Complaint·February 13, 2026

LIC9099-C Continuation Page (Report 1) Department review of facility records document Release of Client/Resident Medical Information was signed. However, the document includes language that the person who authorized this release may revoke this authorization at any time. Department records review reveal and email correspondence dated April 25, 2025 from R1's responsible person to ED Hansen instructing ED Hansen not to contact the hospital and stated that R1's responsible person was the designated representative for updates. ED responded in writing:“As long as (R1) is my resident, I am required and mandated by the Dept of Social Services to speak with the hospital to have updates and make progress notes on (R1's) chart at my community. I / or someone designated on our community’s behalf, will be calling every single day [R1} in the hospital and / or in a rehab to get updates and notating." The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page. An exit interview was conducted with General Manager Jill Johnson, whose signature below confirms receipt of a copy of this report, LIC811, and the Licensee Appeal Rights (LIC9058 03/22). (continued from LIC9099) page Department Interviews with staff and review of facility records revealed that an Incident Report dated May 21, 2025 documented a fall, emergency services was called, and notifications were made to the physician and responsible party. Another Incident Report dated July 11, 2025 documented ER transport for hip pain; however, no fall was referenced. Review of the Service Plan dated May 9, 2025 showed toileting assistance was included, and care logs reviewed indicated services were provided as scheduled. Pharmacy fax dated May 10, 2025 and the MAR were reviewed, and no evidence of medication mismanagement was found. Invoices and care logs reviewed confirmed that Level 8 services billed during June and July 2025 were delivered by facility staff. Department Interviews with staff and outside sources did not reveal any concerns regarding toileting delays, medication errors, or unreported falls beyond what was documented. Documentation reviewed supports that facility staff performed required care tasks and provided billed services. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of evidence has not been met; therefore, these allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with General Manager Jill Johnson, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 03/22).