for residents at any time whether with their own body or with any objects. Interviewed Administrator and staff stated residents may be redirected if confused, but only through verbal communication, support and encouragement never through physical blocking. Administrator stated that residents are free to come and go as they choose. Staff simply ask that they inform staff of their destination so staff can document it for their safety. Interviewed S1 stated they never blocked the door with their body to prevent R1 or other residents from leaving the facility. During interviews residents denied ever being prevented from leaving the facility when they wish to. Interviewed R1 stated that they has never been prevented from leaving the facility when they wanted to and has never had any issues with S1 or other staff blocking the door with their body to stop them from leaving the facility. Continue 9099C Allegation - Staff do not ensure the facility is free of insects. It was alleged that there are roaches in the hallways. Staff interviewed denied the allegation. They stated that they didn't see roaches at the facility / in the hallway. They stated that the facility has a contract with a pest control company, and the facility is serviced every month. Administrator stated that they use "Orkin" pest control services, and the company perform routine treatments throughout the facility twice a month and are available for additional visits as needed (Copies of Invoices dated 11/18/25, 11/28/25 were provided to LPA). Residents interviewed were unable to corroborate the allegation. Interviewed residents stated that they have not seen any roaches in their rooms and at the facility. LPA did not observe roaches during facility tour. LPA toured the common areas and found no evidence of roaches. LPA inspected randomly chosen rooms and did not observe any roaches in the residents’ rooms. Allegation - Staff do not ensure the facility is clean and sanitary. It was alleged that the facility is very dirty. Interviewed Administrator and staff denied the allegation. Administrator stated that they follows strict cleaning schedule to maintain a clean and sanitary environment. All team members work together to make sure the facility is clean and sanitary. Facility floors cleaned / mop every day. In the event there is any issues, staff work together to clean the area immediately. Interviewed staff stated that facility is cleaned several times a day by cleaning staff. Sometimes the floors get dirty / sticky down the hallways after coffee is served. That is because the clients will spill it as they walk around. Staff will always mop the hallways daily, also walk throughout the day making sure facility is kept clean and sanitary. Interviewed staff stated also housekeeping does weekly deep cleaning for resident's rooms and light cleaning on a daily basis and as needed. Residents interviewed confirmed to see staff cleaning, mopping the hallways daily. LPA observed staff cleaning rooms and the hallways during the visit. All interviewed residents, including R1, stated that facility is clean, and staff is doing good job. Interviewed R1 and R2 mentioned that they clean their room by themselves, but they can ask staff for assistance if needed. Continue 9099C Allegation - Staff do not ensure music is maintained at a comfortable volume for residents. It was alleged that staff are playing loud music in the hallways, and it bothers everyone. Staff interviewed denied the allegation. Interviewed Administrator and staff stated that staff ensure that the volume of music or television is kept at a comfortable level for all residents. They stated that facility has different areas where residents are invited to enjoy the activities, music, karaoke, movies. Also, there are quite areas available for the residents to enjoy. Residents are free to choose which area they want to enjoy. Interviewed Administrator stated while staff host enjoyable activities such as karaoke and movie events, these activities are held in designated areas to prevent disruption. Residents interviewed were not able to corroborate the allegation. They stated that facility staff didn't play loud music. Majority of residents stated they enjoy music and level of the volume is comfortable and not bothering them. Interviewed R1 stated that they stay in their room most of the time and can not hear the music from activity areas. R1 stated that they go to ADP program 3 times a week and participates activities in the Day Program. Although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) occurred, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted with Administrator and a copy of this report was provided.