complaint·March 3, 2026

LPA Rodgers conducted an unannounced complaint investigation on 02/26/2026 regarding concerns related to the facility’s call signal system. On 02/26/2026 at approximately 1:25 PM, LPA activated a bathroom call cord in the 200 hallway with assistance from maintenance staff. No auditory or visual alert activated. Maintenance staff reported battery replacement in that hallway had not yet been completed. At approximately 1:43 PM, LPA entered Room 401 and asked the resident to pull the bedside call cord. LPA positioned herself to observe both the resident room and the med tech room. No alert activated, and no staff response occurred. When LPA checked with staff in the Medication room, staff confirmed they did not hear or observe any alert. LPA observation confirmed no alert sound was produced from the computer alert system located in the medication room. Department interviews with staff reveal inconsistent reports regarding how long the call system had been experiencing intermittent outages. Despite the malfunctioning call system, Department observations during multiple unannounced visits showed residents to be clean, odor free, groomed, and regularly attended to by staff throughout hallways and common areas. Staff were consistently observed assisting residents with redirection, incontinence care, mobility, and activities. Outside sources who visit the facility frequently also reported that residents are well cared for, clean, and supported by staff. These combined observations do not indicate an immediate threat to the health and safety of residents. Based on LPA direct observations and interviews and records review, the preponderance of evidence has been met that alleged violation occurred and are therefore substantiated. Deficiencies are cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Executive Director Angela Scott- Kapiloff, to whom a copy of this report, the LIC9099D and the Licensee/Appeal Rights (LIC9058 03/22) were provided.