Non-compliance follow-up·May 6, 2025

Licensing Program Analysts (LPAs) Christi Coppo and Robert Frank arrived unannounced to conduct a Legal Non-Compliance Case Management inspection. The following items were indicated as deficient in the most recent audit dated 1/31/2025: Dementia Care. No monthly activity calendar or daily events. The following items were indicated as deficient in the most recent audit dated 2/27/2025: Dining. Food products with no cover or expiration date. Dementia Care. No monthly activity calendar or daily events. The following items were indicated as deficient in the most recent audit dated 5/2/2025: Medication Management. Med cart two (2) has discontinued medications from 4/21/2025. Dementia Care. In Memory Care two (2) curling iron found under sink and small cleaning spray found on night stand. Dementia Care. Scissors stored on the outside of the Med cart in Memory Care Two (2). These Deficiencies will be cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Continued on 809-C... ...Continued from 809 The following items are some of the requirements required per the current Stipulation and Waiver and Order (dated 6/30/2022) in place for the facility: Facility shall provide a minimum of four (4) hours of training monthly to direct care staff and managers. All staff that provide medication administration must receive one additional hour of training every month. Pacifica shall perform quarterly audits of medication inventory and if errors are found, a plan of correction for each error found shall be included with the applicable audit report Memory Care Unit and Assisted Living unit shall be staffed independently, such that the units do not share direct care staff. The Med Tech will not be a direct care staff, but may provide support when not distributing medication. Facility call system and delayed egress shall at all times be fully functional. As it pertains to item #3, LPAs observed one (1) Caregiver (CG) S4, present in Memory Care building Two (MC2). LPAs reviewed facility staff schedule for 5/6/2025 and found that S2 was the only CG scheduled for the Day shift. LPAs further observed that there was only one (1) CG, S5 scheduled for the PM shift. However, there is one resident identified as being a 2-person assist in MC2. Therefore, facility was found to be deficient in requirement required as part of the current Stipulation and Waiver and Order in place for the facility. LPAs reviewed staff schedule for 5/6/25 with Tiffany Leos, Resident Care Coordinator (RCC) and Admin and pointed out the staffing deficiency. This deficiency will be cited in Complaint #21-AS-20250501120816. On 3/26/25 Healdsburg Senior Living (HSL) representatives met with CCL at the Santa Rosa Regional Office. During this meeting items were discussed pertaining to the Stipulation and Waiver and Order dated July 18, 2022. One item identified as needing to be provided to CCL was: Facility will provide a list of all individuals who have acted as the Liaison since the effective date of the Stipulation and Order and how they ensured facility was meeting the mandate as identified in the Stipulation and Order. HSL submitted the list of individuals. However, during today’s visit, Administrator informed LPAs that current designated liaison, Karen Enciso, Regional Director of Operations (RDO) will no longer be with the company as of 5/9/25, at the latest. Continued on 809-C(2) ...Continued from 809-C Therefore, LPAs are requesting that HSL submit a letter to CCL indicating the name of the new liaison and how HSL will ensure facility will meet the mandate as identified in the Stipulation and Order by end of business day 5/9/2025. Per the stipulation, waiver and order page 3, line items 25-27 and page 4, line items 1-11 Facility shall provide a minimum of four (4) hours of training monthly to direct care staff and managers. Staff, S6, S7, S8, S9,S10 and S11 were all identified as having stipulation training completed per respective Monthly Quality Assurance Audit. Per LPA and Administrator review, documentation of required stipulation training does not indicate the number of hours for each session completed. Therefore, LPAs cannot determine the number of hours completed for the monthly training required by the stipulation. Per page four [4] line item 20 and page five [5], line items 5, 6, and 7 of the Stipulation and Order dated July 18, 2022, HSL is to submit a monthly LIC500 along with the census of each unit and two person assists identified. CCL received LIC500s for the months of January, February, Mar, and April. CCL received resident roster identifying resident requiring 2-person assist for the months of March and April, but did not receive a resident roster identifying residents requiring 2-person assist for the months of January and February. Further of audits dated 1/31/2025, 2/27/2025, 3/31/2025 and 5/2/2025 showed some minor instances of non-compliance however the instances were not significant or frequent enough to warrant a health and safety concern. LPAs discussed and reviewed stipulation with the new Administrator Brandee Rodriguez and provided Administrator with a copy of the stipulation. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC-809Ds, Plan of Corrections, 811 Confidential Names and Appeal Rights discussed and provided to Administrator Rodriguez. Signature on form confirms receipt of documents.