complaint·October 27, 2025

Allegation #1: Facility has insufficient staff to meet residents’ needs. The complaint alleged that residents are paying a significant amount of money, but their needs are not being met. On 10/27/2025, from approximately 10:00 AM to 12:30 PM, LPA Richard interviewed the AED, who denied the allegations and stated that we have enough staff to care for and meet the residents' needs. The AED also noted that the facility has staff on call in case of an emergency. LPA interviewed the (MT), who disagreed and said that the facility has more than enough staff to meet the residents' needs. At the same time, LPA interviewed (DSM), who denied the allegation and stated that we offer various dining services for breakfast, lunch, and dinner to serve residents. LPA also interviewed two staff members (S1 and S2), who denied the allegation and stated that the facility has on-call staff who can help if they are short-staffed. On 10/27/2025, from approximately 1:30 PM to 2:30 PM, LPA interviewed five residents (R1-R5). All five denied the allegation and said the facility served their food on time and met their needs. The caregivers are excellent at caring for them. During the same period, LPA's review of the facility personnel roster showed four on-call caregivers and two on-call Med Techs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur; therefore, the allegation is Unsubstantiated . Report Continued on LIC9099C Allegation #2: Staff failed to provide adequate food service. The complaint alleged that the facility doesn’t serve snacks to the residents in memory care. On 10/27/2025, between approximately 10:00 AM and 12:30 PM, LPA Richard interviewed the AED, who denied the allegations and stated that the facility serves three meals a day and provides snacks between breakfast, lunch, and dinner. At the same time, the LPA also interviewed the (MT), who denied the allegation. Additionally, the LPA interviewed with the (DSM), who denied the allegation and explained that they provide a great weekly menu and an options menu in case a resident does not like what is on the regular menu that day. They also offer snacks between meals for all residents. Furthermore, the LPA interviewed two staff members (S1-S2), who denied the allegation and stated that the residents have many food options. On 10/27/2025, between approximately 1:30 PM and 2:30 PM, the LPA interviewed five residents. All five residents denied the allegation and stated that the facility provides them with adequate food and snacks between meals. They also said that if they don’t like what food they are served, they can order something else. Report continued on LIC9099C On 10/27/2025, LPA reviewed the facility's weekly menu, and the optional menu (dated Oct 26th - Nov 1st, 2025) showed a variety of food choices for the residents. LPA Richard observed the facility serving lunch at 12:00 pm; the residents had a large portion of food with side dishes, fruit, salad, dessert, and different types of beverages. Based on the LPA observations, interviews, and record reviews, the Preponderance of evidence standard has not been met. 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; therefore, the allegation is unsubstantiated. No deficiency cited. An exit interview was conducted. A copy of the report was provided to the Assistant Executive Director Anna Martinez.