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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 075601202
Report Date: 03/27/2025
Date Signed: 03/27/2025 04:07:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/18/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250318143742
FACILITY NAME:AMARYLLIS ASSISTED LIVINGFACILITY NUMBER:
075601202
ADMINISTRATOR:MARSALA, TERRI L.FACILITY TYPE:
740
ADDRESS:2491 MALLARD DRIVETELEPHONE:
(925) 933-4144
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94597
CAPACITY:9CENSUS: 7DATE:
03/27/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Laly Bascao, AdministratorTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Facility is restricting visitation
INVESTIGATION FINDINGS:
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On 03/27/2025, at 12:15pm, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct initial 10-day complaint visit for the above allegation and deliver finding. LPA met with Administrator, Laly Bascao, and explained the reason for the visit. LPA spoke with Licensee, Terri Marsala, and discussed the allegations.

LPA reviewed resident (R) files for R1-R7. LPA interviewed staff (S).

LIC9099-C Continued
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/18/2025 and conducted by Evaluator Lori Alexander-Washington
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250318143742

FACILITY NAME:AMARYLLIS ASSISTED LIVINGFACILITY NUMBER:
075601202
ADMINISTRATOR:MARSALA, TERRI L.FACILITY TYPE:
740
ADDRESS:2491 MALLARD DRIVETELEPHONE:
(925) 933-4144
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94597
CAPACITY:9CENSUS: 7DATE:
03/27/2025
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Laly Bascao, AdministratorTIME COMPLETED:
04:25 PM
ALLEGATION(S):
1
2
3
4
5
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8
9
Facility is not checking residents blood pressure
INVESTIGATION FINDINGS:
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On 03/27/2025, at 12:15pm, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct initial 10-day complaint visit for the above allegation and deliver finding. LPA met with Administrator, Laly Bascao, and explained the reason for the visit. LPA spoke with Licensee, Terri Marsala, and discussed the allegations.

LPA reviewed resident (R) files for R1-R7. LPA interviewed staff (S).

LIC9099-C Continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20250318143742
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: AMARYLLIS ASSISTED LIVING
FACILITY NUMBER: 075601202
VISIT DATE: 03/27/2025
NARRATIVE
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LIC9099-C (Page 5)

Allegation: Facility is not checking residents blood pressure
Finding: Unsubstantiated

On 03/14/2025, LPA interviewed witness (W). W1 stated that the facility is not monitoring residents' blood pressure (bp) by taking their blood pressure readings. On 03/27/2025, LPA interviewed W2 that stated residents that are blood pressure medication are not getting their blood pressure monitored by facility staff. LPA interviewed S1 that stated that before a resident moves in that they will get a medication list from the hospital or skilled nursing facility that will show if the resident is on blood pressure medication. S1 stated that if the doctor's order indicates for example bp "below 140" they will not accept that resident because the facility is not a medical facility and staff are not health professionals. S1 stated that if the resident require their bp to be monitored and check daily then they will tell the resident or resident's family that they can not provide that service. LPA reviewed R1-R7 medication list and doctor's orders and there were no instructions that bp has to be monitored and checked.

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.

Exit interview conducted and a copy of this report provided






SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 15-AS-20250318143742
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: AMARYLLIS ASSISTED LIVING
FACILITY NUMBER: 075601202
VISIT DATE: 03/27/2025
NARRATIVE
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LIC9099 -C (Page 2)

Allegation: Facility is restricting visitation
Finding: Substantiated

On 03/14/2025, LPA interviewed witness (W). W1 stated that the facility has a sign on the front door saying that medical professionals must wear full Personal Protective Equipment (PPE) before entering the facility. W1 stated that there is no mandate required that medical professionals visiting residents are required to wear full PPE. On 03/27/2025, LPA interviewed W2 that stated health professionals from home health agency are being told that they have to wear full PPE before coming inside the facility. W2 stated that there isn't any county mandate currently to require health professionals that are making home visits to have full PPE with them and to wear before entering residential home facility.

On 03/27/2025, LPA interviewed S1 and S2. S1 stated that they receive notices from the county informing of contagious disease outbreaks (i.e., Covid, influenza, scabies) and some of the local facilities and that they know some of these health professionals are making visits at these facilities. S1 stated that they are protecting their residents and that they made the policy that visiting health professionals (i.e., hospice nurse, home health nurse, physical therapist, speech therapist) have to wear gown, mask and gloves. S1 stated that if the visiting health professionals do not have the PPE that they are requiring that they can go back and get the PPE and come back. S2 stated that they have told the agencies up front before any of their health agency staff arrives that they need to wear PPE. LPA observed a sign on outside front door that said, "....medical personnel must wear FULL PPE before entering facility. If you do not have FULL PPE, please reschedule your visit."

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20250318143742
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
E BAY DELTA AC/SC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: AMARYLLIS ASSISTED LIVING
FACILITY NUMBER: 075601202
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2025
Section Cited
CCR
87468.2(a)(1)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities...have all of the following personal rights: (1) To have a reasonable level of personal...accommodations, medical treatment...visits...

This requirement is not met as evidenced by:
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Administrator will send an email to all home health and hospice agencies that they require all vendors need to wear mask, gloves and gown and also update the sign on outside door. Administraor will send a copy of the email and photo of updated sign to CCLD by POC due date.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in by not allowing all home health, hospice, vendors and medical personnel enter the facility before wearing full PPE to make home health visits with residents. There is no local county or state guidance that wearing PPE gown, mask and gloves is a mandated requirement for health professionals which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) 725-7919
LICENSING EVALUATOR NAME: Lori Alexander-WashingtonTELEPHONE: (510) 285-3934
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5